Domiciliary Care Services (UK) Limited was rated Requires Improvement overall following a November 2023 inspection, with breaches of Regulation 12 (safe care and treatment) and Regulation 17 (good governance) identified. Medicines management and risk assessments were inadequate, and audit systems failed to detect these gaps despite the service having fallen from a Good rating in 2019.
Concerns (6)
critical
Medication management
: “The provider did not have risk assessments for people prescribed anticoagulant medicines...no guidance for staff to follow if a person at risk of excessive bleeding was injured.”
criticalCare planning: “Where people had complex healthcare needs, the provider had not developed an accompanying care plan to guide staff how to safely support people with this aspect of their care.”
criticalGovernance: “Quality assurance systems were not robust enough to demonstrate there was an accurate and complete record of the care and treatment people received.”
moderateRecord keeping: “Where daily records were completed, they included little to no information about the care provided, with only basic tasks being checked off.”
moderatePerson-centred care: “Care records were not always person centred and did not always reflect people's preferences.”
minorConsent / capacity: “Documentation around how a person's capacity was assessed was not always clear.”
Strengths
· Safe recruitment procedures followed with DBS checks and right-to-work documentation in place
· Electronic call monitoring software used to verify staff attendance and call durations
· Staff understood safeguarding processes and felt confident raising concerns
· Good infection control practice confirmed by people and relatives
· Staff felt supported and described management as approachable and responsive
Quality-Statement breakdown (10)
safe: Assessing risk, safety monitoring and management; Using medicines safelyRequires improvement
safe: Staffing and recruitmentGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringRequires improvement
well-led: How the provider understands and acts on the duty of candourGood
well-led: Engaging and involving people using the service, the public and staffGood
well-led: Working in partnership with others; Continuous learning and improving careGood
Domiciliary Care Services (UK) Limited was rated Requires Improvement overall following a January 2016 inspection of its Leicester homecare service, with a breach of Regulation 17 (good governance) cited due to the absence of a robust quality assurance system. While the service performed well in safe, effective, and caring domains, responsive and well-led ratings were dragged down by insufficiently detailed care plans and a failure to analyse audits, supervision records, or staff competency checks to drive continuous improvement.
Concerns (8)
criticalGovernance: “The provider did not have a governance system in place to assure themselves of the quality and safety of the service.”
criticalGovernance: “There was not an effective system in place to asses, monitor and improve the quality and safety of the service and to identify where improvements were needed.”
moderateStaff competency: “This was a tick box approach and did not record what practices had been observed, how staff's competence was being assessed, whether the member of staff was competent.”
moderateSupervision / appraisal: “Staff were provided with regular supervision and appraisal however the information was not analysed and used to develop the service or used to produce action plans.”
moderateCare planning: “A quality assurance audit had identified improvements were needed to ensure people's plans of care were person centred and were developed with the involvement of the person.”
moderateRecord keeping: “Training records were not easily accessible and therefore it was difficult to ascertain when staff had undertaken training and if their training required updating.”
minorPerson-centred care: “People did not always have knowledge of their plans of care and other information written about them and was kept within their home.”
minorCommunication with families: “Two people commented that they found staff who spoke in their first language to each other when providing their care was of concern as they were excluded from the conversation.”
Strengths
· People felt safe when receiving care; staff had a good understanding of safeguarding responsibilities and no safeguarding concerns had been raised.
· Sufficient staffing levels with safe recruitment practices; electronic monitoring system in place to detect missed or late calls.
· People were supported by consistent staff groups who understood cultural, religious and language needs, including care from staff who spoke people's first language.
· Community professionals described staff and management as 'exceptionally caring' with a very person-centred approach.
· Staff proactively liaised with health care professionals including GPs and district nurses.
Domiciliary Care Services (UK) Limited was rated Good across all five key questions at its January 2017 inspection, demonstrating sustained improvement since a regulatory breach identified in January 2016. The service showed strong person-centred practice, reliable visit punctuality, well-trained staff and effective quality monitoring under an open and inclusive registered manager.
Strengths
· Consistent staffing groups assigned to geographical areas promoted continuity of care and positive relationships with people and families
· Robust recruitment processes including DBS checks, two written references and validated application forms
· Staff well-trained in safeguarding, MCA, manual handling and communication, with 32 of 33 staff holding NVQ Level 2 or above
· Electronic call monitoring system in place to identify and act on missed or late calls; people reported staff 'always on time'
· Person-centred care plans regularly reviewed and updated to reflect changing needs, with people and families involved in their development
Domiciliary Care Services (UK) Limited at Knighton Road, Leicester was rated Good across all five key questions at its July 2019 inspection, maintaining its previous Good rating from 2017. The service demonstrated consistent strengths in personalised, culturally competent care, robust staff training and supervision, reliable visit management, and effective governance systems.
Strengths
· Staff trained in safeguarding, infection control, moving and handling, and medicines, with competency verified through unannounced spot checks
· Multilingual staff team able to communicate with people in their preferred language, including Urdu, Gujarati and Portuguese
· Electronic call monitoring system alerts office staff if a carer has not arrived within agreed call time, preventing missed visits
· Personalised, outcome-focused care plans co-produced with people and family members and regularly reviewed
· Strong continuity of care with consistent core staff teams, described by families as 'like family'
Quality-Statement breakdown (23)
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Assessing risk, safety monitoring and managementGood
safe: Staffing and recruitmentGood
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Staff support: induction, training, skills and experienceGood
This focused inspection of Knighton Road (November 2016) checked whether a previous breach of Regulation 17 (governance) had been remedied following a January 2016 comprehensive inspection. The provider had made sufficient improvements to governance, quality monitoring, staff appraisal, and communication systems to achieve a Good rating for well-led, though the overall rating remained Requires Improvement as only one key question was assessed.
Concerns (1)
criticalGovernance: “the provider of Knighton Road did not have an effective governance system in place to assure themselves of the quality and safety of the service. This was a breach of Regulation17”
Strengths
· Provider implemented a quality toolkit enabling structured monitoring of care quality across CQC's five key questions
· Staff appraisal and supervision system was improved, including twice-yearly appraisals and self-appraisal processes
· Regular staff meetings and weekly rota/information sharing kept staff updated on people's changing needs
· People's views were actively sought, collated, and shared back with service users via written reports and newsletters
· Commissioners confirmed the service was compliant against their quality assurance framework
Quality-Statement breakdown (1)
well-led: Is the service well-led?Good
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Supporting people to live healthier lives, access healthcare services and supportGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
caring: Ensuring people are well treated and supported; respecting equality and diversityGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
caring: Respecting and promoting people's privacy, dignity and independenceGood
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesGood
responsive: Meeting people's communication needsGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportGood
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: How the provider understands and acts on the duty of candourGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsGood
well-led: Engaging and involving people using the service, the public and staffGood
well-led: Continuous learning and improving care; Working in partnership with othersGood