DCAS Direct Personnel Limited remained in breach of Regulations 12, 17 and 18 at this May 2018 inspection, with persistent failures in risk assessment, medicines record-keeping, staff supervision, health-specific training, and governance oversight. Caring practice was rated Good, with people reporting kind, consistent and dignified support, but systemic management weaknesses across the other four key questions prevented an overall improvement.
Concerns (7)
criticalMedication management: “one person's MAR charts for the month of January did not record what medicines had been administered in the week commencing 22 January 2018”
criticalGovernance: “The registered manager carried out quarterly telephone monitoring calls but did not maintain any records of these calls. They had not carried out any spot checks”
moderateCare planning: “people's risk assessments lacked information for staff on how to mitigate risks to provide safe care”
moderateSupervision / appraisal: “two staff had received only one supervision in the last year”
moderateStaff training: “Staff did not receive health specific training such as dementia, diabetes, stroke to support people with health needs.”
moderateRecord keeping: “some people's daily care notes had minimal information and exactly same description of how they had been supported across weeks”
minorPerson-centred care: “The care plans were detailed and included information on people's background but did not include their likes and dislikes.”
Strengths
· People felt safe with staff and reported staff arrived on time and never missed care visits
· Staff knew safeguarding procedures and could describe types and signs of abuse
· Provider followed safe recruitment procedures including DBS checks, references and identity checks
· People received continuity of care from the same staff members, some for over two years
· Staff treated people with dignity and respect and supported cultural, religious and gender preferences
Quality-Statement breakdown (19)
safe: Risk assessment and managementRequires improvement
safe: Medicines managementRequires improvement
safe: Staffing and recruitmentGood
safe: SafeguardingGood
safe: Infection controlGood
effective: Supervision and appraisalRequires improvement
effective: Staff trainingRequires improvement
effective: Consent and Mental Capacity ActGood
effective: Needs assessmentRequires improvement
effective: Nutrition and hydrationGood
caring: Kindness, dignity and respectGood
caring: Continuity of care and person-centred approachGood
caring: Equality, diversity and cultural needsGood
responsive: Personalised care planningRequires improvement
responsive: Complaints handlingGood
responsive: End of life careGood
well-led: Governance and quality assuranceRequires improvement
well-led: Feedback and engagementRequires improvement
DCAS Direct Personnel Limited was rated Requires Improvement overall at its first inspection in March 2017, with four regulatory breaches identified covering safe care and medicines management (Reg 12), consent (Reg 11), governance (Reg 17), and fit and proper persons employed (Reg 19). While staff were praised for their caring approach and cultural competency, significant failings were found in care planning, medication records, mental capacity documentation, staff recruitment checks, and the absence of any quality audit systems.
Concerns (8)
criticalMedication management: “MAR charts were not appropriately completed. Some MAR charts did not mention the time when staff were required to give medicines.”
criticalRecord keeping: “The service lacked efficient systems and processes to assess, monitor and improve the quality and safety of the care delivery.”
criticalGovernance: “The service had not carried out any audits of people's risk assessments, care plans and staff recruitment documents.”
criticalStaff competency: “Not all staff files had recent DBS checks and still had criminal record checks from their previous employer that had passed the three months period.”
criticalCare planning: “We were only able to view one person's care plan as the service had not developed care plans for other people.”
criticalConsent / capacity: “People's care plans did not make reference to people's capacity and did not include information on how and when to support people to make decisions.”
moderateSupervision / appraisal: “Staff had not been receiving regular supervision, the registered manager confirmed they had not formally supervised their staff.”
moderatePerson-centred care: “'Care task plans' were task oriented, and the care plans were not always completed and lacked personalised information.”
Strengths
· People and relatives reported staff were caring, friendly, and treated them with dignity and respect.
· Staff were matched to people with similar cultural backgrounds and languages, and gender-specific care was provided.
· Staff demonstrated good understanding of safeguarding and were able to describe signs and types of abuse.
· Staff received appropriate induction and mandatory training and could describe individual needs of people they cared for.
· Continuity of care was maintained by allocating two regular staff members to each person.
Quality-Statement breakdown (14)
safe: Medicines managementRequires improvement
safe: Risk assessmentRequires improvement
safe: Recruitment practicesRequires improvement
safe: SafeguardingGood
effective: Staff trainingGood
effective: Supervision and appraisalRequires improvement
DCAS Direct Personnel Limited (Tottenham Town Hall) achieved a Good rating across all five key questions at this June 2019 inspection, having improved from Requires Improvement at the previous inspection in 2018. The service demonstrated safe, person-centred care with strong safeguarding, effective staff training and supervision, and good governance, with only a minor gap in formal recording of lessons learnt from incidents.
Concerns (1)
minorIncident learning: “accident and incident records did not always record lessons learnt. The provider told us in the future they would include lessons learnt in the form for a better audit trail”
Strengths
· Detailed and regularly reviewed risk assessments covering a wide range of individual needs
· Medicines administered safely with accurate MAR records checked weekly
· Staff received regular supervision, annual appraisals, and a broad range of training including health-specific topics
· Person-centred care plans reflecting cultural, religious, communication and dietary needs
· Positive and open leadership culture with unannounced spot checks and monthly staff observation visits
Quality-Statement breakdown (23)
safe: Assessing risk, safety monitoring and managementGood
safe: Using medicines safelyGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Staffing and recruitmentGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
effective: Staff support: induction, training, skills and experienceGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
caring: Dignity and respect
Good
caring: Continuity of care and staff matchingGood
responsive: Care planning and personalisationRequires improvement
responsive: Complaints handlingGood
well-led: Governance and auditingRequires improvement
well-led: Record keeping and data managementRequires improvement
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Staff working with other agencies to provide consistent, effective, timely careGood
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 staff; continuous learning and improving careGood