D R & C Private Home Care Limited was rated Requires Improvement overall following a focused inspection in November 2023, with breaches of Regulations 17 and 18 identified due to insufficient staffing, significant gaps in staff training, and inadequate governance and monitoring systems. Strengths included consistent, person-centred care delivery, positive feedback from relatives, effective safeguarding practices, and safe medication and infection control management.
Concerns (7)
criticalStaffing levels: “There were not always sufficient staff employed to meet people's assessed needs and provide their agreed packages of care.”
criticalStaff training: “Only 24% staff had completed training in moving and handling people, 34% in basic first aid, 31% in food hygiene, and 35% in health and safety.”
criticalGovernance: “Systems and processes had not been sufficiently developed to ensure the effective assessment and monitoring of the service. This is a breach of regulation 17.”
moderateStaff competency: “Satisfactory evidence of conduct in previous employment within the field of health and social care had not been requested. The provider had relied on character references.”
moderateRecord keeping: “Staff records did not contain all the necessary documents and evidence to support robust recruitment practices.”
moderateLeadership: “In response to staff shortages the manager was providing personal care and support to people. This restricted the time available to them to monitor the quality and safety of the service.”
minorPerson-centred care: “The scope and range of questions asked was limited. This restricted opportunities for people to fully comment upon the quality and experience of the care provided.”
Strengths
· Relatives were positive about the quality of care provided by a small, consistent team of staff who knew people well.
· Staff understood people's individual care needs and associated risks, responding appropriately to non-verbal communication.
· Risks were assessed and staff took action to mitigate identified risks; relatives expressed confidence in staff's knowledge.
· Medicines were managed safely with documented administration records and appropriate guidance from health professionals.
· Staff wore appropriate PPE and people were protected from infection risks.
Quality-Statement breakdown (9)
safe: Staffing and recruitmentRequires improvement
safe: Assessing risk, safety monitoring and managementGood
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
safe: Systems and processes to safeguard people; Learning lessons when things go wrongGood
well-led: Managers and staff clear on roles; quality performance, risks and regulatory requirements; continuous learningRequires improvement
well-led: Promoting a positive person-centred, open, inclusive and empowering cultureGood
D R & C Private Home Care received an overall Good rating across all five key questions at its August 2017 announced inspection, demonstrating safe, personalised and well-managed care for seven people. Minor improvements were required to medicines recording practices, environmental risk assessments, and care plan organisation, all of which the registered manager agreed to address.
Concerns (5)
moderateMedication management: “Records did not always show the amount, for example in milligrams, of medicines to be given so staff might not be aware if a mistake had been made.”
moderateMedication management: “There were no PRN (as required) medicines protocols in place so it was not clear when and why these medicines should be administered.”
minorRecord keeping: “Some of this information was spread throughout care plans so was not always easy to find.”
minorRecord keeping: “There was no care plan for food and drink in their records so it was unclear how meals were chosen and whether they were suitable for the person in question.”
minorCare planning: “General risk assessments for people's premises were not routinely in place.”
Strengths
· People felt safe and staff demonstrated good knowledge of safeguarding responsibilities; safeguarding policy improved since last inspection.
· Staff well-trained with full induction, ongoing refresher training, and specialist training for conditions such as dementia, Parkinson's and epilepsy.
· Personalised care plans in place including communication plans, cultural preferences, and daily task sheets supporting person-centred care.
· Registered manager knowledgeable about all service users, conducted monthly care package audits and spot checks.
Linda Deazle t/a D R & C Private Home Care received an overall rating of Requires Improvement at its August 2016 inspection, with weaknesses in risk assessments, staff recruitment checks, medicines recording, Mental Capacity Act implementation, and governance audits. People and relatives were consistently positive about the caring, responsive approach of staff and the accessibility of management, resulting in Good ratings for caring, responsive and well-led domains.
Concerns (10)
criticalStaff competency: “for one staff member whose reference stated they had been subject to disciplinary procedures...there was no evidence that further checks had been carried out.”
moderateCare planning: “risk assessments for managing behaviour that challenged the service or for preventing pressure sores. Staff did not have the information on how to keep people safe.”
moderateRecord keeping: “a medicine have not been supplied from June to July 2016 and there was no reason recorded as to why this was.”
moderateStaff training: “staff needed training on how to assess people's capacity to make decisions about how they lived their lives.”
moderateConsent / capacity: “there were no formal procedures in place to assess people's mental capacity.”
moderateGovernance: “a small number of records where staff had not attended at the agreed time...had not been picked up in the audit process.”
moderateSafeguarding: “in the safeguarding adults policy, this did not include information as to what different types of abuse were.”
minorSupervision / appraisal: “Staff told us they received supervision and there was some evidence of these sessions, though this was infrequent.”
minorMedication management: “there was no information in place for staff on the purpose of specific medications and their side effects.”
minorComplaints handling: “no response had been provided to the complainant setting out the results of the investigation.”
Strengths
· People and relatives consistently reported staff as friendly, kind, caring and respectful of privacy and dignity.
· Staff had received training in safeguarding and understood their responsibilities, including relevant outside agencies to report concerns to.
· Sufficient staffing levels maintained; calls made on time or people were notified of any delays.
· Care plans were individualised, involving people and relatives in their development and review.
· Staff appropriately contacted health professionals in most instances when people's health needs changed.