Date of assessment: 11 September to 5 November 2024. At our last inspection, the service was rated requires improvement. At this assessment we found the provider had made improvements to comply with 1 regulation. However, during this assessment we found 2 breaches of legal regulation in relation to safe care and treatment and governance arrangements. This means the service needs to make improvements in these areas. Our overall service rating remains requires improvement. We found areas of concern and good practice. The provider had assessed people’s care needs; however, they did not adequately assess and mitigate the risks to people’s health and safety. People’s care records were not always updated when their needs changed and lacked personalisation. It was unclear whether people’s care was being monitored and reviewed. People’s medicines were not always managed safely. Safety checks of people’s equipment were not robust. The provider failed to demonstrate clear oversight of incidents, accidents, and safeguarding concerns. There were insufficient systems to support oversight and governance at the service. Not all areas of the service were being audited and for those areas that were, the provider had failed to identify and address the issues we found during this assessment. Staff had not received training to meet people’s specialist care needs. The provider had not ensured safe recruitment practices were consistently followed. The provider failed to manage the risks of staff working alone. Records of staff and management meetings indicated a lack of reflective practice, learning and actions. People were supported to have maximum choice and control of the lives. There were enough staff in place to meet people’s needs. Staff felt supported by the provider. In instances where CQC have decided to take civil or criminal enforcement action against a provider, we will publish this information on our website after any representations and/ or appeals have been concluded.
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DAS Care Limited improved from Inadequate to Requires improvement overall but remains in special measures with continued breaches of Regulations 11 (consent), 12 (safe care) and 17 (good governance) due to insufficient care plans, missing mental capacity assessments and weak quality monitoring. Well-led remains Inadequate as the registered manager lacks the skills and oversight systems needed to deliver safe, high-quality care.
Concerns (10)
criticalCare planning: “care plans had been developed to guide staff about what care people required, there was insufficient detail of how care should be carried out safely”
criticalCare planning: “Some areas of risk, such as choking, mobility or specific health conditions had not been assessed at all.”
criticalConsent / capacity: “where people may have lacked capacity, mental capacity assessments had still not been completed... no record of how decisions had been made in their best interests”
criticalGovernance: “Quality Assurance systems and systems to monitor staff practice were ineffective. Systems to manage risks to people's health and well being were not sufficiently detailed.”
criticalLeadership: “The registered manager's skills, knowledge and understanding of their role required further development to enable them to fully understand how to make improvements”
moderateStaff competency: “spot checks... lacked detail about how this judgement was made... did not demonstrate that the member of staff's competency had been sufficiently assessed”
moderateMedication management: “Checks to assess staff's competency in relation to medicines management formed part of the provider's spot check process. However, this was not robust”
moderatePerson-centred care: “not sufficient information within care documentation to ensure people were receiving care that met their needs, preferences and individual characteristics”
moderateRecord keeping: “The provider did not have a system in place to monitor care calls to ensure care was provided at the right time, for the correct duration and that no calls were missed.”
minorCommunication with families: “The service did not currently provide information in different formats... they had not considered whether these people may have benefitted from information being provided to them in different formats.”
Strengths
· Staff received safeguarding training and understood how to report concerns internally and externally
· Safe recruitment processes in place with criminal record checks and references obtained
· Enough staff to meet care needs; people reported no missed calls and staff arrived on time
· Staff trained in infection prevention and control with adequate PPE supplies
· Staff worked well with external professionals (GPs, physiotherapists, community nurses, SLTs)
Quality-Statement breakdown (20)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Staffing and recruitmentGood
safe: Using medicines safelyRequires improvement
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawRequires improvement
caring: Ensuring people are well treated and supported; respecting equality and diversityRequires improvement
caring: Supporting people to express their views and be involved in making decisions about their careRequires improvement
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 preferencesRequires improvement
responsive: Improving care quality in response to complaints or concernsGood
responsive: Meeting people's communication needsRequires improvement
responsive: End of life care and supportNot rated
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsInadequate
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
First inspection of this domiciliary care service identified widespread breaches across recruitment, safeguarding, medicines, training, consent, person-centred care, complaints and governance, resulting in an Inadequate rating and placement in special measures. CQC imposed conditions on the provider's registration preventing them from taking on new care packages until improvements are made.
Concerns (17)
criticalMedication management: “Medicines were not managed safely. Only two members of care staff, out of the nine staff actively providing support to people... had received the appropriate medicines administration training”
criticalSafeguarding: “the provider who was unaware that they needed to notify safeguarding concerns to both ourselves and the local authority”
criticalStaff training: “Staff had not completed essential training to provide safe and effective care. This exposed people to greater risk of harm.”
criticalStaff competency: “Competency checks relating to administering of medication were not taking place.”
criticalGovernance: “No audits were being completed at the service. This meant there were no systems for identifying, capturing and managing organisational risks and issues”
criticalLeadership: “There was a significant lack of provider oversight at this service. The provider had failed to develop effective systems and processes”
criticalConsent / capacity: “The provider did not work within the principles of the MCA... best interest decisions were not in place”
criticalPerson-centred care: “Staff did not understand the term 'person-centred' and care plans were not personalised.”
criticalCare planning: “people's care records lacked detail and we were not assured that people were receiving person-centred care. People's life history had not been recorded.”
criticalComplaints handling: “The provider had failed to establish an accessible system to identify, record and respond to complaints.”
criticalInfection control: “The provider was not checking that staff were following COVID-19 guidelines to prevent the spread of infection.”
criticalSupervision / appraisal: “there was no formal induction for new employees, supervisions, appraisals or competency assessments taking place for staff”
criticalIncident learning: “Recording of incidents and accidents was not taking place at the time of our inspection.”
criticalRecord keeping: “Medication records we reviewed were incomplete... There were no medication records in place for people who were self-medicating but required prompting.”
moderateMissed or late visits: “The provider had failed to put systems in place to monitor late or missed care calls.”
moderateEnd-of-life care: “Staff confirmed they had not completed any end of life training with the service. This meant that EOL care may not be as dignified as it could be”
moderateCommunication with families: “Not all people's communication needs had been considered or assessed... no further details providing guidance on how to best support the individual's communication needs.”
Strengths
· Relatives reported their loved ones felt safe with staff and that a regular team of staff visited who knew them well
· Staff spoke in a caring way about people, knew their preferences, and respected cultural diversity
· Positive feedback from a social care professional praising creative, person-focused work on a complex case
· Relatives confirmed dignity, privacy and independence were respected during personal care
· Provider was open, approachable and welcomed inspection feedback, responding positively to findings
Quality-Statement breakdown (24)
safe: Staffing and recruitmentNot rated
safe: Systems and processes to safeguard people from the risk of abuseNot rated
safe: Assessing risk, safety monitoring and managementNot rated
safe: Using medicines safelyNot rated
safe: Preventing and controlling infectionNot rated
safe: Learning lessons when things go wrongNot rated
effective: Staff support: induction, training, skills and experienceNot rated
effective: Ensuring consent to care and treatment in line with law and guidanceNot rated
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawNot rated
effective: Supporting people to eat and drink enough to maintain a balanced dietNot rated
effective: Staff working with other agencies; supporting people to access healthcare servicesNot rated
caring: Ensuring people are well treated and supported; respecting equality and diversityNot rated
caring: Supporting people to express their views and be involved in making decisions about their careNot rated
caring: Respecting and promoting people's privacy, dignity and independenceNot rated
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesNot rated
responsive: Improving care quality in response to complaints or concernsNot rated
responsive: Meeting people's communication needsNot rated
responsive: Supporting people to develop and maintain relationships to avoid social isolationNot rated
responsive: End of life care and supportNot rated
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsNot rated
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringNot rated
well-led: Duty of candour; continuous learning and improving careNot rated
well-led: Engaging and involving people using the service, the public and staffNot rated
well-led: Working in partnership with othersNot rated