Date of assessment 10 March to 2 April 2025. The assessment was triggered by concerns received about the quality of the service. This is a specialist service that is registered for use by autistic people or people with a learning disability. At the time of the assessment, the registered manager informed us that the service was not supporting anyone whose primary need and reason for support was related to their learning disability or autism. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group. We found 3 breaches of the legal regulations in relation to safeguarding, safe care and treatment and governance. We have asked the provider for an action plan in response to the concerns found at this assessment. The provider did not consistently protect people from abuse and improper treatment. We identified a safeguarding concern during the assessment. Staff did not always have appropriate guidance to enable them to provide care to meet people’s needs that was safe, supportive and in line with best practice. The governance of the service had failed to create a positive culture and staff morale was low. Staff did not feel involved, valued or listened to by management. Issues, concerns and complaints were not always robustly investigated to support effective learning. There was not always a strong proactive and positive culture of safety within the service. The provider did not always report safety events. Whilst care calls were covered, staff were required to travel long distances and work long hours. There was a high staff turnover. Staff supervisions were not always meaningful and there were some shortfalls in staff training. There were multiple medicine errors identified in audits. The provider had implemented new processes in an attempt to reduce these errors. The provider took some steps to support continuity of care across services. Some areas of people’s care plans contained a good level of information, and some professionals spoke positively about staff knowledge of people’s needs. The provider had introduced focus groups to try and involve staff more and improve morale. The registered manager was a member of a local external care group who met weekly to share knowledge, experiences and promote good practice. The provider had measures in place to gather feedback. Professionals told us communication with the service was good.
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DayByDay Care Limited improved from Requires Improvement to Good following a focused inspection of Safe, Effective and Well-Led domains, having remediated a prior breach of Regulation 18(2) around staff training and supervision. The service demonstrated robust safeguarding, medicines management, governance and person-centred care practices.
Strengths
· People felt safe with staff and systems and processes effectively safeguarded people from abuse
· Medicines administration was done safely with staff trained and assessed as competent
· Staff received regular supervisions, appraisals and competency checks, resolving previous breach of Regulation 18(2)
· Robust governance framework with regular audits and oversight of all aspects of the service
· Strong recruitment processes including two interviews, DBS checks, ID and reference checks
First inspection of newly registered domiciliary care service rated Requires Improvement overall, with a Regulation 18 (Staffing) breach for failures in induction, training, supervision, appraisal and competency oversight. Care delivery was safe, caring and responsive with positive feedback from people, but governance audits failed to drive timely improvements.
Concerns (8)
criticalStaff training: “A list of staff training deemed mandatory was provided with many incomplete records and no evidence of oversight to ensure staff remained up to date.”
criticalStaff training: “records confirmed that practical training for moving and handling had not been completed and this was not booked.”
criticalSupervision / appraisal: “The provider failed to ensure staff received supervision and appraisal in line with their policy.”
criticalStaff competency: “There was no robust system in place to determine if staff were competent in their roles following recruitment or completion of online training”
criticalStaff training: “Systems and processes failed to ensure all staff completed an initial induction to the service on commencement of their role.”
moderateGovernance: “Governance and performance checks used to manage the service were not always effective. Systems and processes were not regularly reviewed”
moderateRecord keeping: “Staff did not have routine access to important company policy and procedures.”
minorLeadership: “we received mixed feedback from staff about accessibility of management... 'We don't see the manager, but the office hasn't always been open due to COVID-19.'”
Strengths
· People reported feeling safe with staff and knew which staff were visiting
· Safe recruitment practices including DBS checks were in place
· Medicines were administered safely with accurate MAR records and PRN protocols
· Good infection prevention and control with appropriate PPE use
· Person-centred care plans considering cultural backgrounds, preferences and communication needs
Quality-Statement breakdown (20)
safe: Systems and processes to safeguard people from the risk of abuse; Learning lessons when things go wrongGood
safe: Assessing risk, safety monitoring and managementGood
safe: Staffing and recruitmentGood
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
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 lawGood
effective: Supporting people to eat and drink enough to maintain a balanced diet
Good
effective: Staff working with other agencies to provide consistent, effective, timely care; 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 care; 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
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 empowering, which achieves good outcomes for peopleRequires improvement
well-led: How the provider understands and acts on the duty of candourNot rated
well-led: Engaging and involving people using the service, the public and staff; Working in partnership with othersNot rated
well-led: Continuous learning and improving care; Working in partnership with othersNot rated