Destiney Social Care Provider

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

While people we spoke to said that they were generally happy with their care, our assessment found elements of care did not meet the expected standard. We identified a breach of the legal regulations. This was because people did not always have comprehensive risk assessments that provided staff with information on how to minimise people's known risks. Where risks were assessed, this was inconsistent. Risk assessment documents did not always provide adequate guidance to staff. While there was a safeguarding policy in place, staff did not always apply it to report or prevent abuse or neglect of people using the service. Overall, medicines were always well managed, although improvements were required in recording topical medicines. People gave us mixed feedback about call times and length of calls. However, staff recruitment was robust and appropriate background checks and information were always sought, and there was sufficient staffing.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

While people we spoke to said that they were generally happy with their care, our assessment found elements of care did not meet the expected standard. Overall, people using the service and their relatives provided very positive feedback about the care and support provided by Destiney Social Care . People told us they felt safe, had no worries or concerns, and felt they could raise concerns if they needed to. Comments included, “My relative is very happy with the care. They feel safe. The staff are lovely, and they treat [Relative] very well,” and “My relative feels safe in their care and communicates with them well.” People told us staff asked them what care they wanted at each visit, which helped to ensure people consented to care delivery on an ongoing basis.

Discussions held with the management team demonstrated they fully understood their roles and responsibilities to safeguard people and keep them safe. Staff confirmed they had received safeguarding training. However, we were not assured that staff had the appropriate knowledge or experience to safeguard people using the service. Staff did not always take appropriate action without delay when abuse was suspected and reported. We identified an incident where the staff did not act appropriately. For example, where people were at risk of pressure ulcers, staff had failed to record changes in people's skin conditions, to raise concerns with the management team and to report in line with the providers safeguarding policies and procedures. This meant staff did not show that they understood the local safeguarding policy and procedures and the actions they needed to take in response to suspicions and allegations of abuse or neglect. As a result, people were placed at risk of harm.

The provider's systems, processes, and practices to make sure people are protected from abuse and neglect were not always effective. While there was a safeguarding policy in place, staff did not apply it to report or prevent abuse of people using the service. The provider acknowledged the service had received concerns from the local authority and relatives. The local authority had decided to place an embargo on the service to stop any further people being taken on by the service until they had strengthened their policies and procedures. The provider spoke with integrity, was open, and recognised the improvements they needed to make. They had taken immediate action to address the concerns identified by the local authority and relatives. However, some of these systems needed to be more structured, embedded, and sustained to ensure they remained effective over time.

While people we spoke to said that they were generally happy with their care, our assessment found elements of care did not meet the expected standard. People told us they were involved in making decisions about their care and support. Relatives were mainly positive about their involvement in the care planning process. Relatives said their care plans were reviewed regularly. One relative commented, “[Relative] has a care plan, which I access via the app. The manager came to the house to create it, and it has been reviewed when necessary.”

While staff had a good awareness of people’s needs and how best to support them our assessment found elements of care did not meet the expected standard. We could not be assured that staff had a good awareness of people's needs and how best to support them. The provider had not ensured each person’s risks had been effectively assessed and measures in place to manage those risks. Peoples risk assessments needed more information which put people at risk of not being supported safely.

The provider had failed to robustly assess the risks relating to the health, safety and welfare of people. People did not always have comprehensive risk assessments that were sufficiently detailed to enable staff to support people safely. Where people had identified risks, these had not always been robustly assessed. For example, where a person was diabetic, there were no details about what type of diabetes the person had, how it was controlled, or what actions the staff should take should the person suffer from low blood sugar or high blood sugar. Moving and handling risk assessments were basic, not person centred and did not detail actions staff should take should there be a fall or accident. Where a person needed a catheter, there was no risk assessment in place.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

While people we spoke to said that they were generally happy with their care, our assessment found elements of care did not meet the expected standard. Records showed there had been incidents where the staff had not acted appropriately. For example, where people were at risk of pressure ulcers, staff had failed to record or report changes in people's skin conditions, to raise concerns with the management team, and to report in line with the providers safeguarding policies and procedures. This meant staff did not show that they understood the local safeguarding policy and procedures and the actions they needed to take in response to suspicions and allegations of abuse or neglect. As a result, people were placed at risk of harm. However, overall, people were positive about the support they received from staff. People said staff generally attended at planned times, and they would contact people and relatives if they were running late. Comments included, "Sometimes they are a bit late and don’t let us know.” Other relatives commented, “The carers are never rushed,” and “Occasionally I have called the office if they do not arrive on time. That’s OK with me. They are very responsive to my care needs.”

Throughout the inspection, the registered manager was honest and open with us. They acknowledged the shortfalls identified at this inspection and were eager to put processes in place to ensure people receiving care and support were safe and protected from harm. Discussions held with the management team demonstrated they fully understood their roles and responsibilities to safeguard people and keep them safe. The provider confirmed they had reviewed their policies and procedures, and further training had been provided to staff following the concerns received from relatives and the local authority.

Whilst we acknowledge training was in place we could not be assured that the training was effective in enabling staff to be competent in providing appropriate care. For example, we could not be assured safeguarding training had been effective.However,The provider supported staff in accessing and completing the care certificate. The Care Certificate is an agreed set of standards that define the knowledge, skills, and behaviours expected of specific job roles in the health and social care sectors. It is made up of the 15 minimum standards that should form part of a robust induction programme.The provider had a system in place to safely recruit staff. Pre-employment checks were carried out prior to staff commencing in post. This included Disclosure and Barring Service checks (DBS). DBS checks provide information, including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions. We looked at 3 recruitment files and found staff had been safely recruited and all appropriate employment checks had been carried out.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

Where people required support with their medicines, relatives were positive care staff supported their loved ones well. Relatives said, "Yes, they help with medication. [Person] gets medication when [person] needs it. No issues" and "They make sure [person] takes their medication."

Staff had received training in medicine administration. Following training, staff received a competency assessment to ensure they were safe to administer medicines. However, records we reviewed showed staff were not following the provider's safe management of medicines policy and procedure.

The provider had systems in place to support staff to manage medicines safely. However, records around the administration of topical creams required improvement. Following the site visit the provider confirmed they were reviewing all topical MAR charts.The provider had suitable medicine management policies, which staff were required to follow. Staff received training to support them in managing medicines safely. The provider had a structured system to ensure staff remained competent to administer medicines.