About the service DCC High Peak Home Care is a domiciliary care agency. It provides care to people living in their own houses and flats and within two extra care facilities in the High Peak area of Derbyshire. The service supports younger adults, older people, people living with dementia and people with physical disabilities living in their own homes. Some people received a short-term service following a period of hospitalisation. At the time of this inspection there were 118 people using the service.
Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.
People’s experience of using this service and what we found
Roles, responsibility and accountability arrangements were not clear. Systems for identifying, capturing and managing risk were ineffective, for example, medicine records and care plans were not routinely reviewed. People and staff told us the service was not well-led and they were not clear on who held managerial responsibility. People told us they were happy with their care and felt involved and included in care planning and delivery. However, staff consistently told us they did not feel listened to, valued or involved in the running of the organisation.
Assessment of risks to people’s safety were not always available or effective. There was a lack of up to date available guidance for staff to follow. People told us they received their calls on time and were supported by staff who they felt were suitably qualified. Accidents and incidents were reviewed, and outcomes recorded.
Care planning and reviews were inconsistent. Care plans contained person-centred information and people told us they felt involved in developing their own care, but some information in care plans was not up to date. People told us they knew how to make a complaint if they needed to and complaints we reviewed had been handled as per the provider’s policy.
The provider understood that staff required training, and this was readily available to staff. However, staff training was not always up to date or in line with best practice. Staff training records did not demonstrate that staff had completed mandatory training. However, people told us they felt staff were well trained and staff told us there was an abundance of training.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. The provider was working in line with the Mental Capacity Act (MCA). People’s ability to make their own choices was assessed and respected. People told us staff always gained their consent before supporting them.
People consistently spoke highly of staff and told us they were kind and caring. People and their relatives said they were treated with respect and kindness by staff who were patient and respected their dignity. People said they formed close relationships with staff.
Rating at last inspection (and update)
The last rating for this service was Requires Improvement (published 12 May 2020). At the last two inspections, breaches of Regulations were found. At this inspection we have found the provider has not implemented enough improvement and remains in breach of Regulations.
Why we inspected
This was a planned inspection based on the previous rating.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified breaches in relation to governance at this inspection. Please see the action we have told the provider to take at the end of this report.
Follow up
We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Special Measures:
The overall rating for this service is ‘Requires improvement’. However, we are placing the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any Key Question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.
For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.