Archived: Direct Health (Crewe)

Updated 8 November 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 18 October and was announced. The provider was given 48 hours’ notice prior to the inspection visit. Prior notice was provided because the location provides a domiciliary care service and we needed to be sure that staff would be available on the day to speak with us

The inspection team consisted of one adult social care inspector and an ‘Expert by Experience’. An ‘expert by experience’ is a person who has personal experience of using or caring for someone who uses this type of care service.

Before the inspection visit we reviewed the information which was held about Direct Health (Crewe). This included notifications we had received from the registered provider such as incidents which had occurred in relation to the people who were being supported. A notification is information about important events which the service is required to send to us by law.

A Provider Information Return (PIR) was received prior to the inspection. This is the form that asks the registered provider to give some key information in relation to the service, what the service does well and what improvements need to be made. We also contacted commissioners and the local authority prior to the inspection. We used all of this information to formulate a ‘planning tool’, this helped us to identify key areas that we needed to focus on during the inspection.

During the inspection we spoke with the supporting manager, one ‘Care Services Director’, four members of staff, one person receiving support and six relatives who agreed to speak to us over the phone.

We also spent time reviewing specific records and documents, including five care records of people who received support, five staff personnel files, staff training records, medication administration records and audits, complaints, accidents and incidents and other records relating to the management of the service.

Updated 8 November 2018

This inspection took place on 18 October 2018 and was announced.

This was the first inspection since Direct Health (Crewe) was registered with the Care Quality Commission (CQC).

Direct Health (Crewe) is a domiciliary care agency. The registered provider is Accord Housing Association Limited. This service provides care and support to people living in their own homes and supports them to live as independently as possible.

Direct Health (Crewe) provides a service to young and older adults who are living with a range of different support needs such as learning disabilities, autism, physical disabilities and sensory impairments. At the time of the inspection the registered provider was supporting 41 people.

There was no 'registered manager’ at the time of the inspection however a newly recruited manager had been in post for approximately three weeks; they had submitted the relevant registered manager applications to CQC. A registered manager is a person who has registered with CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Care plans and risk assessments were in place for people who were receiving support. Records contained up to date and relevant information. Staff were familiar with people’s individual support needs and the risks which needed to be mitigated.

Medication management systems were safely in place. Staff received the relevant medication training and regularly had their competency assessed. Routine medication audits were completed and any medication errors which occurred were thoroughly explored.

Recruitment was safely managed. Staff were appropriately vetted, suitable references were obtained and Disclosure and Barring System (DBS) checks were in place.

There were sufficient numbers of staff to provide the support that people required. Staff confirmed that from ‘time to time’ staffing levels did decrease but this was an area that was well managed. People still received the support they needed; the management team and staff team worked together to support this.

Accidents and incidents were appropriately recorded and analysed. The manager explained that there was very little activity in relation to accident/incidents but staff were aware of the reporting procedures.

People were protected from avoidable harm and risk of abuse. Safeguarding and whistleblowing policies were in place, staff received the necessary safeguarding training and were familiar with reporting procedures.

Infection prevention control procedures were in place and staff were provided with the relevant personal protective equipment (PPE).

The registered provider was complying with the principles of the Mental Capacity Act, 2005. People’s capacity had been assessed; consent to care had been obtained by people who had the capacity to make decisions.

Staff told us that they were fully supported by the registered provider and had developed the correct skills and competencies to provide the level of support that was expected. Staff were regularly supported with training, learning and development opportunities.

The overall health and well-being needs of people who received support was effectively managed. Appropriate referrals were taking place to external healthcare professionals (when needed) and the relevant guidance and advice which was provided was routinely followed.

Nutrition and hydration needs were effectively assessed. People were supported with a ‘choice’ of food and drink and support needs were well managed.

Staff received dignified, respectful and compassionate care. We received positive feedback about the level of care that was provided and how staff always ensured that care was delivered to a high standard.

People’s sensitive and private information was stored at the registered address and was not unnecessarily shared with others. Confidential information was protected and securely stored in line with General Data Protection Regulation (GDPR).

People and relatives received a ‘service user guide’ from the outset. This contained essential information about the expected level of care and support people would receive from Direct Health (Crewe).

People received person-centred care. Records contained information in relation to a person’s wishes, choices and preferences. We received positive feedback about the level of responsive care people received.

The registered provider had a clear complaints policy in place. People and relatives knew how to make a complaint and told us that they would feel confident making a complaint if they needed to. At the time of the inspection, no complaints were being responded to.

The registered provider had a variety of different processes in place to monitor and assess the quality and safety of the care people received. Audits, checks and observations were in place which helped to establish areas of strength as well as areas of improvement.

Measures were in place to gather the thoughts, views and suggestions of the people who received support. Questionnaires were circulated, surveys were conducted and reviews took place. Feedback received helped to prompt positive change and supported with continued development.

We received positive feedback about the leadership and management at Direct Health (Crewe). Staff told us there was a supportive, responsive and transparent culture. Relatives also confirmed that the they felt Direct Health (Crewe) was a safe, effective and well-led service.

The registered provider had a range of different policies and procedures in place. Policies we reviewed included safeguarding, whistleblowing and medication administration.

The manager was aware of their regulatory responsibilities and understood that CQC needed to be notified of events and incidents that occurred in accordance with the CQC’s statutory notifications procedures. The necessary notifications were submitted to CQC in timely manner.