Dignity Direct Homecare Ltd - Sheffield

On this page

• 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

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. This is the first assessment for this newly registered service. This key question has been rated requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed. We identified breaches of legislation relating to safeguarding, medicines and managing risks.

This service scored 44 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service did not always have a proactive and positive culture of safety based on openness and honesty. They did not always listen to concerns about safety and did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice. We found several incidents which were not recorded effectively and not monitored by senior staff. Falls were not appropriately monitored for frequency, themes or trends.

The service did not always work well with people and healthcare partners to establish and maintain safe systems of care. People had mainly received pre assessments prior to receiving support from the service. Partners told us the service worked well with them. One professional told us, “We have a long, positive and established professional relationship with Dignity Direct.” Online care planning was in place, which ensured information could easily be shared. However, due to care records containing discrepancies, we could not be assured information shared between services was always correct.

The service did not work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They did not concentrate on improving people’s lives or protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. They did not share concerns quickly and appropriately. Staff were trained and understood their roles in relation to safeguarding. Most staff told us they felt able to raise concerns. However, some staff told us they did not feel appropriate action would be taken if they raised safeguarding concerns. One staff member said, “I am able to report any wrongdoing, I have never had to report anything, but I would report to my manager.” Whilst another staff member said, “I don’t think things get done when reports are made. It can be difficult to get in touch with the office, sometimes care has been given wrong because the care plans are wrong.” We found several safeguarding incidents which had not been reported to CQC as required. Following our inspection retrospective notifications were submitted to us. Safeguarding logs were not accurately kept, to ensure the management team had effective oversight of safeguarding concerns and took action to learn lessons from these. During our inspection some staff raised allegations of safeguarding concerns, we referred these concerns to the local authority and investigations were ongoing at the time of our inspection. We received mixed feedback from people regarding safe and adequate care. One person said, “They keep me safe and make sure I’m comfortable. They ask me what I want doing. Really good carers.” Whilst another person said, “I’m safe but they don’t do the job right. They (staff) please themselves.”

The service did not work well with people to understand and manage risks. They did not provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. Accidents and incidents were not appropriately recorded or monitored to ensure risks posed to people were mitigated. We found incidents where action had not been taken in a timely way to support a person showing signs of infection and another person who had not received foot care in a timely way. Risk assessments contained conflicting information, and care plans lacked detail and guidance to staff about how to support people with pressure care, mobility, choking and epilepsy.

The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. People were supported in their homes. Risk assessments were in place to ensure people's homes were safe to complete care and staff were aware of any potential environmental risks. H&S audits were in place to ensure office areas were safe for use.

The service did not always make sure there were enough staff. They did not always work together well to provide safe care that met people’s individual needs. We found most training had been completed for staff several months after commencing employment. However, the service had received an increase in care packages and had worked to ensure staff had received training. Staff were trained to carry out their roles and regular spot checks were in place to monitor staff compliance and performance. Staff received supervisions, and most staff told us they were supported in their roles. Most staff were recruited safely. However, we found 1 staff member had not had a DBS check prior to commencing employment. This is covered in the well led section of this report. We received mixed feedback from people and relatives regarding staffing. One relative said, “We get three regular carers now. It’s improved and reasonable. The time of arrival varies depending on previous visits. They don’t let us know if they are late.” Another person said, ““They (carers) don’t come on time. They hardly wash you. One didn’t wash me at all about three weeks ago. I want to change from them. I talked to the manager and they promise the world.” The service monitored calls through a digital system, this system showed some people had missed and late calls, some people had a shorter call time and we also found staff had logged in at 2 separate locations on a number occasions, meaning we could not be assured all people had received their calls.

The service did not always assess or manage the risk of infection. Staff were trained in infection control and prevention. Staff told us how they protected people from the risk of infection and policies and procedures were in place. One staff member said, “I have had infection prevention control training, I would prevent infection by putting on full PPE and also keeping the area clean.” Staff spot checks were in place to ensure staff adhered to safe IPC practices. However, some people told us staff did not always adhere to safe hygiene practices. For example, one person told us staff put soiled continence aids on the floor.

The service did not make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. One person said, “Carer gave me one paracetamol instead of two even though I was prescribed two. Otherwise, they give me the tablets alright. I take them from a container. They will give me skin cream if I ask. They should do it themselves as it’s on their job list.” We found Medicine Administration Records (MAR’s) which were inaccurately completed, meaning we could not be assured people had their medicines as prescribed. Some medicines risk assessments contained conflicting information about people's needs. Medicines audits did not cover a range of people, meaning a large number of people did not have their medicines audited regularly. Audits which were completed highlighted concerns which were actioned. However, as concerns were identified with a small number of people, more robust auditing was required, to ensure the service could accurately monitor the safety of all medicines administration. Where people received ‘as required’ medicines, protocols were in place to guide staff about how to administer these.