Dignity Direct Homecare Ltd - Sheffield

At our last assessment the provider was in breach of legal regulations in relation to safeguarding, managing risks, managing medicines and governance. Whilst we found some systems were in now in place, improvements were required to fully embed and use these in practice. We found continued breaches in relation to safeguarding, managing risks, managing medicines and governance at this assessment. The service has a continued rating of requires improvement.

Whilst we found no evidence of harm to people, feedback from people and their relatives identified concerns regarding the reliability and consistency of care delivery. We received mixed feedback from people and their relatives regarding frequent late visits, high staff turnover, inconsistent care staff and poor communication from the provider regarding changes to rotas and staffing. Concerns were also raised about communication barriers, and staff members infection prevention practices. Care records were not always kept up to date and contained conflicting information about risks posed to people, and how these should be managed. Systems for recording and monitoring accidents, incidents and safeguarding concerns were not always effective, and the management team did not consistently monitor these to ensure lessons could be learned. Medicines were not always managed safely and effectively.

Systems were not always effective in ensuring people received care and support that met their assessed needs. Care plans contained discrepancies and lacked detailed information about people's health conditions, associated risks and support requirements, which meant staff were not always provided with clear and up-to-date guidance. Records did not consistently evidence how care was delivered in line with advice from external healthcare professionals, and there was limited information to demonstrate people were supported to achieve their desired outcomes. In addition, records relating to consent were incomplete and contained conflicting information regarding people's capacity to make decisions.

We could not be assured people always received responsive, person-centred care. Care records contained inaccuracies, conflicting information and omissions relating to people's needs, preferences and health support, which increased the risk of inconsistent care. Although staff worked with external professionals and supported people to access healthcare services and community activities, records did not always contain sufficient information to ensure continuity of care or effective monitoring of people's outcomes. People and relatives provided mixed feedback about feeling listened to, and we found weaknesses in the management of complaints, with not all complaints being captured or analysed for themes and trends.

We found leaders had established a clear management structure, values and systems to support the operation of the service, and staff spoke positively about the support they received, team morale and opportunities to provide feedback. Staff were recruited safely and had undertaken all relevant training in relation to their roles. However, governance and oversight arrangements were not always effective in identifying and addressing concerns. Audits and monitoring processes had not identified the concerns found during this assessment, including inaccuracies and inconsistencies within care records, medicines management and the oversight of incidents and complaints.

Feedback from people and relatives regarding leadership was mixed, with some expressing concerns about communication, organisation and the accessibility of the management team. Although the provider had implemented improvement plans and was working with partner agencies, some concerns identified at previous assessments remained. This meant quality assurance systems had not been sufficiently embedded to drive and sustain improvements or provide leaders with effective oversight of the quality, safety and performance of the service.