About the service: Direct Health (Telford) is a domiciliary care service. At the time of our inspection 111 people received care from the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

People’s experience of using this service:

• Significant improvements had been made in all areas of the service. However, further work was needed to ensure these improvements were sustained. Despite staff completing training, their learning was not always put into practice. They had failed to follow the provider’s policies and procedures in making office staff aware of changes in people’s care needs. Improvements were needed to ensure people’s care records were updated in a timely manner.

• Staff had received training in and understood how to protect people from any harm and abuse.

• People were supported by safely recruited staff and felt safe with them in their homes.

• Staff skills were kept up to date through regular training and staff were also supported in their roles by their line managers and their colleagues.

• Staff asked people’s permission before they helped them with any care or support.

• People’s right to make their own decisions about their own care and treatment were supported by staff.

• People were supported to eat and drink sufficient amounts in line with their assessed needs.

• People’s diverse needs had been planned for, which ensured people received individualised care.

• People were supported by staff who were kind and caring. People were involved in their own care and treated with dignity and respect.

• Complaints systems were in place, which people and relatives knew how to use.

• Feedback was encouraged from people who used the service and was used to help improve the delivery of care.

• People praised the staff who supported them. Improvements made to the service had had a positive impact on the care they received.

Rating at last inspection:

At the last inspection the service was rated requires improvement (report published 28 February 2018).

The service has been rated requires improvement for the past two inspections.

Why we inspected:

This was a planned inspection to check the provider had made improvements since our previous inspection.

At our previous comprehensive inspection in January 2018, we found two breaches in regulation because the provider did not have sufficient staff to meet people’s needs at the times they needed it. Also, the providers systems for checking the quality of the service were not effective. After the inspection, the provider wrote to us with an action plan, to say what they would do to meet the legal requirements in relation to their staffing arrangements and governance practices.

At this inspection, improvements had been made and the regulations were met. However, some further improvements were still needed in the key questions of Safe and Well Led.

Follow up:

We will continue to monitor the service through the information we receive and will inspect within 12 months of this report being published.

The inspection site visit took place on the 11 and 12 January 2018 and was announced. Calls to people and staff continued on 15, 16 and 19 January 2018. Direct Health (Telford) is a domiciliary care agency. It provides personal care to people living in their own homes in the community. It provides a service to older adults, younger disabled adults and children. At the time of our inspection there were 247 people using the service.

There was a registered manager in post at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission 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.

At this inspection we found the provider was not meeting all the regulations. We found the provider did not have sufficient staff available to ensure people had their care and support when they needed it and their quality systems were not driving improvements to the service. You can see what action we told the provider to take at the back of the full version of the report.

People were not always supported by sufficient staff and this meant they had to wait for their support and could not have their calls when they needed them. Medicines were not always recorded as being administered. The registered manager analysed incidents to help them learn when things went wrong, however this was not being used to drive improvement. Staff were recruited safely. People were protected from harm and they had risks to them assessed and managed appropriately. Staff understood how to prevent the spread of infection.

People had their needs assessed, however guidance for staff was not consistently provided in peoples care plans. Staff were trained to deliver effective support to people and had their competency checked, however this was not effective in ensuring medicines polices were followed. People did not always receive consistent care and support. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice. People were supported to manage risks associated with food and drink. People were supported to access health professionals when required.

Staff were not always able to provide support which was caring as they were rushed. People did not always have control over when their care was delivered. People’s privacy and dignity was not always maintained as staff were late for their calls.

People’s needs were assessed and plans were in place however these required review. People did not always have their needs met in the way that they preferred. People understood how to make a complaint but felt their concerns were not addressed.

The systems in place to monitor the quality of the service were not always effective. A registered manager was in post; however people felt they were not easy to communicate with. Staff were not always providing consistent care and support.