Desire Care

We Are Specialised in People's Personal Care Needs

Desire Care - Burton Inspection report 12 October 2017
Mr Johnson Gyamfi Amoo
Desire Care - Burton
Inspection report
166 Waterloo Road
Burton on Trent
DE14 2NG
Tel: 01283777300
Website: www.desire-care.co.uk
Date of inspection visit:
07 September 2017
08 September 2017
Date of publication:
12 October 2017
Overall rating for this service Good
Is the service safe? Good
Is the service effective? Good
Is the service caring? Good
Is the service responsive? Good
Is the service well-led? Requires Improvement
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Summary of findings
Overall summary
We inspected this service on 7 and 8 September 2016. This was an announced inspection and we notified
the provider two days before our inspection in order to arrange to meet with people who used the service.
Desire provides domiciliary care for people who live in their own home in Burton upon Trent, Derby and
Birmingham. At the time of our inspection, fourteen people were receiving personal care support from the
The provider was also the registered manager in the service. 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.
On our last inspection in September 2016, we rated the service as Requires Improvement as we found
medication audits had not identified where there were potential errors and action had not been taken to
review medicine procedures. Formal systems for staff supervision were not completed to ensure staff
development and completion of the care certificate were needed. On this inspection we found
improvements had been made in these areas. Further improvements were still needed to ensure systems in
place to assess and monitor the quality of care to drive improvements within the service. This included
where people's care had been changed and ensuring all information was reviewed to demonstrate how
people were supported to manage any complex behaviour.
People felt safe when they received care. Staff understood how to recognise potential harm and protect
people from abuse and knew how to report concerns. Recruitment checks were made to confirm staff were
of good character to work with people and sufficient staff were available to meet people's support needs.
People had capacity to make decisions about their own care and staff sought their consent before providing
care and support. Staff had effective supervision and their work was reviewed through regular checks on
their performance and appraisals. People received an agreed level of staff support at a time they wanted it.
People were happy with how the staff supported them and were helped to take their medicine as
There was a small team of staff who had the skills to meet their needs. People knew who was delivering their
support and the provider was flexible and responsive to changes in people's needs. People received kind
and compassionate care and were supported to maintain their dignity, independence and privacy.
People chose how support was delivered and were positive about the way staff treated them. Staff listened
to people's views and people knew how to make a complaint or raise concerns.
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The five questions we ask about services and what we found
We always ask the following five questions of services.
Is the service safe? Good
The service was safe.
People felt safe when they received care. Risks to people had
been assessed and there was information about action to be
taken to minimise the chance of harm occurring to people and
staff. There were sufficient staff available and recruitment
procedures were in place to ensure people were suitable to work
with people.
Is the service effective? Good
The service was effective.
Staff had the skills and knowledge they required to care for
people and understand how to provide their support. Staff
understood the importance of helping people to make decisions.
People were encouraged to eat healthily and staff ensured they
had access to food and drink they wanted.
Is the service caring? Good
The service was caring.
People and their relatives were positive about the way staff
provided their care and support. The staff were kind and
compassionate and provided support in a respectful and
dignified way.
Is the service responsive? Good
The service was responsive.
People were involved in the review of their care and decided how
they wanted to be supported. People felt able to raise any
concerns and staff responded to this to improve the support
people received.
Is the service well-led? Requires Improvement
The service was not always well-led.
Systems had been developed to assess and monitor the quality
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of care although further improvements were needed. People
were happy with the support they received and were asked how
they could improve the support and service. Staff were
supported in their role and felt able to comment on the quality of
service and raise any concerns.
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Desire Care - Burton
Detailed findings
Background to this inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our
regulatory functions. This inspection checked 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 visit took place on 7 and 8 September 2016 and was announced and carried out by one
inspector. The provider was given two days' notice because the location provides a domiciliary care service
and we wanted to make sure we had an opportunity to speak with people and staff.
On this occasion we did not ask the provider to send us a Provider Information Return (PIR). This is a form
that asks the provider to give some key information about the service, what the service does well and
improvements they plan to make. However we offered the provider the opportunity to share information
they felt relevant with us.
We used a range of different methods to help us understand people's speaking with two people who used
the service, two relatives, six staff and the human resource manager.
We looked at five people's care records to see if their records were accurate and up to date. We also looked
at records relating to the management of the service including quality checks.
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Is the service safe?
Our findings
On our last inspection we found that when new staff started working in the service, all the required
recruitment checks were not completed. This meant the provider could not ensure they were suitable to
work with people who used the service. This demonstrated a breach in Regulation 19 of the Health and
Social Care Act 2008 (Regulated Activities) Regulations 2014. On this inspection we found improvements had
been made.
Staff recruitment and selection procedures were in place to ensure new staff were suitable to provide
people's care. Relevant employment checks had been undertaken before staff had started work, which
included police checks and written references. Where written references were provided in a language other
than English, a certified translation was provided.
People were confident that the staff supported them in a way which helped to keep them safe. Where
people needed equipment to move or to maintain their independence, this was provided after an
assessment by an occupational therapist. One person told us, "I have a hoist and the staff are very good at
using it. There are always two of them and they make sure I'm alright when they use it." Where people used
equipment, an assessment of risk had been completed which recorded how staff should support each
person. One person told us, "I feel completely safe. I'd rather not use it at all but I don't have much choice as
I'd be stuck in bed. The staff always make sure I'm comfortable and let me know when I have to start
Risks within the environment were assessed. Where people needed help to move around the home, hazards
were identified, for example a rug in the middle of the room. In discussion with the person we saw this was
removed to reduce the risk of trips or falls. One person told us, "The staff are always reminding me to take
care or help to move things that would get in my way. They really care." The external environment to the
property was considered to ensure staff could keep safe. For example, whether the area was well let or an
uneven entrance to people's home.
Staff demonstrated they had a good understanding of how to protect people. The staff had undertaken
training in safeguarding adults and described different forms of abuse and what they would look for. The
staff explained what they would do if they had concerns about any person's safety and felt confident to raise
any concerns with the registered manager or provider. One member of staff told us, "People are our priority
and we want to look out for them and would do what's right. We had the safeguarding training so know
what to look for and if we were worried about anything then we'd let the manager know.
Some people were responsible for taking their own medicines and were independent in this area and other
people needed support or prompting. One person told us they received their medicines in blister packs and
said, "I can't manage to get the tablets out of the packets so the staff do that for me. I'm quite able to take
them myself once they have got them for me." Staff received training to safely administer medicines and one
member of staff told us, "We only give people their tablets when we have had the training. I've done the
training but don't get involved with medication as most people are responsible for doing their own tablets."
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There was a record of the medicines people needed and staff recorded when this was administered. Where
people needed any creams to be applied, there was a body map which highlighted the areas where this was
needed. One member of staff told us, "We've all had the training for giving medicines and I found it really
useful. I know what to check to make sure everything is right and feel a lot more confident."
People felt there were enough staff working in the service to meet their needs and received their visit on time
by the same staff team. One person told us, "I have a group of about six staff who visit me. It tends to be the
same four staff but sometimes they are on holiday so there are some staff who know me in case of
emergencies. It works out really well." Another person told us, "They turn up when they should and I've
never been let down. It's good that they are so reliable." People knew how to contact staff in the event of any
emergency and one person told us, "I have the phone number here and if I was worried or the staff weren't
here I could call them. It wouldn't be a problem but it's never happened."
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Is the service effective?
Our findings
On our last inspection we found that improvements were needed with how information was recorded with
how people needed to be supported. On this inspection we found some people had complex behaviour
which may harm themselves or others. A small group of staff provided this care and knew people well and
one member of staff told us, "We understand why people become frustrated and behave the way they do.
We will move back and keep safe and talk with them. Some days it's different and if we felt we needed some
more support the manager would come along who knows them really well and they would help us." Staff
understood how to keep safe and what to do to prevent further harm although the care records needed to
be updated to reflect these agreed strategies and how these were reviewed.
On our last inspection we found that new staff had received an induction into the service, however this did
not cover all the areas required as detailed within the care certificate. Staff did not receive any formal
supervision to ensure they were safe to work with people who used the service and improvements were
needed. On this inspection we found improvements had been made.
Staff had now completed the care certificate. The care certificate sets out common induction standards for
social care staff. It has been introduced to help new care workers develop and demonstrate key skills,
knowledge, values and behaviours which should enable them to provide people with safe, effective,
compassionate and high quality care. Staff told us they had found this training valuable and it had
enhanced their skills. One member of staff said, "The training was really good. I learnt how to approach
people when they were agitated and feel more confident when doing anything with medication." Another
member of staff told us, "We've had so much training now and I feel much better. It's good to understand
the reason you are doing something. If we feel we don't understand anything then we just tell the manager
and they arrange for us to have more."
On our last inspection we found that the provider had not considered who had the legal authority to help
people to make decisions where they may lack capacity. The Mental Capacity Act 2005 (MCA) provides a
legal framework for making particular decisions on behalf of people who may lack the mental capacity to do
so for themselves. The Act requires that as far as possible people make their own decisions and are helped
to do so when needed. When they lack mental capacity to take particular decisions, any made on their
behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their
liberty to receive care and treatment when this is in their best interests and legally authorised under the
MCA. On this inspection we found this had been explored as part of the assessment process to ensure where
this was in place the details were recorded.
Staff informed us that people who currently used the service had capacity to make decisions about their
care and support. People were happy with the staff that supported them and told us they treated them with
respect and listened to what they had to say. One person told us, "The staff always talk to me about what is
happening and what they are doing. They respect my views and I'm always asked about everything that
happens." We saw the care records included information about how decisions had been made about their
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People retained responsibility for managing their own health care and continued to be registered with their
GP. One person told us, "My family help me with appointments or going to the hospital. The staff are very
good at noticing if I'm not too well and ask me how I am." One member of staff told us, "If people want us to
go with them then that can be arranged. I went to the dentist with [Person who used the service] and made
sure they were safe. It wasn't a problem and it was better for them than going alone."
Some people needed support to prepare and eat their meals although retained responsibility for their
personal shopping. One person told us, "My family do all my shopping but there is food here so the staff can
make each meal and leave me a drink. This works really well." Where concerns were identified that people
were not eating and drinking, the staff reported this so action could be taken to ensure their welfare. One
relative told us, "The communication is great and the notes they make are very detailed. This helps when I
do the shopping because if they didn't like a meal or didn't eat very much, I can see that and do something
different next time."
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Is the service caring?
Our findings
People were treated with care and kindness and were happy with the support they received from the staff.
One person told us, "I know the staff really well and I trust them and feel comfortable with them. This is what
I like. I don't want people I don't know helping me to wash. This is my home and I need to trust people and I
do. I'm very happy with this." Another person told us, "I wouldn't change any of the staff, they are beautiful
people inside and out. I am very fortunate to know them and for them to visit me."
People's right to privacy and dignity was upheld and staff recognised people diverse cultural needs. A
member of staff told us, "People are able to choose who provides their care. For some people because of
their beliefs, only male carers provide the support and this is respected. Female carers never go and we work
closely together to make sure this is always possible. The manager will come and cover these shifts too as he
knows them really well and knows how important this is to them."
People were given choices in the support they had and staff asked them what they needed. They said their
views about their care had been taken into consideration and included in their care plans. One person told
us, "The occupational therapist suggested I have a ceiling track in my house but I told them I didn't want one
fitted. The staff understood and were happy to use the hoist and that's what they do. There are two staff
who visit me and they know what they are doing. I'm happy that they listened to me." A relative told us, "I
think it works so well because they care about individual needs and what they really want. All the staff are
brilliant and treat [person who used the service] like a member of their own family. They make them feel
important and listen to what they say."
People were encouraged and supported to be as independent as they wanted to be. People's support plans
guided staff on how to ensure they were encouraged to do as much as they wanted so that they retained
control. One person told us, "The staff are always nearby but not pushy. They know what I can do and don't
interfere. If they see I need help they are always there though."
People's right to confidentiality was protected. All personal records were kept securely in the office and were
not left in public areas. People had a copy of their care records in their home and one person told us, "I'm
happy with how they provide all my care. When they visited me they wrote it all down and gave me a copy.
They tell me to keep it safe and I do."
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Is the service responsive?
Our findings
On our last inspection we found improvements were needed to ensure that people's care plans were
reviewed and up to date when their needs changed. On this inspection we saw improvements had been
Where concerns were raised about people's care, a senior member of staff visited to check they were safe
and well. We saw staff had reported that people were unable to get out of bed, had difficulty walking or
when continence supplies had not arrived. People also notified the office when there were any changes to
their care plan; for example, if they visited the hospital or GP which affected how they wanted to be
supported. One person told us, "If anything changes then the staff know straight away and there's never any
problem." A member of staff told us, "If something is different we get in touch with the office and make those
changes straight away. We work closely together so we all know what changes are being made."
People were confident their concerns would be responded to and knew how to raise any concerns and
make complaints if needed. There was a complaints procedure in place and people told us they would
contact the office if they had any concerns. One person told us, "I wouldn't have any problems telling them if
something was wrong."
People were involved in the planning and delivery of their care and their views about this were listened to.
People could tell staff how they wanted to be supported and this was recorded. Before staff started to
provide any support, they met with the manager who discussed the agreed care. One member of staff told
us, "People are often surprised that we know so much when we first meet them, but we sit down and go
through the plan and read everything. If there's anything we are unsure of then we can talk to the manager
about it." They told us, "After a few weeks we review the plan. Sometimes it says people like things a certain
way but they change their mind or want things done differently. That's fine so we can just change it to the
way they want."
Care was planned to ensure people received a service at the time they expected it. The support visits
allowed travelling time for staff to travel to their next support visit. The local area was subject to road
closures for a lengthy period of time and had resulted in a high volume of stationary traffic. One member of
staff told us, "They rota has even been changed to recognise that it takes longer to get some people at the
moment. It's better this way as we are not late." Another member of staff told us, "It's good that we have
time between each visit as if people just want more time to sit and talk with us, then we have this flexibility
so we don't have to rush off." One relative told us, "If there is anything else they need, they will stay later;
there's no quibbling about it."
People were assisted to pursue activities and interests that were important to them. The provider arranged
services for people to be supported with their interests or staff spent time with people in their home. During
these support visits, personal care was not provided and therefore this support is not regulated by us.
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Is the service well-led?
Our findings
On our last inspection we found that quality monitoring systems had not been developed. This meant the
provider had not managed the risks associated with managing this service and delivering support to people.
This demonstrated a breach in Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities)
Regulations 2014. On this inspection improvements had been made although further improvements were
still required.
The provider carried out checks to monitor the quality and safety of the service. Records were audited when
they were received into the office to make sure people received their medicines as prescribed and care was
delivered as outlined in their support plans. However, these checks were not recorded to demonstrate how
this information was reviewed and how this was used to make improvements within the service. A record of
any changes required with people's care was kept in a shared communication book; the provider recognised
this practice could be reviewed to ensure all information was included in people's individual care records.
Where people had complex needs, the quality assurance systems had not identified that information was
not available to guide staff on how to provide safe and effective care. This meant further improvements were
A new system had been introduced to monitor and identify whether people received their support on time
and for the agreed length of time. Staff logged their time of arrival and departure on a phone and this was
monitored electronically by the manager. If any staff failed to arrive at the expected time, a text and email
alert would be sent to them to ensure people received their call as expected and staff were safe. We saw that
people received their call on time and for the agreed length.
A questionnaire had been developed and sent to people who used the service as part of an annual quality
assurance survey. The surveys were being completed at the time of our inspection. The staff understood that
these would need to be analysed to drive improvements within the service and people were to be informed
of the results.
Staff now received formal supervision to review their performance and unannounced checks were carried
out to monitor staff performance. These checks included reviewing whether staff were suitably dressed,
arrived on time and provided dignified personal care. People were asked for their views on the conduct on
staff and whether any improvements were needed. One person told us, "The managers come out and check
the staff are doing things right. I know they are but it's good that they are interested in what the staff are
People felt the manager was approachable and listened to what they said. One person told us, "He is a good
man. A proper gentleman and very caring. Nothing is too much trouble." Another person told us, "We are
lucky that we have caring staff and owners. They are genuinely caring people and it's always nice when they
visit so I can tell them how happy I am."
Staff knew how to raise concerns and knew about the whistle blowing process. Whistle blowing is the
Requires Improvement
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process for raising concerns about poor practices. One member of staff told us, "It wouldn't bother me if
other staff knew I had reported something because that's the right thing to do. We work with different
people throughout the day so we wouldn't necessarily be identified." Another member of staff told us, "The
manager is always there at the end of a phone or you can just come to the office. If anything was bothering
us we could just speak with them and I know they would sort it out."
It is a legal requirement that a provider's latest CQC inspection report is displayed at the service and on their
web site where a rating has been given. This is so that people, visitors and those seeking information about
the service can be informed of our judgments. We found the provider had conspicuously displayed. update here...