Background to this inspection
Updated
8 June 2019
The inspection: We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
The inspection was prompted in part by concerns shared with the CQC about staff training, the rotas and how risks were managed. This inspection examined those risks.
Inspection team: The inspection was carried out by two inspectors.
Service and service type: This service is a domiciliary care agency. It provides personal care to people living in their own homes. Not everyone who used the service received regulated activity. The CQC only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.
Since our last inspection the provider had appointed new directors to manage the service. The service did not have a registered manager. A registered manager is a person who has registered with the CQC to manage the service. Like the provider they are legally responsible for how the service is run and for the quality and safety of the care provided. A manager was in post and they had applied to become the registered manager.
Notice of inspection: The first day of our inspection was unannounced. We told the provider we would be visiting on the second day. Inspection site visit activity started on 10 May 2019 and ended on 16 May 2019; it included telephone calls and visits to people who used the service as well as visits to the office location.
What we did before the inspection: We reviewed information we had received about the service from the provider since the last inspection, such as serious injuries. We sought feedback from the local authority and professionals who work with the service. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
During the inspection: We spoke with five people who used the service, three people’s relatives, and received feedback from four health and social care professionals about their experience of the care provided. We spoke with two directors, the manager and five care workers.
We looked at three people's care records in full and two people's care records in part. This included medication administration records and people’s daily notes. We looked at four staff’s recruitment, induction, training and supervision records as well as other records relating to the management of the service.
Updated
8 June 2019
About the service: Diamond Care Company Ryedale provides care and support in people’s own home. They support younger adults and older people as well as people who may be living with mental health needs, a physical disability or sensory impairment.
People’s experience of using this service: People were at increased risk of harm, because of how the service had been managed. Medicines had not been managed safely. The provider had not made sure staff had the training needed to provide people with safe care and support.
There had been a high turnover of staff. Problems with organisation of the rota and staffing levels had led to missed visits and people’s care being cancelled.
Management had not always responded appropriately to safeguarding concerns and other incidents including missed visits. This meant opportunities to learn lessons and improve the service were missed.
Staff were not adequately supported to provide person-centred care. Care plans and risk assessments did not always reflect people’s needs or have enough information to guide staff on how those needs should be met.
People were not supported to have maximum choice and control of their lives; the policies and systems in the service did not support this practice. Consent to care was not explored or documented when people lacked mental capacity.
People were supported by kind and caring staff, but the organisation and leadership of the service effected the overall quality of the care people received.
New directors had taken over management of the service since our last inspection. A manager was in post, and they had applied to become the registered manager. The new providers and manager had not adequately monitored the quality and safety of the service. People and staff raised concerns about poor communication, organisation and leadership. There were widespread issues and concerns about the quality and safety of the service provided.
For more details, please see the full report which is on the Care Quality Commission’s (CQC) website at www.cqc.org.uk.
Rating at last inspection: At the last inspection service was rated Good (report published 29 November 2017).
Why we inspected: This inspection was planned in response to concerns about the service provided.
Enforcement: We have identified breaches of regulation in relation to the safety of the care provided, how the provider safeguarded people from abuse and avoidable harm, the quality of person-centred care, recruitment practices, staff training and the governance of the service. Please see the action we have told the provider to take at the end of this report.
Follow up: We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will monitor the progress of the improvements working alongside the provider and local authority. We will return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.
Special Measures: The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.
For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.