Diamond Heart Health Care LTD

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 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.

In this key question the provider was in breach of the legal regulation relating to staffing.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always have a proactive and positive culture of safety. Lessons were not always learnt to continually identify and embed good practice.

Whilst there was a relatively low level of untoward events within the service, where such events did occur, it was not always clear where opportunities for shared learning had taken place. For example, where concerns had been raised by staff around moving and handling practices, this had not always translated into meaningful actions by the provider.

The provider did not always manage or monitor people’s safety effectively. Initial assessments were completed when people first started using the service, including risk assessments. However, evidence around planned and responsive reviews of care plans to identify any change of needs was limited. Further time was needed to ensure safe practices in systems, pathways and transitions were fully embedded.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. People and their relatives told us they felt safe using the service. Comments included, “I feel safe with the staff, the manager would never send two new people together. If there's a new person, one is always a regular.”

The provider had appropriate policies and procedures in place for staff to follow which sought to safeguard people from the risk of abuse. Staff were able to describe the signs of potential abuse and how they would report it. Staff had training and could evidence to us their understanding of the Mental Capacity Act 2005 (MCA) and how they supported people's right to make choices.

The provider did not always work well with people or staff to understand and manage risk.

Risks related to moving and handling of people were not always reviewed in a timely manner. We saw that for some people, there had been changes to their needs around mobility since they first started using the service, but these changes had not always been reviewed and communicated to the relevant agency. We shared examples of these with the registered manager so that onward referrals could be made back to the local authority.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

Home environment risk assessments were completed when people first started using the service. However, as reviews were not always undertaken in a timely manner, we were not assured that risk assessments associated with slips, trips or falls around the home were up-to-date and relevant.

The provider did not always make sure staff were deployed effectively within the service.

At the time of this inspection the service was supporting approximately 28 people. All care packages were commissioned by a local authority based in the West Yorkshire area. However, most staff lived in the Greater Manchester area at the time of this inspection.

Deployment of staff across a wide geographical area presented practical challenges. For example, some staff did not drive and access to public transport was limited which meant staff were dependant on the registered manager to drive them to care calls or pay for taxi journeys. Comments from people included, “I spoke to [Manager] at length, about if she wants to grow the business, she will really need to have drivers, because it’s an issue as staff are so reliant on public transport.”

Furthermore, arrangements put in place by the provider to temporarily accommodate staff in West Yorkshire for the duration of their time on duty were less than adequate. For example, staff told us consistently they spent the entirety of their shifts working in the West Yorkshire area which meant they were required to be temporarily accommodated for days on end in the West Yorkshire area which took them away from their own families.

We analysed electronic care call monitoring data for the month prior to our inspection. Where there were timekeeping anomalies, such as late care calls or short care calls, the reasons were explained by the registered manager. However, most people were happy with their care call visits. Comments from people included, “They're very reliable; they come on public transport so occasionally they can be a few minutes late, but they are reliable” and “They stay for the full 40 minutes they’re contracted for.”

We spoke at length with the provider about the situation outlined above. It was clear that the recruitment model adopted by the provider when first setting up the service was not one that could be sustained. We signposted the provider/registered manager to credible sources of information for developing a proper recruitment strategy, including those provided by Skills for Care.

Pre-employment checks were completed to ensure staff were safe to work with the people they were supporting. Staff had an interview, and their Disclosure and Barring Service (DBS) was checked and previous employment references sought. DBS checks provide information including details about convictions and cautions held on the police national computer. Right to work in the UK and visa status records were held on file by the provider and the relevant checks had been completed.

The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Staff had access to Personal Protective Equipment (PPE) at the point of care. Records showed that staff were trained in infection prevention and control. Comments from people included, “The carer turns up at the times expected and they always wear PPE when doing personal care.”

The provider made sure that medicines were safe and met people’s needs, capacities and preferences.

Support was provided to people with their medicines where this part of a planned package of care. Processes were in place to ensure the supply of medicines arrived on time. Supporting information to assist staff in administering medicines showed who was responsible for the ordering, collecting and storing medicines and whether any family members would be involved in the administration of medicines. Comments from people included, “They supervise mum taking her Dossett box medication and it’s always given on time” and “Carers assist with medication, and they know that they need to be on time for this as it is kept in a cupboard, which [person] cannot reach, to keep it safe from younger visitors."