Dolphin Care is a domiciliary care agency. It provides personal care to people living in their own houses in the community. It provides a service to 20 older adults for a total of 138 hours per week. Each person received a variety of care hours, depending on their level of need. The CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where this is provided, we also take into account any wider social care provided.The inspection was conducted between 20 December 2017 and 5 January 2018 and was announced. We gave the provider 48 hours’ notice of our inspection as we needed to be sure key staff members would be available.
There was a registered manager in place. 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. The registered manager is also a director of the provider’s company.
At our last comprehensive inspection, in March 2017, we identified breaches of Regulations 9, 12, 13, 17, 18 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had failed to ensure: that people's individual needs and preferences were assessed; that individual risks to people were managed effectively; that people’s medicines were managed safely; that people were protected from the risk of abuse; that sufficient staff were deployed; that robust recruitment processes were in place; that records relating to people’s care and the effective running of the service were complete and accurate; and that effective systems were in place to assess, monitor and improve the service.
We issued warning notices to the provider in respect of Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, requiring them to become compliant with the regulations by 5 May 2017 and 26 May 2017 respectively. We issued requirement notices to the provider in respect of Regulations 9, 13, 18 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Following this, the provider sent us an action plan detailing the action they would take to become compliant with the regulations. At this inspection, we found action had been taken and there were no longer any breaches of regulation.
Following our inspection in March 2017, the service was placed in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.
Although we did not identify any breaches of regulation at this inspection, we found further improvement was still required.
The provider had developed their quality assurance processes. However, these needed time to become fully embedded in practice. The provider used a range of methods to seek feedback from people. However, issues raised were not always addressed effectively.
Where people needed assistance to take their medicines, these were managed and administered safely. However, more robust systems were being implemented to ensure staff always received appropriate training before administering medicines to people.
Staff took appropriate action to protect people from the risk of infection. Some staff had not received infection control training, although this was being scheduled.
The provider was aware of some risks posed to staff, but had not completed individual risk assessments for staff, as required by their lone working policy. Therefore, they may not have been aware of factors that might have affected the safety of individual staff members.
Appropriate recruitment procedures were in place to help ensure that only suitable staff were employed. Staffing levels were based on people’s needs and there were enough staff available to attend all care visits.
Risk assessments had been completed for all identified risks posed to people using the service, together with action staff needed to take to reduce the risks. Staff understood their safeguarding responsibilities and knew how to identify, prevent and report allegations of abuse.
Staff encouraged people to maintain a healthy, balanced diet based on their individual needs and preferences, although most meals were planned and prepared by people or their relatives.
With the exception of infection control training, staff had completed suitable training to equip them for their role. They demonstrated an understanding of the training they had received and were appropriately supported by managers.
Staff followed legislation designed to protect people’s rights. They sought consent before providing care and acted in people’s best interests. They also supported people to access healthcare services when needed.
People told us they looked forward to their visits from Dolphin Care and said their needs were met in a caring and compassionate way. They had a team of regular staff with whom they had built positive relationships.
Staff protected people’s privacy and respected their dignity. They promoted independence and involved people in decisions about their care.
Assessments of people’s care needs had been completed and detailed care plans had been developed. These supported staff to provide personal care in a consistent and individualised way.
Staff were flexible and responded promptly when people’s needs changed. They were able to accommodate the varying level of support people needed at each visit. Staff supported people at the end of their lives to help ensure they experienced a comfortable and pain free death.
There was a complaints procedure in place. People knew how to raise a complaint. All complaints were recorded and dealt with promptly.
Records relating to the management of the service were organised. There was an open and transparent culture. The registered manager was aware of the need to promote equality and inclusion within the workforce.