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Inspection carried out on 3 July 2018

During a routine inspection

This inspection took place on 3 and 5 July 2018. The provider was given 48 hours' notice because the location provides a domiciliary care service. At the time of the inspection Daryel Care provided domiciliary care and support for 57 people in their own home. The service worked primarily with older people living with dementia and a small number of people with physical impairments.

At our last inspection on 31 May and 1 and 2 June 2017 the service was not meeting the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found breaches of Regulations 12 and 18 which related to recording risk assessments and recording medicines provided as well as professional development opportunities not being made available for care workers. Each of these areas had been addressed and the provider was now complying with these regulations.

There was a registered manager in post. A registered manger is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of law; as does the provider. The registered manager was present during the inspection.

Risk assessments had improved and provided care workers with guidance on how to mitigate people’s individual personal risks. Risks had been clearly identified and risk reduction measures were outlined.

People we spoke with told us they received their medicines safely and on time. The service was now keeping records of the assistance people received with their medicines or lists of medicines which each of these people took. These medicines records were being audited regularly to ensure that medicines were managed safely.

Care workers told us that they felt supported by the manager and other senior care workers at the agency and they were offered the opportunity to meet and discuss their work regularly through supervision. Care workers appraisals were taking place as well as training and development needs being offered for care workers.

New care workers completed an induction. The induction policy stipulated that all new care workers were expected to achieve the care certificate within twelve weeks of employment and this was being complied with.

The service operated safe staff recruitment procedures and ensured that all staff were suitable for the role before beginning any care work.

Procedures relating to safeguarding people from harm were in place. Care workers we spoke with understood what to do and who to report it to if people were at risk of harm. Care workers understood the systems in place to protect people who could not make decisions and were aware of the legal requirements outlined in the Mental Capacity Act 2005.

People were involved in planning their care and had regular reviews to gain their opinion on how things were. Care plans were person centred and included suitable information on how people wanted their care to be delivered as well as their likes and dislikes.

People and relatives were provided with information on how to make a complaint and their views were obtained and acted upon. People were treated with dignity and respect and trusted the care workers that supported them.

At this inspection we found that the previous breaches of Regulations 12 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been complied with. There were no further breaches of regulation identified. Please refer to the main body of this report for further details.

Inspection carried out on 31 May 2017

During a routine inspection

This inspection took place on 31 May, 1 and 2 June 2017. The provider was given 48 hours' notice because the location provides a domiciliary care service. At the time of the inspection Daryel Care provided domiciliary care and support for 91 people in their own home. The service worked primarily with older people living with dementia and a small number of people with physical impairments.

At our last inspection on 3 June 2015 the service was meeting the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

There was no registered manager in post, although the recently appointed manager had applied for registration with the Care Quality Commission (CQC). A registered manger is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of law; as does the provider. The registered manager was present during the inspection.

Risk assessments did not provide staff with guidance on how to mitigate people’s individual personal risks. Risks had been clearly identified although risk reduction measures were not outlined for all people when a moderate or substantial risk of trips or falls had been identified.

People we spoke with told us they received their medicines safely and on time. However, the service had not kept records of the assistance all relevant people received with medicines or lists of medicines each of these people took.

Staff supervision had been lacking from mid to late 2016 but had improved since. Staff told us that they felt supported by the new manager and knew that they were each being offered the opportunity to meet with them. Staff had been informed that this was to discuss their work and developments that were being introduced to the service. The provider could not, however, provide evidence of a small number of staff appraisals. The manager had identified this issue, had begun to take action, and had developed an action plan in order to address this in full.

The service could confirm that all staff had an induction which was described as being a “skills for care induction.” The induction policy had recently been amended to stipulate that all new staff were expected to achieve the care certificate within twelve weeks of employment. However, the service could not confirm who among the already employed care staff had already done so.

Although some auditing of the service was in place this could not be evidenced prior to the new manager coming into post, although they had identified areas of improvement that were required and had developed an action plan for making the improvements.

The service operated safe staff recruitment procedures and ensured that all staff were suitable for the role before beginning any care work.

Procedures relating to safeguarding people from harm were in place. Staff we spoke with understood what to do and who to report it to if people were at risk of harm. Staff had an understanding of the systems in place to protect people who could not make decisions and were aware of the legal requirements outlined in the Mental Capacity Act 2005.

Staff were provided with on-going regular training to support them in their role.

People were involved in planning their care and had regular reviews to gain their opinion on how things were. Staff knew people well and people and relatives felt that they were treated with dignity and respect. Care plans were person centred and included information on how people wanted their care to be delivered as well as their likes and dislikes.

People and relatives were provided with information on how to make a complaint and their views were obtained and acted upon. People were treated with dignity and respect and trusted the staff that supported them.

At this inspection we found breaches of Regulations 12 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the pr

Inspection carried out on 3 June 2015

During a routine inspection

We carried out an announced inspection on the 3 June 2015. This was first inspection of this service. Date

Daryel Care is a domiciliary Care providing personal care to five people with physical disabilities and dementia in their own homes.

The service has 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.

Staff had a good understanding of safeguarding adult’s procedures and keeping people safe. They knew how to recognise and report concerns appropriately and understood how to ‘whistle blow’.

Risk assessments and care plans for people using the service were effective. They were person centred and recorded all the required information. People and their relatives were involved in the care planning process.

Staff prompted people to take there medicines usually from blister packs and this was recorded on a Medicine Administration Record (MAR). We saw evidence that forms had been completed appropriately.

We saw there was adequate staff allocated to provide care and support for people on the rota. Recruitment practices ensured staff undertook relevant checks prior to employment to ensure they were suitable to work with the people using the service.

Staff had the knowledge and skills to enable them to support people effectively. They had undertaken induction training and other mandatory training to enable them to support people safely and effectively.

The registered manager and staff had a good understanding of the Mental Capacity Act 2005 (MCA) and how to support people who lacked the mental capacity in line with the principles of the act and particularly around decision making.

People were supported to access their GP and ongoing healthcare support including emergency medical services as appropriate.

Supervision was conducted regularly with care staff and was documented and retained in their files. Records were also kept on a new computer software system alongside training records and this allowed a skills match to ensure staff were only allocated to people they have been trained to support.

The staff team were caring and promoted positive caring relationships. People’s dignity and privacy was maintained. They were supported with personal care and other tasks and were encouraged to do as much for themselves as possible in order to maintain and increase their independence.

There were up-to-date and detailed care plans in place that had been devised from assessment information. They were reviewed every three months or when a circumstance around a person’s care and support needs had changed. We saw evidence that people who used the service and their relatives were involved in planning their care.

The registered manager monitored the service for quality by regularly speaking with people and their relatives and undertaking a combination of announced and unannounced spot checks. This included observing the standard of care provided and visiting people to obtain their feedback. The spot checks included reviewing the care records kept at the person’s home to ensure they were appropriately completed.