Daryel Care

Daryel Care is a domiciliary care agency providing care and support to adults living in their own homes in the London Boroughs of Islington and Barnet. At the time of our inspection, there were 45 people using the service. Some people were receiving short term care packages as part of their rehabilitation after an illness, fall or hospital admission. Other people received care on a long-term basis. Some people were living with the experience of dementia and/or other mental health needs.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

People’s experience of using this service and what we found

We received some feedback about instances of staff lateness and timekeeping. We have made a recommendation about monitoring staff deployment.

People told us they felt safe using the service. Where risks were identified, plans were in place to manage these risks safely.

Medicines were managed in a safe way and people received their medicines as prescribed.

Staff followed appropriate infection control practices. Accident and incidents were recorded and acted upon. Any lessons learnt were used as opportunities to improve the quality of service.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

There were procedures in place to respond to complaints. The provider had investigated and responded promptly to any concerns received.

Auditing and quality assurance processes were in place. However, these were not sufficiently robust as they did not identify issues we found.

The provider worked in partnership with healthcare services and professionals to plan and deliver an effective service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 28 November 2020).

Why we inspected

The inspection was prompted in part due to concerns received about safeguardings and complaints about the service. A decision was made for us to inspect and examine those risks.

We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe, responsive and well-led sections of this full report.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Daryel Care on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

About the service

Daryel Care is a domiciliary care agency in North London providing care and support to adults living in their own homes in the London Boroughs of Islington, Haringey and Barnet. The number of people using the service varied from week to week. At the time of our inspection, there were 100 people using the service. Some people were receiving short term care packages as part of their rehabilitation after an illness, fall or hospital admission. Other people received care on a long-term basis. Some people were living with the experience of dementia and/or other mental health needs.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

People’s experience of using this service and what we found

The provider had a range of different audits and checks on the service. Medicines audits had not always identified discrepancies in recording. We discussed this with the registered manager. We found no indication people had not received their medicines as prescribed.

Records of care provided included terminology and language which did not always show respect for people being supported. We discussed this with the registered manager who felt this was partly due to the written English language skills of staff. People using the service told us they felt the staff showed them respect, and this issue appeared to be related to records rather than the care provided.

People using the service were happy with the care and support they received. They liked their regular care workers and felt their needs were met. One person said, ''The best thing is having someone every day to chat to otherwise I would just be on my own. I can tell they are interested in what I am saying. I would recommend them and tell people to 'go for it'. They are very good, helpful, attend to your needs and your embarrassment soon disappears.'' Another person told us, ''I cannot praise the agency enough, they are always there at the end of a phone. I cannot praise the carers highly enough.''

People received medicines as prescribed and in a safe way. The risks to their safety and well-being had been assessed and planned for. There were systems for reporting and investigating abuse and learning from when things went wrong.

There were enough staff to support people and meet their needs. The staff arrived on time for care visits and stayed the agreed length of time. The staff received training and support so they could carry out their jobs effectively and understand their responsibilities. There were procedures to help make sure only suitable staff were recruited.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were able to make decisions about their care and support. They told us staff respected their choices and listened to them. Care plans and risk assessments were regularly reviewed and updated. Where the agency or person had identified changes in their needs, the agency liaised with the commissioning authorities so that their care package was reviewed, and more care was provided when needed. The agency staff worked with other organisations and health care professionals to help make sure people's needs were being met, for example, ensuring people being cared for at the end of their lives were comfortable and pain free.

The registered manager was suitably qualified and experienced. There were effective systems to manage the service and make sure improvements were made when needed. People using the service and other stakeholders were able to give their feedback about the service and make complaints. The agency listened to these and had developed the service to reflect people's feedback and changes they wanted.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (published 28 September 2018).

Why we inspected

This was a planned pilot virtual inspection. The report was created as part of a pilot which looked at new and innovative ways of fulfilling CQC’s regulatory obligations and responding to risk in light of the COVID-19 pandemic. This was conducted with the consent of the provider. Unless the report says otherwise, we obtained the information in it without visiting the provider.

The pilot inspection considered the key questions of safe and well-led and provided a rating for those key questions. Only parts of the effective, caring and responsive key questions were considered, and therefore the ratings for these key questions are those awarded at the last inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Daryel Care on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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.

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 provider to take at the back of the full version of the report.