We carried out a review of the data available to us about Dignicare on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Dignicare, you can give feedback on this service.
Dignicare is a domiciliary care service providing personal care to people in their own homes. At the time of our inspection there were 125 people using the service in the areas of Ilkley, Skipton and Bingley. 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
People told us they felt safe using the service and saw known staff when they were expecting to.
The provider had policies and practices in place to ensure people were protected from any potential abuse, and make sure any concerns were appropriately investigated and reported. Staff backgrounds were checked and assessments of any risks associated with people’s care and support were well assessed.
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.
Staff were trained and supported to provide effective care, and the provider worked well with other professionals to deliver the care people needed. People’s capacity to make decisions was well managed, and there was good support in place to make sure people had enough to eat and drink.
Dignicare provided a consistent standard of person-centred care. People’s diverse preferences and wishes were understood and respected.
There was a strong approach to understanding people’s needs and wishes for end of life care, and the provider was working with suitably qualified health professionals to further improve this aspect of their service provision.
There was a robust response to any concerns or complaints which enabled the provider to understand how they were able to maintain and exceed these standards even when something may have gone wrong. People sent in heartfelt compliments about the service and how it delivered good care.
People and staff got on well together, and people were able to be involved in planning and reviewing in their care. People received respectful care and their independence was promoted whenever possible.
There was a clear vision in the service, and the provider monitored quality well. People and staff were asked for their opinions, and the provider was candid when things went wrong.
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 25 April 2017)
Why we inspected
This was a planned inspection based on the previous rating.
Dignicare is a home care service providing personal care to people in Bradford, Craven and Airedale.
The service had a registered manager in place at the time of our inspection. 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 and associated Regulations about how the service is run. The registered manager was present throughout the inspection.
The service was following the guidance in people's risk assessments and care plans and the risk of unsafe care was reduced. People's records were up to date and indicated that care was being provided as detailed in people's assessments. The records had been updated to reflect changes in people's care needs.
Medicines were managed safely. We saw medicines were administered by trained staff according to people’s prescriptions.
People were safeguarded from abuse because the provider had relevant guidance in place and staff were knowledgeable about the reporting procedure.
The provider's arrangements for staff recruitment and deployment helped to make sure there were staff who were of suitable character to provide care for vulnerable people.
We saw sufficient staff were deployed to support people with their needs. When staff were sick or on leave, other staff were able to fill the gap.
Staff were not always supported in their role through supervision sessions and appraisals.
We recommend that the registered manager plans and attends formal supervision meetings and appraisal meetings with staff in line with their organisational policy.
Staff understood their roles and responsibilities in caring for people.
The staff team were trained in the provider’s mandatory training courses and this was monitored by the registered manager.
The principles and requirements of the Mental Capacity Act (2005) were being met. When required, best interest processes and capacity assessments had been completed.
People were supported by staff who knew them well. Staff were aware of promoting people's safety, whilst providing information to support people to make day-to-day decisions.
People received appropriate support to manage their meals and nutrition when required. This was done in a way that met with their needs and choices.
People's health needs were met. Referrals to external health professionals were made in a timely manner.
People and their relatives told us the care staff were caring and kind and that their privacy and dignity was maintained when personal care was provided.
People and their relatives were involved in the planning of their care and support. Care documentation was changing to a new electronic system. The new system was written in a detailed, person specific and person centred way.
Complaints were well managed. The leadership of the service was praised by relatives and communication systems were effective.
Systems to monitor the quality of the service were in place and they were effective in identifying areas for improvement. Shortfalls were resolved in a timely manner and the provider had obtained feedback about the quality of the service from people, their relatives and staff.
Dignicare is a home care service providing personal care to people in the Bradford and Bingley areas of West Yorkshire and the Craven area of North Yorkshire.
A registered manager was not 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.
.As a result of the January and March 2015 inspections the Commission intended using its enforcement powers to restrict admissions and to cancel the provider’s registration. The provider was clear that the use of enforcement action was unnecessary and the justification for such action would be tested before the courts. The Commission’s inspection in June 2015 (this report) assured the Commission that enforcement action was unnecessary and that the matter need not remain before the courts.
This inspection was a comprehensive inspection where we also checked whether Dignicare had made necessary improvements. It was an announced inspection. The provider was given 48 hours’ notice because the location provides a domiciliary care service and management were not always office based.
We found improvements had been made and the service was no longer in breach of regulation.
Medicines were appropriately managed. The service had improved its systems and records were now consistently in place which provided evidence people received their medicines as prescribed. Consideration had been given to ensuring people were supported with medicines at the correct times.
We found there were sufficient quantities of staff to ensure the service delivered appropriate care that met people’s needs although currently the provider and manager were regularly delivering care. They told us they hoped to deliver care in a standby capacity only once further staff were recruited. Safe recruitment procedures were in place.
Risks to people’s health and safety were appropriately managed. The service had ensured up-to-date risk assessments were in place detailing how staff should manage identified risks.
People and their relatives all told us that the service provided high quality care. Improvements had been made to the training system with all staff now up-to-date with mandatory training. Work had been undertaken by the service to ensure new staff received induction training in line with the new Care Certificate to ensure they attained recognised standards of competency.
People’s choices were promoted through care planning and people had been asked about their preferred call times. We found that improvements to documentation were required to ensure the service could evidence that decisions made on behalf of those without capacity were made in their best interests.
People and their relatives told us they were treated well by staff who delivered a personalised and caring service. They said staff were always friendly and treated them with dignity and respect.
At previous the inspection, we had concerns about people not receiving calls at times which met their individual needs. We found improvements had been made. The timeliness of calls now showed a greater level of consistency and amendments had been made to call times where we had previously expressed concern that they were not meeting people’s individual needs. People and their relatives all said they were all now happy with the times that care workers visited.
People’s needs were assessed in a range of areas to help staff deliver appropriate care. Personal support plans were all up-to-date and a robust system of review was in place to ensure any changes in people’s needs were identified and give people the chance to make any changes to their plans of care.
A range of quality checks were now in place to help ensure the service identified shortcomings and addressed them to reduce the risk to people. Audits of call times, documentation and checks on staff practice were regularly undertaken.
People were asked for their views via periodic surveys and these showed sentiment towards the service had improved and demonstrated a high level of satisfaction with the service. This was confirmed by our discussions with people and their relatives.
We carried out an announced comprehensive inspection of this service in January 2015. Breaches of regulations were found.
We undertook this focused inspection between 24 and 26 March 2015 to check if the provider now met legal requirements. This report only covers our findings in relation to those requirements identified at our January 2015 inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Dignicare on our website at www.cqc.org.uk.
A registered manager was not 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.’
We spoke with ten people who used the service and two relatives. Feedback from people was mainly positive about the quality of the service with a marked improvement since the January 2015 inspection. Eight people and one relative were generally satisfied with the care but two people and a relative were particularly unhappy with elements of call times. In seven of the 14 care records we looked at, we found inconsistencies in the call times which showed the service was not always meeting people’s individual needs and preferences. We found this was a result of poor planning of rotas and staff not always following rotas. The service had failed to completely address this issue which was first raised during inspection in September 2014 and raised again in the January 2015 inspection.
Some improvements had been made to medicine management processes, for example the introduction of Medication Administration Records (MAR’s) which recorded the individual medicines people took and ensuring a complete record of the medicines people were prescribed. However, we found the service had failed to assess the impact of call times on the administration of medicines for two people, which put them at risk of receiving their medicines in a way which reduced their efficacy. Further improvements were also required to ensure staff consistently documented the medication support they provided.
Improvements had been made to some aspects of the training system, for example staff were up-to-date with medicines and manual handling training. These were key concerns raised during the January 2015 inspection. However, we found a number of staff were overdue training updates in subjects such as Mental Capacity Act, Dementia and Infection Control. We were also concerned about two incidents involving a new member of staff which demonstrated that the induction process was not sufficiently robust.
Improvements in care plan documentation had taken place, which helped to demonstrate that people’s needs had been assessed in a number of areas and provided valuable information to enable staff to deliver effective care. Care plans were up-to-date and reviews had taken place involving people and their relatives.
Incidents were now being routinely recorded by the provider. However, we were concerned by four incidents which had occurred in March 2015 which included two missed calls, a medication error and the service not following a key procedure designed to protect people when staff did not receive a response on arriving at the person’s home. We also found detailed learning from incidents was not always robustly documented.
Audits had been introduced and there was evidence the provider was identifying some issues and addressing them with staff. However, further improvements were required to ensure the system was able to effectively identify and investigate concerns such as late calls or missing entries in care records.
Breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 were identified which corresponds to the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the back of the report.
We did not change the rating for any domains as further improvements were still required in all the domains we inspected. In order to improve the rating the provider is required to demonstrate consistent good practice over time. We will check this during our next planned Comprehensive inspection.
Dignicare provides a home care service to people living in Keighley, Bingley and Craven areas of Yorkshire. On the date of the inspection, 77 people were using the service.
A registered manager was not 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 and associated Regulations about how the service is run. A new manager had been recruited who was in the process of applying to become the registered manager of the service.
At the last inspection in September 2014, we found breaches of three regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, Regulation 9 (care and welfare), Regulation 10 (assessing the quality of the service provision) and Regulation 22 (staffing). During this inspection we found breaches continued in all of these regulations.
We found 13 people were not always receiving care in line with their assessed needs. Call times were often erratic and unpredictable from day to day. The consequence of this was people did not always receive assistance with key care tasks such as medication continence, mobility and food at times which ensured their safety and met their individual needs. Records showed that for eight people, there was a tendency for evening calls to take place earlier than planned and/or morning calls later than planned which meant these people were often left without support overnight for unacceptable amounts of time.
Staffing levels were still a concern and we judged the lack of staff was responsible for the erratic nature of call times. For example, rotas revealed that one person who should have received their morning visits at 8am were on the rota as late as 10.00am indicating there were not enough staff to meet people’s assessed needs. Following the inspection the provider told us it was withdrawing from providing care in the Keighley area as it did not have sufficient staff.
We found the quality assurance system had not improved and there was still a lack of process in place to assess and monitor the quality of the service. There was no system in place to promptly identify and measure the number of missed calls. Care records were not robustly audited, there were no audits of the medicine management system and we found significant risks in these areas.
Medicines were not safely managed. An accurate record was not kept of the medicines each person was supported with. This meant it could not be verified whether people received their medication as prescribed. Medication was not considered in the planning of visit times and we found erratic call times put one person who received support with time specific medication at risk.
People did not always receive consistent support at mealtimes with food and drink. The erratic nature of call times meant people received an inappropriately small gap between their morning call where breakfast was prepared and their lunchtime call. We identified five people whom this had effected, including observing one person given their breakfast and lunch during the same visit.
People’s capacity was not assessed in line with the requirements of the Mental Capacity Act (MCA). Where relatives had signed to consent to plans of care, capacity assessments had not been undertaken to determine whether the person had the capacity to make care decisions themselves.
People told us staff were caring, kind and friendly when they visited and most people cited staff attitude as the best thing about Dignicare. However, we found people were not informed if staff were going to be late and this caused some people upset and worry.
There was no effective system in place to record and action verbal complaints. 9 out of 16 people we telephoned told us they had “major concerns” about call times. One person told us a meeting with management had not materialised, another person told us the manager was rude to them and a third person told us that no action had been taken to address their complaint.
We found a number of breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we asked the provider to take at the back of the report.
' Is the service safe?
' Is the service effective?
' Is the service caring?
' Is the service responsive?
' Is the service well led?
This is a summary of what we found. The summary describes the records we looked at and what people who used the service and the staff told us.
Most of the people we spoke with told us they were generally satisfied with the care they received. For example one relative said 'Really pleased over the last few years, carers have gone that extra mile.' Another person said 'very friendly, generally very happy.' Most people we spoke with said the carers did a good job in carrying out the required tasks and were friendly and pleasant. However people and their relatives consistently said that the time that staff visited them was erratic and some people said this impacted on them and caused uncertainty and worry.
Is the service safe?
We found the service was not always safe as staffing levels were not adequate to ensure people received consistent care at a time that suited them. People and staff told us there were not enough staff to ensure the consistent delivery of timely care. We found occasions when both staff did not always attend to "double up calls" where two staff were needed to assist with people's mobility needs, putting people at risk.
Is the service effective?
The service was not always effective. People generally reported that staff generally did a good job, and completed the required tasks on each visit. However as call times were erratic, people did not receive effective care. People did not always receive care at the agreed time, for example saw several people were regularly assisted with their evening call at 18.00 instead of the agreed time of 21.00. We found instances of inappropriate gaps between visits, which meant there was a risk people's nutritional, continence and medication needs were not always met.
Is the service caring?
People and relatives reported that staff were caring and kind and treated them with dignity and respect. People said staff were friendly and provided them with companionship during visits.
Is the service responsive?
The service was not always responsive. People's needs were assessed, and these assessments were recorded so staff could follow their advice. Some documentation required updating as it did not reflect people's current needs. This created a risk that staff did not have access to the most up-to-date information about people's care needs.
Is the service well led?
The service was not consistently well led. There was no monitoring of whether staff attended visits or of their timeliness. We found this impacted on people, for example the manager was unaware of a missed call which we brought to their attention. Staff told us the manager tried their best but that the service was chaotically managed due to the workload of the manager.