Archived: Diamond Care Company Ryedale

People’s experience of using this service: People were at increased risk of harm, because of how the service had been managed. Medicines had not been managed safely. The provider had not made sure staff had the training needed to provide people with safe care and support.

There had been a high turnover of staff. Problems with organisation of the rota and staffing levels had led to missed visits and people’s care being cancelled.

Management had not always responded appropriately to safeguarding concerns and other incidents including missed visits. This meant opportunities to learn lessons and improve the service were missed.

Staff were not adequately supported to provide person-centred care. Care plans and risk assessments did not always reflect people’s needs or have enough information to guide staff on how those needs should be met.

People were not supported to have maximum choice and control of their lives; the policies and systems in the service did not support this practice. Consent to care was not explored or documented when people lacked mental capacity.

People were supported by kind and caring staff, but the organisation and leadership of the service effected the overall quality of the care people received.

New directors had taken over management of the service since our last inspection. A manager was in post, and they had applied to become the registered manager. The new providers and manager had not adequately monitored the quality and safety of the service. People and staff raised concerns about poor communication, organisation and leadership. There were widespread issues and concerns about the quality and safety of the service provided.

For more details, please see the full report which is on the Care Quality Commission’s (CQC) website at www.cqc.org.uk.

Rating at last inspection: At the last inspection service was rated Good (report published 29 November 2017).

Why we inspected: This inspection was planned in response to concerns about the service provided.

Enforcement: We have identified breaches of regulation in relation to the safety of the care provided, how the provider safeguarded people from abuse and avoidable harm, the quality of person-centred care, recruitment practices, staff training and the governance of the service. Please see the action we have told the provider to take at the end of this report.

Follow up: We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will monitor the progress of the improvements working alongside the provider and local authority. We will return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

Special Measures: The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The service was run by two directors one of whom was the registered manager as well as the provider's nominated individual. 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. They were in the process of applying to become the registered manager at the time of our last inspection, and completed this process in December 2016.

We completed our comprehensive inspection of this service on 5 and 12 October 2017. The inspection was announced. The provider was given 48 hours’ notice of our inspection, because we needed to make sure someone would be in the location office when we visited. The inspection was completed by one inspector.

At our last inspection in August 2016, we rated the service ‘requires improvement’. We identified breaches of regulation relating to the need for consent, safe care and treatment, good governance and with regards to ensuring fit and proper persons were employed. We asked the provider to take action to make improvements. At this inspection, we found improvements had been made and this action has been completed. The provider was now compliant with these regulations.

People who used the service told us they felt safe with the care and support staff provided. We found appropriate recruitment checks were complete to ensure suitable staff were recruited and sufficient staff were deployed to meet people’s needs. People told us staff were reliable and punctual.

People were supported to take their prescribed medicines, but we made a recommendation about ensuring support provided with topical creams was recorded on people’s medication administration records.

Staff received training on how to recognise and respond to safeguarding concerns. Care plans and risk assessments were in place to support staff to provide safe and effective care. People provided positive feedback about staff’s knowledge and skills. Staff received training, supervision and appraisals to monitor their practice and support continued professional development.

Consent to care was sought and the registered manager was mindful of issues regarding people’s mental capacity. Staff supported people where necessary to ensure they ate and drank enough. Staff were flexible and proactive in ensuring people received the supported they needed to access healthcare services and to promote and maintain their health and well-being.

People told us staff were very kind, caring and attentive to their needs. People had developed positive caring relationships with the staff who visited them. Staff listened to people’s wishes and views and respected their decisions. Staff supported people to maintain their privacy and dignity.

Care plans provided person-centred information to support staff on how to best meet people’s needs. There were systems in place to ensure staff had up-to-date information where people’s needs changes. People told us they had not needed to complain, but knew who the registered manager was and told us they were very approachable, encouraged feedback and was responsive to any requests they had.

People consistently told us the service was well-led and provide very positive feedback about the care and support staff provided. The provider completed audits and there were systems in place to monitor the quality of the service.

Ryedale is a domiciliary care agency run by Diamond Care Company Limited and is registered to provide personal care to people living in their own homes. At the time of our inspection, the service was supporting 63 people, with approximately 45 people receiving support with the regulated activity ‘personal care’.

This was our first inspection of this service after it was newly registered in December 2014.

The registered provider is required to have a registered manager as a condition of registration for this service. 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. At the time of our inspection the service did not have a registered manager. However, a manager was in post and in the process of applying to become the service’s registered manager.

During the inspection, we found that recruitment checks were not robust. DBS checks were not consistently completed before new staff started work. This meant people who used the service could have been supported by staff unsuitable to work with vulnerable adults.

It was not always recorded that people had consented to the care and support provided. Clear and complete records were not in place in relation to people's capacity to make decisions.

Effective and robust quality assurance processes were not in place. We found that care files lacked sufficient information and detail. Issues and concerns found during our inspection had not been identified and addressed by the registered provider.

People who used the service were positive about the support provided by staff to take prescribed medicines. However, we identified that Medication Administration Records (MARs) were not always appropriately completed. Robust audits of MARs were not used to identify and address these concerns.

People who used the service and staff we spoke with were positive about the management of the service. However, the service did not have robust systems in place to monitor the quality of the care and support provided.

We found that people who used the service felt safe with the care and support provided by staff. However, risk assessments lacked detail about the level of risk and specific guidance to staff on how to safely support each person who used the service.

Staff received on-going training to support them to provide effective care and support. Staff told us they felt supported in their work and that advice and guidance was always available when needed.

People who used the service had developed positive caring relationships with the staff that supported them. People told us that staff treated them with dignity and respect and we could see that people were supported to make decisions and have choice and control over their care and support.

People who used the service provided positive feedback about the responsive staff. People were supported by regular staff who knew them well and knew how best to meet their needs.

The registered provider had a policy in place to manage and respond to complaints. Surveys were completed to gather people’s opinions about the service provided. People who used the service felt able to raise issues or concerns with the manager or staff and were confident that their comments would be listened to.

We found breaches of regulation in relation to managing risks, recruitment checks, consent to care and treatment and the governance of the service. You can see what action we told the registered provider to take at the back of the full version of this report.