Archived: Dignity Care (York) Limited

Updated 10 August 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection took place on the Tuesday 28 June 2016 and was announced. The registered provider was given 48 hours' notice because the location provides a domiciliary care service and we needed to be sure that someone would be in.

One adult social care inspector undertook the inspection. Before this inspection, we reviewed the information we held about the service, such as notifications we had received from the registered provider. The registered provider submitted a provider information return (PIR) prior to the inspection. This is a form that asks the registered provider to give some key information about the service, what the service does well and improvements they plan to make.

During the inspection, we spent time with three people receiving services in their own homes. We spoke with the registered manager, the manager and a care supervisor. We looked at records, which related to people's individual care; this included the care planning documentation for four people. We also looked at three care workers' recruitment records, care worker rotas, training records, audits, policies and procedures, records of meetings and other records associated with running a community care service.

Following the inspection we spoke with three care workers and requested copies of additional training records from the registered manager.

Updated 10 August 2016

We undertook an announced comprehensive inspection on Tuesday 28 June 2016. We gave the provider 48 hours' notice of our intention to undertake an inspection. This was because the organisation provides a domiciliary care service and we needed to be sure that someone would be at the agency office that could assist us with the inspection.

This service was registered by CQC on 12 June 2011. A previous inspection had been completed on 06 January 2014 and the provider was found to be compliant in the areas we inspected at that time.

Dignity Care (York) Limited is registered to provide personal care for Older People and people with a Physical Disability. At the time of our inspection, 27 people received a personal care service. The service provides domiciliary care and support services from the registered office location, on the outskirts of the City of York.

The registered provider is required to have a registered manager in post and on the day of this inspection, there was a registered manager registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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.

Care workers were able to discuss signs of abuse and how to report their concerns. However, management of training in safeguarding for care workers was ineffective and not robustly managed or recorded. Safeguarding policies and procedures were available for care workers to read however, they required updating.

Other Quality Assurance checks included an annual survey sent to service users. We saw this was not analysed and there was no evidence of how the service used feedback from Quality Assurance to continually evaluate and improve the service provided or where this was recorded. We concluded that although there were some Quality Assurance checks in place these were not robustly implemented across the service to ensure they could be used to drive improvement.

The registered provider did not have a dedicated file or procedure to record and manage accidents and incidents. This meant that the registered provider could not demonstrate how they learned from such events to minimise re-occurrence.

The registered provider had a file with compliments and they told us these were fed back to the care workers. This showed that the service actively sought peoples feedback however, it was not evident that complaints would be addressed with actions and outcomes recorded.

The registered provider had a training record to manage training for care workers. However, at the time of our inspection the registered manager told us and we saw that the training record was not in use and had not been updated. Procedures in place to manage training for care workers including the induction programme were ineffective and it was not clear if they had the appropriate skills to undertake their role. We spoke with care workers who told us they did not have regular documented supervisions or reviews. We saw these were not recorded and it was not clear how their capability was monitored by the registered provider. The registered manager told us they did not have regular staff meetings and that information was shared with care workers using weekly emails and text messages.

Care plans we looked at contained up-to-date risk assessments for their homes, environments and for the individuals and these were reviewed and updated. This meant the registered provider had procedures in place to recognise the importance of risk management to help care workers deliver care and support in a safe way to people.

The registered provider recorded appropriate recruitment checks and these were completed before they worked alone with people. This helped the registered provider to ensure people employed were of suitable character to work with vulnerable people.

People received their medication in a safe way and care workers had received training and followed the policies and procedures that were in place for the safe management of medications.

The registered provider was working under the guidelines of the Mental Capacity Act 2005 and people were supported to make informed decisions wherever possible.

People told us and we saw they received support and care from care workers who understood the importance of treating them with dignity and respect. Care workers told us how they would maintain and respect people's confidentiality and would only share information they discussed with people where it was appropriate to do so with others directly involved with the persons care.

We saw care workers were kind, efficient and caring when they addressed people how they wanted to be. People confirmed that care workers cared for them and that they felt the care they received was personal and not just task related. Care workers told us that when required to do so they would spend additional time with people to make sure they were ok before they left.

Care plans were available in the main office and in people’s homes. These were reviewed, updated, and included people’s preferences. Care workers told us that care plans provided sufficient detailed information to enable them to provide care and support that met their current needs. Care workers also told us and people confirmed they were involved in their care planning and reviews and that their wishes were respected. We saw care plans were signed by people to demonstrate they had understood and agreed to the content.

There was a clear management structure and care workers employed by the registered provider understood their roles and responsibilities. Care workers and people who received a service spoke positively about management and their involvement with peoples care and support.

The registered provider had policies and procedures in place and these were available in the ‘Staff Handbook’ that was issued to all care workers. We saw the registered provider completed Quality Assurance audits on Medication Administration Records and care workers confirmed there was a process in place to deal with any concerns raised as a result.

We found three breaches in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to the staff training, supervisions and quality assurances procedures. You can see what action we told the provider to take at the back of the full version of this report.