We carried out a review of the data available to us about Destiny Intergrated Care Limited 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 Destiny Intergrated Care Limited, you can give feedback on this service.
Destiny Integrated Care Limited is a domiciliary care agency providing personal care to people living in their own homes or flats. At the time of inspection, the service provided support to 40 people, of which 21 were in receipt of personal care.
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 spoke positively about the service they received and told us they would recommend the service to others. One person told us, “I can’t fault the care. The care is so good.” Another person said, “When they first came, I wasn’t sure, but now I know them they are brilliant.”
People were supported in a safe manner. Care plans and risk assessments provided clear guidance and direction for staff to reduce risk. People and relatives told us they had been involved in the care plan and review process.
Staff were familiar with people's care and support requirements and acted in a timely manner requesting appropriate professional support where they identified changes in needs.
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 told us they felt the staff cared for them in a caring and thoughtful manner and felt involved in all aspects of their care. Staff spoke with passion and enthusiasm about their role and those they supported.
The registered manager demonstrated the values of the service and supported staff in the delivery of care. Staff felt supported and valued by the registered manager and found the manager to be approachable at all times.
Quality assurance audits supported driving change and service improvements.
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 requires improvement (published 16 December 2019).
Why we inspected
This was a planned inspection based on the previous rating.
The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection.
The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Destiny Integrated Care Limited 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.
Destiny Intergrated Care Limited is a domiciliary care agency providing personal care to 25 people at the time of the inspection. 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 mainly received very good care from staff they knew well and had a regular team of staff. They said most care visits were on time and they had not experienced missed calls. They were treated with respect and their dignity was upheld.
However, while people said most care visits were on time and this had improved, people also told us on days the regular staff were off, times of care visits varied greatly. They said this also had an impact on the quality of care received and people were sometimes rushed and care was not as thorough.
People told us they did feel safe with staff who knew them well but not always with staff who were not regular. People were safe as they were supported by staff who were well trained and had a good understanding of different forms of abuse and how to keep people safe.
People’s care needs were regularly reviewed and care practices assessed by the registered manager to ensure the guidance for staff was accurate to enable them to support people well. People and their relatives felt involved in this process.
People and relatives were also asked for their views of the service generally. However, people told us they did not receive feedback on the outcomes and actions of those surveys.
People told us they received their medicines safely and staff were aware of deterioration in any health conditions and supported them to access the relevant health professionals such as district nurses or doctors.
People were happy to raise concerns if needed and agreed that the registered manager acted quickly to resolve any complaints. Staff were also confident to raise concerns with both the managers and external bodies such as local authority.
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’s needs had been assessed and this was used to create detailed support plans and risk assessments that was mindful of people’s personal likes, dislikes and preferences. Plans also took into account how peoples specific health conditions might impact their ability to complete daily tasks and fluctuating independence.
We have made a recommendation about the management of some rotas and scheduling care visit times. We have also made a recommendation about ensuring staff follow agreed plans of care in-line with peoples assessed needs and preferences at all times.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was inadequate (published 19 June 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.
This service has been in Special Measures since 19 June 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.
Why we inspected
This was a planned inspection based on the previous rating.
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.
People and their relatives told us that care visits were often late, and some were missed entirely. People said that they found it difficult to get a response from the office when they phoned to find out where the carer was. Some people said they had to rely on their relative to help them instead of the carer from the service.
The management team did not have adequate systems in place to ensure that people received care visits at times that they were happy with. Some people lived alone and could not get help if they needed it. The management team did not know there was an issue with this until we told them what we had found during this inspection.
As a result of what we found, the management team then acted to review staff rotas, and they advised staff to call people if they were running late. They also purchased an electronic system to help them monitor if people were getting their care visits at the correct times and for the right duration. Although this response was positive, systems should have been in place to identify these failures.
People did not have completed risk assessments in place, with plans to show staff what they needed to do to keep people safe. We had been told about two potential safeguarding events where people may have come to harm. The management team had not followed safe practices in one of these cases. In the other the member of staff had not responded appropriately. Staff were not clear about how to protect people from potential harm.
Staff competency was being checked but these were not effective. The management team were not checking if staff were supporting people safely. Staff received training, but the management team were not checking if this training was effective. We found some shortfalls in staff skills and knowledge which the management team were not aware of. Staff did not have completed recruitment checks.
The management team were not assessing people’s abilities to make their own decisions People’s permission to share sensitive information with other agencies such as social services was not obtained
Some people and their relatives spoke well of the staff who supported them. However, most people spoke passively, finding staff to provide adequate care, but not finding staff overly kind or thoughtful. Some people did not find staff friendly.
People told us that staff promoted their dignity and offered them choices with their daily needs.
People did not have holistic care assessments and reviews in place to check that they were having a positive experience from the service. The management team were therefore not identifying any shortfalls to the service.
Lessons were not being leant when things went wrong to try and prevent them from happening again. Audits and systems to check the quality of the service were not effective.
There were multiple breaches of the Health and Social Care Act 2008.
Why we inspected: This was a scheduled inspection based on the services previous rating.
Rating at last inspection: At the last inspection the service was rated Good (07 October 2016). At this inspection we found the service is now rated as Inadequate.
Follow up: 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 in 6 months to check for significant improvements.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Destiny Integrated Care provides personal care to people who live in their own homes.
At the time of our inspection the provider confirmed they were providing personal care to 12 people. Prior to this inspection we had received concerns in relation to the care people were receiving and the management of the service. We therefore needed to ensure that people's care was being delivered in line with the fundamental standards.
There was a registered manager in post. 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.
Medication administration was not always recorded accurately. Medication Administration Records (MAR) were not being used for the application of topical medicines. Topical medication was being administered as prescribed, but this information was being recorded by staff within a person’s daily notes, and not on a MAR. This meant that the correct recording procedures were not being followed. People told us they were happy with the way in which they were supported with medicines, and we saw that MARS were in use for all other medication being administered.
Staff had a good understanding of abuse and the safeguarding procedures that should be followed to report abuse and were confident in using them. There were risk assessments in place to guide staff to support people safely within their homes, and enable people to be as independent as possible.
We saw that there was a sufficient amount of staff employed within the service which meant that staffing levels were adequate to meet people's current needs.
The staff recruitment procedures ensured that appropriate pre-employment checks were carried out to ensure only suitable staff worked at the service.
Staff all confirmed that they had a thorough induction into the service and that on-going training was provided to ensure they had the skills, knowledge and support they needed to perform their roles.
Staff told us they were well supported by the registered manager and senior team, and had regular one to one time and the opportunity to discuss anything of concern with their manager.
People's consent was gained before any care was provided and the requirements of the Mental Capacity Act 2005 were met.
People were able to choose the food and drink they wanted and staff supported people with this when required.
People were able to have support to access health appointments if required.
Staff treated people with kindness, dignity and respect and spent time getting to know them and their specific needs and wishes.
People were involved in their own care planning and were able to contribute to the way in which they were supported.
The service had a complaints procedure in place to ensure that people and their families were able to provide feedback about their care and to help the service make improvements where required.The people we spoke with knew how to use it.
Quality monitoring systems and processes were used effectively to drive future improvement and identify where action was needed