Archived: Cultural Dignity 'n' Care Limited

Cultural Dignity and Care is a domiciliary care agency. 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. At the time of the inspection, eight people were receiving support with personal care.

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

The service had improved since our last inspection and were no longer in breach of regulation. However, we have made one recommendation in relation to quality assurance systems to ensure they are fully effective in identifying and acting on areas for improvement.

People told us they were happy with the service they received and felt safe with staff. Comments included; “Yes, what little concerns I’ve had she’s listened to so I have no complaints.” And “I’ve got a number. I’ve got a personal number of the lady in charge.”

Staff told us they felt well supported and able to talk to the manager if they had any concerns or issues. They told us they had been given good supplies of PPE during the pandemic and had been well supported throughout. Staff had been given training on how to use PPE. Staff had also received training in safeguarding, so they felt confident in raising any reporting issues. We saw that the registered manager worked with the safeguarding authority when required to investigate concerns. There were checks in place to ensure staff were safe and suitable to work.

Not everyone received support with their medicines, however where they did, a medicine administration record chart was used. These were checked by the registered manager. There was clear information in people’s care documentation about the medicines they were prescribed. Staff confirmed they had received training in how to administer medicines.

The registered manager was responsive to feedback from our inspection. We saw they worked with other agencies such as the local authority when necessary.

At out last inspection we found a breach of regulation 17, good governance. At this inspection we found improvements had been made. There was clear evidence in people’s files they were audited and people’s feedback was sought about the service they received. We have made a recommendation to improve quality assurance systems further in order to fully support continual development.

Rating at last inspection (and update)

The last rating for this service was requires improvement with one breach of regulation (published 20 January 2020). At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection to inspect the key questions of safe and well led. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions 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 cultural dignity and 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.

Cultural Dignity and Care is a Domiciliary Care agency. 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. At the time of our inspection there were seven people receiving support with personal care.

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

People using the service were happy with the care they received. At our last inspection we found that missed and late visits were causing people some concern. Since that time, we found that the registered manager had written to people using the service to acknowledge and apologise for the shortfalls in the service. There were systems in place to monitor that calls were taking place and people told us they were happy with the service they received. This reflected some progress made by the service since our last inspection. However, we were not yet assured that governance systems were robust enough to drive and sustain improvement. This was a breach of regulation.

The registered manager and staff knew people being supported very well and could tell us about their care needs. People and staff told us they felt able to raise issues or concerns with the registered manager and felt confident they would be addressed. However care plans didn’t fully reflect the person centred nature of the support being provided. In places, care plans were not detailed enough to ensure that people got the support they needed. We also found that risk assessments were not always completed in full so that there was a clear overall picture of the risks associated with a person’s care. These areas of the service required improvement.

Staff received training and support to help them perform their roles effectively. This included key topics such as safeguarding and mental capacity. Staff performance was monitored and checked through spot checks and supervision.

People told us, and we saw from their feedback to the provider that they were happy with their care and support. One relative described it as “brilliant” and they were “very impressed”.

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.

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 19 April 2019) when two breaches of regulation were found. This was a focused inspection and did not look at all aspects of the service provided. At the last comprehensive inspection (published September 2018) we also found breaches of regulation. We asked the provider to submit action plans in relation to these breaches and these were checked at this inspection.

This service has been rated requires improvement for the last three consecutive comprehensive inspections.

At this inspection enough improvement had not been made and the provider was still in breach of regulations.

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People’s experience of using this service:

¿ People continued to feel happy with the care and support they received.

¿ Relatives of people also said staff were friendly and cared for family members properly and in a caring and positive way.

¿ People had no concerns about safety or well-being when with the staff.

¿ People received flexible care and support from a small team.

¿There were enough staff to keep people safe. Risks to people were managed in ways that kept them as safe as possible. Guidelines were in place to help staff when supporting people.

¿ For three staff there were significant gaps in staff recruitment checks and there was no assurance these staff were safe to work with people who were vulnerable.

¿The provider failed to have in place robust and effective systems and processes to ensure the quality and safety of service.

Rating at last inspection: The service was rated requires improvement at our last inspection in July 2018.

Why we inspected: We inspected in response to an allegation of some missed care visits, and an allegation that some staff did not have the required employment checks carried out against them. These checks are to help ensure staff are safe to work with people.

Enforcement You can see what action we have taken at the end of the report.

Follow up: We will be following up and monitoring the service. This will be published when our processes are complete.

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

Cultural Dignity ‘n’ Care is a domiciliary care agency registered to provide the regulated activity of personal care. They provided care and support to people in their own homes. At the time of the inspection the service was provided to five older people.

After our last Inspection in October 2017 we asked the provider to complete an improvement action plan . This was because we had identified shortfalls in aspects of all our key questions. Is the service Safe? Is it Effective? Is it Caring? Is it Responsive? and is it Well Led?

At that inspection we had found that staff recruitment procedures were not robust enough. Pre-employment checks had not been completed satisfactorily in all cases. The management of medicines and the support provided to people with medicines had not been fully safe.

Staff induction training and the on-going mandatory training for all staff required improvement. The feedback we had received from relatives we spoke with during the inspection did not evidence that they were always happy with the service their family member received. We also found that care plans did not provide the care staff with the information they needed to be able to support people with the tasks they needed. The service had not been well led as the views and experiences of people using the service had been gathered but the feedback had not been acted upon.

At this inspection we found that some actions had been taken to address some of the shortfalls identified at our last inspection. The management of medicines and the support for those people who needed assistance, was safe and clearer records were now maintained.

We found that staff recruitment procedures were more robust and safer. Pre-employment checks were being completed.

Staff induction training and on-going mandatory training for all staff had been completed and was up to date.

The feedback we had received from relatives we spoke with during this inspection showed overall they were happy with the service.

The service continued to require improvement for the key question: is the service Well Led? This was because quality auditing systems were not fully effective and did not always pick up shortfalls in the service. We saw clear evidence that the provider acted on the views and experiences of people using the service.

There was a registered manager for the service, they were also the provider. 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.

The service was not fully safe. This was because there were occasions when visits did not take place or were late. This impacted on the safety and wellbeing of the people concerned. The provider was in the process of reviewing how staff were deployed. This was to ensure there were no missed or late visits in the future.

The service had improved and was effective. A new system of staff supervision was now being used to check and monitor staff performance and development.

People and relatives praised the caring nature of all the staff they saw. Relatives told us all the staff were very kind to their family members.

The service people received was responsive. This was because care plans provided staff with the information they needed to support people with the tasks and care they needed. Feedback from relatives and people was clear that staff were flexible and responsive to people's needs.

There was evidence that the provider acted on feedback about the service although this was not always recorded.

We found two breaches 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 this report.

The inspection was announced. We gave the registered provider 48 hours notice of the inspection. We did this to ensure key staff were available for the inspection. The registered provider (who was currently also the registered manager for the service) chose not to be present when we visited the offices, but said a newly appointed manager who had been in post for two weeks would be present. At the time of the inspection the service was providing personal care to seven people and supporting four people with domestic support. The service employed up to 16 care staff but not all were actively working at the time of the inspection.

There was a registered manager in post at the service. A registered manager 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 the law; as does the provider. 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.

The service people received was not safe in all areas. We found that staff recruitment procedures were not robust enough. Pre-employment checks had not been completed satisfactorily in all cases. Where criminal offences had been disclosed on one staff members DBS certificate no risk assessments had been undertaken to ensure people using the service were not at risk. The management of medicines and the support provided to those people who needed assistance, did not follow safe working procedures and clear records were not maintained.

The service people received was not effective in all areas. Staff induction training and the on-going mandatory training for all staff required improvement. Training records were not adequate and did not provide a clear picture of what training care staff had received. Mandatory training did not include Mental Capacity Act 2005 or infection control training.

The feedback we received from relatives we spoke with during the inspection did not evidence that they were always happy with the service their family member received. On the whole staff were able to build good working relationships with the people they supported but reasons for any changes to work programmes were not always communicated. We were given examples were people/relatives were not treated respectfully or in a professional manner. Details are in the main body of the report.

The service people received was not responsive in all areas. This was because care planning arrangements were insufficient and care plans did not provide the care staff with the information they needed to be able to support people with the tasks they needed.

The service was not well led and this required improvement. There were examples where the views and experiences of people using the service had been gathered but the feedback had not been acted upon. This meant the service was missing the opportunity to evaluate the service and make improvements.

Those staff we spoke with and the manager understood their role in safeguarding people from harm and knew what to do if they witnessed or were told about any bad practice. Risks to people’s health and welfare were assessed but management plans to reduce or eliminate any risk need to be kept up to date. There were sufficient care staff employed to meet the number of people being supported at the time of the inspection.

We found five breaches of the Health & 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.