Archived: Diamond Care

The service had its office in Polegate and covered Eastbourne and the surrounding area.

The service was owned and operated by an individual who was both the registered provider and the registered manager. 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. In this report when we speak about the registered provider and the registered manager we refer to them as being, 'the registered person'.

At the last comprehensive inspection on 17 January 2017 the overall rating of the service was, ‘Requires Improvement’. We found that there were five beaches of the regulations. This was because there were shortfalls in the arrangements that had been made to notify us about two occasions when there had been a concern that people had not been suitably safeguarded from the risk of abuse. There were also shortfalls in the assistance some care staff had provided to people to enable them to safely manage their medicines. Another concern referred to omissions in the way the registered person had obtained people’s consent to parts of the care they received. We also identified that some care staff had not received all of the training that the registered person said they needed. This shortfall had increase the risk of care staff not having all of the knowledge and skills they needed. In addition to these shortfalls, we noted that the registered person had not consistently assessed, monitored and evaluated the operation of the service to ensure that people reliably received safe care and treatment.

We told the registered person to take action to make improvements to address each of our concerns. After our inspection the registered person wrote to us and said that the necessary changes had been made.

At the present inspection the overall rating of the service was, ‘Good’. We found that most of the individual concerns we had previously raised had been addressed. We noted that the registered person had adopted new systems and processes that were designed to ensure that the occurrence of significant incidents were notified to us in the correct way. We also noted that care staff were supporting people to safely manage their medicines and that there were suitable arrangements to obtain people’s consent to the care they received.

Although records showed that care staff had been given additional training in relation to key parts of their work, there were still examples of individual care staff who had not received all of the training planned for them. Nevertheless, we found that in practice care staff had the knowledge and skills they needed to care for people in the right way.

Lastly, documents and records showed that the registered person had further developed the quality checks they used to assess, monitor and evaluate the operation of the service.

Our other findings were as follows. People had been safeguarded from situations in which there was the risk of them experiencing abuse. People received safe care and treatment. This included being helped to avoid preventable accidents and being supported to manage medicines safely. There were enough care staff who were organised in the right way to complete care calls as planned. Background checks had been completed before new care staff were appointed and lessons had been learned when things had gone wrong.

Suitable arrangements were in place to assess people’s needs and choices so that care was provided to achieve effective outcomes. This included providing people with the reassurance they needed if they became distressed. People were helped to eat and drink enough to maintain a balanced diet. Also, suitable arrangements had been made to help people receive coordinated care when they moved between different services.

People had been assisted to access healthcare services and care staff had helped people to ensure that their accommodation met their needs and wishes.

People were treated with kindness and compassion. Also, care staff respected people’s privacy and gave people emotional support when it was needed. Furthermore, people had been supported to express their views and be actively involved in making decisions about their care as far as possible. This included them having access to lay advocates if necessary. Confidential information was kept private.

Although people received responsive care that met their needs for assistance, information was not always presented to them in an accessible manner. However, people had been offered the support they needed to pursue their hobbies and interests and to engage in social activities. Furthermore, suitable arrangements had been made to promote equality and diversity. In addition, there were suitable arrangements for managing complaints and suitable steps had been made to support people at the end of their life to have a comfortable, dignified and pain-free death.

There was a registered manager who had taken a number of steps to enable the service to learn, innovate and ensure its sustainability so that it met regulatory requirements. Most care staff considered there to be an inclusive culture in the service and people who used the service had been consulted about its development. Furthermore, care staff had been helped to understand their responsibilities to develop good team work and to speak out if they had any concerns. In addition, the registered person was actively working in partnership with other agencies to support the development of joined-up care.

Diamond Care is a domiciliary care service providing support to 33 people living in their own homes who are in receipt of the regulated activity of personal care. The service supports older people and people who are living with dementia or other conditions, to enable them to continue living in their own homes. Some people privately funded their care whilst others had their care funded by the local authority. The service is based in Polegate, East Sussex. .

The service was the only service owned by the provider, who was also the manager. A registered provider is a person who has registered with the Care Quality Commission to manage the service. 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.

People were asked their consent and were involved in day-to-day decisions. However, practice and the lack of records confirmed that there was a lack of understanding in relation to the practical application of the Mental Capacity Act 2005 (MCA). There was a lack of mental capacity assessments and best interests decisions, in relation to specific decisions for people who lacked capacity. Decisions regarding one person’s care had been made by people who did not have the legal authority to do so.

Staff told us that they were supported within their roles and were able to approach the provider if they needed any assistance. Some staff had diplomas in health and social care. However, there were concerns with regard to staffs’ access to on-going, formal training. The provider had not ensured that staff received appropriate training to enable them to have the relevant knowledge and skills to support people effectively.

There was a lack of quality assurance systems to enable the provider to have sufficient oversight and awareness of all of the systems and processes within the service. There was a lack of notifications sent to CQC. This is part of the provider’s responsibilities. By not being informed of these incidents CQC were potentially unable to ensure that the appropriate actions had been taken to ensure that people were safe. Organisational policies had not been updated to reflect current good practice guidance or legislation.

People were protected from harm and abuse as they were supported by staff who knew what to do if they had concerns about peoples’ safety. Risks had been assessed and managed to ensure peoples’ safety. People told us that they felt safe, one person told us, “Safety? No concerns whatsoever”. There were sufficient staff to meet peoples’ needs and people told us that they received their calls on time and that they were always informed if staff were going to be late. People had received their medicines on time and told us they were happy with the support that they received. However, staff did not have access to training in relation to the administration of medicines.

People were cared for by staff that showed compassion and kindness. Comments from people included, “They are wonderful”, “They do everything you could ask for, I don’t need anything else” and “Good as gold”. Peoples’ care was personalised to them and they were involved in the development of their care plans. Peoples’ health needs were assessed and met and they had access to medicines and healthcare professionals when required.

Staff worked in accordance with peoples’ wishes and people were treated with respect and dignity. It was apparent that staff knew peoples’ needs and preferences well. Positive relationships had developed amongst people and staff. One person told us, “Very good, they have been coming such a long time we are like old friends”. People, when required, received appropriate support with their nutrition and told us that they were able to choose what food they had to eat.

The provider welcomed feedback and people and relatives were aware of the procedures they needed to follow to make a comment or complaint. People, relatives and staff were complimentary about the leadership and management of the service. One member of staff told us, “She is a really good manager, if there are any problems you can go and speak to her and she does help”. Another member of staff told us, “They make it inviting to come into the office, if I’ve got a problem I know who to come to”.

We found several breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the back of the full version of the report.

The people we spoke with told us they were happy with the care they had received and with the management and home carers. One person who used the service told us, 'I receive marvellous care in my own home. I'm very pleased with everybody who comes to me." Another person who used the service told us, "One carer stayed with me for over an hour once when I was feeling a little under the weather. Nothing's too much trouble." Staff we spoke with had a good understanding of the support needs of the people who used the service.

Staff we spoke with confirmed that they felt supported and had received relevant training, which included the safeguarding of vulnerable adults. Staff told us that they understood the signs of abuse and were aware of how to raise concerns. One care worker told us "I am alert to the signs of abuse. I wouldn't hesitate to respond when it was needed".

People had been involved in making decisions about their care and treatment. During our inspection we found that people's needs were comprehensively assessed before and during the delivery of care.

Diamond Care had effective systems in place to monitor and assess the quality of the service.