Diversity Health and Social Care Bow Branch

Updated 28 September 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2014.

Inspection team

This inspection was carried out by 2 inspectors.

Diversity Health and Social Care Limited is a domiciliary care agency. It provides personal care to people living in their own homes.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was no registered manager in post, although the provider had appointed a new manager who was due to apply for registration with the Care Quality Commission (“CQC”).

Notice of inspection

This inspection was unannounced although we announced when we would be returning on the second day.

Inspection activity started on 14 June 2023 and ended on 31 July 2023. We requested a range of documents that were sent to us by the provider between 14 June 2023 and ended on 31 July 2023. We visited the office location on 14 and 16 June 2023 to see the acting manager and to review further records related to the service. We made telephone calls to people, their relatives and care staff between 16 June 2023 and 20 July 2023.

What we did before the inspection

The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We reviewed information we had received about the service since the last inspection. This included any significant incidents that occurred at the service as well as concerns that had been reported to us anonymously.

We reviewed information from the local authority commissioning team and reviewed the previous inspection report. We used all this information to plan our inspection.

During the inspection

We reviewed a range of records related to 15 people’s care and support. This included people’s care plans, risk assessments, medicines records and 5 staff files in relation to recruitment and training. We reviewed records related to the management of the service, which included safeguarding incidents, quality assurance records, minutes of staff meetings and a range of policies and procedures.

We communicated with 20 staff members. This included the acting manager, a senior member of staff, office staff including the deputy manager and 15 care workers. We spoke with 15 people and 9 relatives.

We continued to seek clarification from the provider to validate evidence found after the inspection. We looked at further quality assurance records and correspondence with a range of professionals related to people’s care.

We provided feedback to the registered manager via email on 21 July 2023.

Updated 28 September 2023

Diversity Health and Social Care Limited is a domiciliary care agency. It provides personal care to people living in their own homes. The service provides personal care to older people, some of whom have dementia. At the time of our inspection there were 336 people using the service.

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

Full pre- employment checks were not always conducted before people were hired to work, as we found not all care workers had full employment histories on their file. The provider was not consistently promoting a positive culture within the service as people did not find office staff helpful in relation to their complaints about the timeliness of care calls.

The provider safely managed people’s medicines and were auditing people’s medicines administration records. The provider was also conducting monitoring calls with people to get feedback on their care but were also unable to demonstrate the frequency of these.

The provider was working within the principles of the MCA, had effective systems and processes in place to safeguard people from the risk of abuse and safely managed risks to people’s health and safety. There were clear systems in place to minimise and control the spread of infection and lessons were learned when things went wrong.

The provider used an electronic system to monitor care calls, which was constantly reviewed. They were aware of concerns relating to timeliness and lack of care worker consistency and had taken action in respect of specific complaints they had received.

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 requires improvement (published 23 May 2023) and there was a breach of regulations. 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 the provider remained in breach of regulations.

At our last inspection we made recommendations in relation to the safe management of people’s medicines and consent. At this inspection, we found the provider had acted on those recommendations.

Why we inspected

The inspection was prompted due to concerns we received about the safety and quality of the service. A decision was made for us to inspect and examine those risks.

Enforcement and recommendations

We have found a breach in relation to staffing.

Please see the action we have told the provider to take at the end of the full version of this report.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.