Diversity Health and Social Care Limited

This service is a domiciliary care agency and is based in the London Borough of Barking & Dagenham. The service provides personal care to adults in their own homes. 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, the service provided personal care to two people.

People’s experience of using this service

Since our last inspection on 24 September 2018, improvements had been made on risk assessments, pre-employment checks, training and quality assurance processes. Care plans contained suitable and sufficient risk assessments to effectively manage risks and keep people safe. Pre-employment checks had been carried out to ensure staff were suitable to support people. Staff had been trained to perform their roles effectively. Audits were being carried out to ensure people always received safe, high quality care.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. People's ability to communicate was recorded, however, information did not include how to communicate with people effectively based on their communication ability. We made a recommendation in this area.

People told us that they were safe when supported by staff. People told us staff were punctual and systems were in place to monitor time keeping. Systems were in place for infection control and to learn lessons following incidents.

People received care from staff who were kind and compassionate. Staff treated people with dignity and respected their privacy. Staff had developed positive relationships with the people they supported. They understood people’s needs, preferences, and what was important to them.

Care plans were person centred and included people’s support needs. Care plans had been reviewed regularly to ensure they were accurate. Complaints had been managed in a timely manner.

Systems were in place to obtain feedback from people and relatives. People and staff were positive about the management of the service.

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 2 November 2018). We identified four breach of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to risk assessments, pre-employment checks, staff training and good governance.

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.

Why we inspected

This was a planned inspection based on the rating of the last inspection.

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.

The service had a 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 legal requirements in the Health and Social Care Act 2008 and the associated regulations on how the service is run.

Risks to people were not always robustly managed. We found some care plans did not contain suitable and sufficient risk assessments to effectively manage risks. This placed people at risk of not being supported in a safe way at all times.

Pre-employment checks had not been carried out in full to ensure staff were suitable to provide care and support to people safely. We found the provider did not follow their recruitment policy in some instances, which detailed that two references should be requested before employing staff.

Staff had not received mandatory and specialist training required to perform their roles effectively in accordance to people’s support needs and circumstances. Some staff had not received Mental Capacity Act 2005 (MCA) training therefore some staff we spoke to were unable to tell us what this was. Consent had been sought from people when supporting them with care and support.

People’s ability to communicate were recorded in their care plans. However, there was no information on how staff should communicate with people particularly how staff would make information accessible to people.

Effective quality assurance systems were not in place. Systems were not in place to carry out robust audits on staff training, care plans such as risk assessments and medicine management.

Accurate and complete records had not been kept to ensure people received high quality care and support.

Staff told us they had time to provide person centred care and the service had enough staff to support people. However, we noted where there was a risk staff may be late, this was not being pursued by office staff to minimise risk of late calls or missed visits. We made a recommendation in this area.

Staff, relatives and people were positive about the management team. People’s feedback was sought from surveys. However, this had not been analysed in full to identify best practise and areas of improvement ensuring a culture of continuous improvement. We made a recommendation in this area.

People received their medicines on time. Staff had been trained to manage medicines safely.

Staff were aware of how to identify abuse and knew who to report abuse to, both within the organisation and externally.

Pre-assessment forms had been completed in full to assess people’s needs and their background before they started using the service. Reviews were held regularly to identify people’s current preferences and support needs.

People were being cared for by staff who felt supported by the management team.

People had access to healthcare services if needed.

People’s privacy and dignity were respected by staff. People and relatives told us that staff were caring and they had a good relationship with them.

Complaints received had been investigated and relevant action had been taken. Staff were aware of how to manage complaints. However, the surveys were not being analysed to ascertain what the service was doing well in and what area’s required improvement. We made a recommendation in this area.

Spot checks of staff supporting people had been carried out to observe staff performance.

We identified four breaches of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to risk management, training, staff recruitment and good governance. You can see what action we have asked the provider to take at the back of the full version of this report.

There was a registered manager at the service at the time of our inspection. 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 and associated Regulations about how the service is run.

Systems were in place to help ensure people were safe. Staff had undertaken training about safeguarding adults and had a good understanding of their responsibilities with regard to this. Risk assessments were in place which provided information about how to support people in a safe manner. Staff understood their responsibilities under the Mental Capacity Act 2005. We found there were enough staff working to support people in a safe way in line with their assessed level of need.

Staff received regular training and were knowledgeable about their roles and responsibilities. They had the skills, knowledge and experience required to support people with their care and support needs. People were cared for by sufficient numbers of suitably qualified, skilled and experienced staff. Robust recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work.

Staff knew the people they were supporting and provided a personalised service. Care plans were in place detailing how people wished to be supported and people and their relatives were involved in making decisions about their care.

The registered manager was open and supportive. Staff and relatives felt able to speak with the registered manager and provided feedback on the service. The service had various quality assurance and monitoring mechanisms in place.

We made a recommendation that on-going supervision is completed for all staff.