This comprehensive inspection took place on 4 and 5 December 2018. The registered provider was given short notice of the visit to the office, in line with our current methodology for inspecting domiciliary care agencies. We carried out the inspection a little earlier than planned due to concerns raised with us about the way the service was operating.
Dearne Valley Business Centre is a domiciliary care agency. It provides personal care to people living in their own homes in the community. It provides a service to older adults and younger disabled adults. The registered provider is Anderby Care Limited. Not everyone using service receives regulated activity. CQC only inspects the service being received by people provided with 'personal care.' This means help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.
The last comprehensive inspection took place in March 2018 and the service was rated as requires improvement. We identified two breaches of regulation. This was because there were gaps in the records of staff recruitment, so it was not always evident that staff had been safely recruited. Also, the registered providers systems to ensure the service operated to an expected standard were not used and required embedding into practice. Following the last inspection, we asked the registered provider to complete an action plan to show what they would do to improve the key questions safe, effective, and well led, to at least 'good'. The action plan told us this would be completed by 31 July 2018; however, this was not completed.
You can read the report from our last inspections, by selecting the 'all reports' link for ‘Dearne Valley Business Centre’ on our website at www.cqc.org.uk.
At this inspection we found the registered provider had made some improvements but not addressed all the concerns raised at our last inspection. We also found a further breach of regulation. This was because some staff told us they liked working for the agency and had received support, training and supervision to help them to carry out their roles. However, written records were not always available to show this. Other staff told us they had not received any training since they started work for the agency. The service continues to be rated 'requires improvement.' This is the second time the service has been rated 'requires improvement.'
At the time of our inspection there were 83 people using the service, 74 of whom were receiving personal care. The service was managed on a day to day basis by the owner, who was also 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.
The recruitment process was still not sufficiently robust despite this shortfall being referred to in the last inspection report. Recruitment of new staff was not always carried out in line with the requirements of the regulations and the organisation's policies and procedures. This meant people were not fully protected against the potential employment of unsuitable staff.
Generic risk assessments regarding people's care were documented. However, individual care plans and records were not always adequate in informing actions staff should take to keep the person safe.
There were processes in place to help ensure people received their medicines as intended. However, audits were not always completed in a timely way and we found improvements were required in medicine administration records.
The written records available did not always reflect the positive aspects of the service that people told us about. The people who used the service and relatives spoken with were all happy with the service provided. They told us the service was particularly person centred and risks were well managed.
There was a procedure in place to ensure any safeguarding concerns were addressed and reported. People spoken with felt safe using the service. There were sufficient numbers of staff to meet people’s needs.
People told us they were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. However, there was a need to improve the written records in relation to this.
The service supported people to maintain a healthy diet, when this was part of the persons care package. People who required the involvement of healthcare professionals were assisted to obtain this support.
People told us the registered manager and care staff were very kind and caring. They said they treated people with respect and dignity, and cared for them in a way which met their needs.
People and their relatives told us they had been involved in formulating care plans. However, there was a need to improve the written records in relation to this.
The people we spoke with told us they would feel comfortable raising concerns, if they had any and said they would be listened to.
The registered manager had addressed some of the areas for improvement in the previous inspection report. However, issues of concern regarding staff recruitment and good governance of the service were still found. This showed that more in-depth monitoring of the quality of the service was needed.
The registered manager had introduced a system to monitor the quality of service delivery and of staff performance. However, this needed to be embedded into practice so that its effectiveness in improving the service could be seen.
People told us they had been consulted about their satisfaction in the service they received.
We found three breaches, two of these were continued 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 the full version of this report.
Further information is in the detailed findings below.