Dawn To Dusk Care Services Limited

Updated 5 December 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 5 and 7 November 2018 and was announced. We gave the service 48 hours’ notice of the inspection visit because the location provides a domiciliary care service and we needed to be sure that they would be in.

The inspection team consisted of one adult social care inspector, an assistant inspector and a bank inspector.

We reviewed information we held about the service, such as notifications and information from Healthwatch. Healthwatch is an independent consumer champion which gathers information about people’s experiences of using health and social care in England. We contacted commissioners and the local authority safeguarding team prior to inspection.

The registered provider had been asked to complete a Provider Information Return (PIR) and they returned this to us prior to the inspection. This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.

During the inspection we spoke with three people who used the service, two relatives, three members of care staff and the registered manager.

We looked at a variety of documentation including, care documentation for six people, two staff files, meeting minutes, documents relating to the management of medicines and quality monitoring records.

Updated 5 December 2018

Dawn to Dusk is a domiciliary care agency which provides care services to people living in their own homes. There were 11 people receiving personal care at the time of inspection.

At the last inspection, the service was rated Good. At this inspection we found the service remained Good.

There was a registered manager in post at the time of 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 2008 and associated Regulations about how the service is run.

Medication records were completed and demonstrated clear responsibility for administration of medicines. We recommended the provider put a system in place to ensure medicine administration records (MARs) were countersigned to make sure the information was transcribed accurately.

Staff explained the signs of abuse and what they would do to make sure people were safeguarded. Staff knew who to report any concerns to both within the organisation and to external agencies, such as the CQC.

We saw risk assessments were kept up to date and covered areas such as medication, moving and handling, equipment and the environment.

Staff recruitment records demonstrated the service was ensuring staff were subject to the appropriate scrutiny. There were enough staff to meet people’s needs. Staff received appropriate support and training.

People’s care and support was assessed and reviewed on a regular basis. We saw people had access to healthcare professionals such as speech and language therapists, dieticians, district nurses and GPs. People and their relatives told us they were involved in the care planning process to ensure it met their needs.

We checked whether the service was working within the principles of the Mental Capacity Act 2005. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People told us they were involved in their care. People’s care plans provided information about capacity to make decisions with regard to certain aspects of their care. We made a recommendation that the provider ensured they had copies of Lasting Power of Attorneys (LPA) and to make clear that LPA for finances did not give authority to act in relation to a person’s health and welfare.

People were treated with kindness, respect and compassion and were given emotional support when needed. Staff went the 'extra mile' to ensure people received good quality care. All the people and relatives we spoke with were very happy with the service provided. Staff promoted people’s independence and respected their privacy and dignity.

People contributed to their care planning and support which was responsive to their needs. We saw evidence of identified concerns being followed up and referrals made to other healthcare professionals for support.

The provider had a complaints policy and procedure in place. The manager kept an overview of complaints in order to identify any patterns and trends. No complaints had been received since the last inspection.

Staff felt supported and listened to. People were asked to provide feedback on the service and they felt their contribution was important.

The registered manager had a system in place to audit medication, daily records, risk assessments, care plans, equipment, accidents, incidents, complaints, safeguarding and monitoring charts. Where issues were found action was taken and this was clearly recorded. For example, it was identified through the medication audit that staff had not signed the MAR. This was discussed with staff and an improvement was made.

We made a recommendation to ensure there was independent oversight in relation to audits as the provider and the registered manager were the same person. The registered manager followed this up immediately and engaged the service of a third party to do this.

Further information is in the detailed findings below.