Dawn To Dusk Care Services Limited

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.

Our last inspection took place on 12 November 2013 and, at that time, we found the regulations we looked at were being met.

Dawn to Dusk Care Services Limited is a small domiciliary care agency which provides care services to people in their own homes. On the day of our visit seven people were receiving personal care. The agency can provide a service to adults, older people, people living with dementia, people with physical disabilities, people with learning disabilities and people with sensory loss.

There was a registered manager in post, who is also the owner of the company. 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.

People who used the service told us they felt safe with the care they received. We found there were appropriate systems in place to protect people from risk of harm.

There were policies and procedures in place in relation to the Mental Capacity Act 2005 and Deprivations of Liberty Safeguards (DoLS). The registered manager had completed training and knew the procedures to follow.

People who used the service told us staff were extremely caring and regularly ‘went the extra mile,’ caring out acts of kindness in addition to those required to meet people’s needs. People were treated with compassion, respect and dignity by staff who had built meaningful relationships with them.

We found that people were provided with care and support by staff who had the appropriate knowledge and training to effectively meet their needs. The skill mix and staffing arrangements were also sufficient. Robust recruitment processes were in place and followed, with appropriate checks undertaken prior to staff working at the service. This included obtaining references from the person’s previous employer as well as checks to show that staff were safe to work with vulnerable adults.

Staff had opportunities for on going development and the registered manager ensured that they received induction, supervision, annual appraisals and training relevant to their role.

The staff we spoke with were able to describe how individual people preferred their care and support to be delivered and the importance of treating people with respect in their own homes.

The relatives of people who used the service told us staff were reliable, kind and caring and always provided care and support in line with the support plan in place. We found staff provided a highly person centred service and were consistently going the ‘extra mile’ to provide an exceptional service.

The support plans we looked at were person centred and were reviewed on a regular basis to make sure they provided accurate and up to date information. The staff we spoke with told us they used the support plans as working documents and they contained sufficient information to enable them to carry out their role effectively and in people's best interest.

There was a complaints procedure available which enabled people to raise any concerns or complaints about the care or support they received.

People using the service, relatives and staff we spoke with were very positive about the registered manager. They all said the registered manager was committed to providing the best service they could offer, was approachable and provided effective leadership. Relatives and staff all said they had and would recommend the service to other people.

There was a quality assurance monitoring system in place that was designed to continually monitor and identify any shortfalls in service provision.

'It is an extremely reliable service with consistent and competent staff. They are very precise on timing of visits. We have had different service providers but this is the best by far, everything is done 'spot on' and it has transformed our lives.'

'It is a fantastic service and my relative likes the carers. The staff are always on time and they care, it's not just a job to them and they are nice people.'

'This agency was recommended to us. The manager has been out to meet us and has bent over backwards to help us. We have only just started with this company and my relative said that staff were polite and courteous when they visited.'

'When my shift has finished I have a warm feeling that I have left everyone comfy and happy.'

'It's a small company, the staff team are good and we all get on well and keep each other informed about what is going on.'

People were fully involved in designing and reviewing their care packages.

There were systems in place to make sure that people were kept safe and procedures for reporting any suspected abuse.

Before stating work staff were being properly checked to make sure they were suitable and safe to work with vulnerable people.

Our conversations with people and staff indicated staff were well trained and staff told us they felt supported in their role.

There was a complaints procedure in place and people told us they would feel able to raise any concerns.