Archived: Divine Motions Acacare Limited

The service had a registered manager who had been in post since 2014. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

We previously inspected the service in December 2017. At that inspection we gave the service an overall rating of "Requires Improvement". This was because we found the provider did not always provide safe care and treatment or notify the CQC of notifiable events and we found there was a lack of effective systems to assess and monitor the quality of care people received. The provider was required to send us an action plan detailing how and when they planned to make the required improvements. This inspection was conducted to check that the required improvements had been made.

People told us they felt safe whilst being supported by the staff. People were protected from the risks of abuse. Risks associated with people’s care had been identified and there was guidance for staff on how to manage these risks and keep people safe. Accidents and incidents were reported in line with the provider's procedures and the registered manager reviewed them to make sure the correct action was taken in response. Staff understood their responsibilities in regard to infection control and used protective equipment, such as gloves, when required.

People’s needs were assessed. They had a care plan which reflected the support they needed and provided guidance for staff. People were supported to maintain their health and had access to healthcare professionals. People’s medicines were managed safely and they received them as prescribed

Staff had been recruited safely. They had the training and skills to provide people with effective care and support. They received appropriate support from the provider through regular supervision and performance review. There were sufficient staff to provide people with the care they needed.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; policies and systems in the service supported this practice. Staff had an understanding of the Mental Capacity Act 2005 and how it impacted on the people they supported.

People received care that was responsive to their needs. Staff were caring and respected people’s privacy and dignity. People were usually supported by the same staff who knew them well and understood their needs. People were involved in making decisions about the level of care and support they needed. People told us they knew how to complain.

The provider had effective systems in place to assess and monitor the quality of care people received.

The service had a registered manager who had been in post since 2014. 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.

We previously inspected the service in August 2017. At that inspection we gave the service an overall rating of "Good". Since that inspection the service had gone through a period of rapid expansion after being awarded a large contract by a local authority. The systems in place for assessing and monitoring the quality of care people received were not sufficiently robust to effectively manage the increase in the number of people using the service which resulted in some areas of the service no longer being well-managed.

Staff did not always follow the provider's medicine administration policy and procedures and the provider's medicine administration auditing process was not sufficiently robust to identify this. This meant there was a risk of people receiving their medicine in a way which was unsafe.

Half the people we spoke to told us they had experienced late visits. People also told us they had experienced missed visits particularly at weekends. This meant that people were at risk of unsafe care and treatment as they received support with their personal care, taking their medicines and having their meals late or not at all on occasions. People told us that the issue of missed visits and poor punctuality was particularly bad in the three months before our visit but it had improved recently.

Registered providers must notify the CQC about certain changes, events and incidents that affect their service or the people who use it. The provider did not notify CQC of notifiable events such as allegations of abuse. This meant the CQC did not have full oversight of the risks associated with the service.

The provider had a thorough recruitment process which was adhered to by the management and included conducting appropriate checks on staff before they began to work with people. People were supported by the right number of staff to meet their needs. However, staff were not adequately supported by the provider to deliver effective care because staff training and supervision were not up to date.

People felt safe from abuse. Staff had been trained in protecting adults from abuse and had good knowledge of how to recognise abuse and report any concerns. People were protected from avoidable harm because risk assessments identified the risks each person faced and gave staff guidance on how to manage those risks which staff followed.

Staff understood their responsibility in relation to infection control. They had access to an ample supply of personal protective equipment such as gloves and aprons. They consistently followed the provider's infection control policies and procedures which helped to protect people from the risk and spread of infection.

Staff treated people with kindness and respect. They supported people in a way that maintained their privacy. However some people's dignity was compromised when they had to wait to be supported with personal care because staff arrived late.

People who were supported with their meals told us the quality of food was good and they had a sufficient amount to eat and drink. Staff supported people to maintain good health and access external healthcare professionals.

People were supported by a consistent staff team. People were involved in planning their care and were asked for their consent before care was provided. Staff knew people well and understood people's routines and preferences. People were given choices and their wishes were listened to and acted on.

Staff understood the main principles of the Mental Capacity Act 2005. People felt able to raise any concerns and knew how to make a complaint. The provider responded appropriately to people's concerns and complaints but did not have a system in place to monitor them so as to identify trends and drive improvement.

There were a variety of systems in place to assess and monitor the quality of care people received. However these were not always effective in identifying areas which required improvement. The management of the service was reactive rather than proactive which meant that there was not a clear strategy for ensuring that people received consistently good care or a contingency in place for when things went wrong.

We found breaches of the regulations in relation to the provider's failure to provide safe care and treatment, notify the CQC of notifiable events and the lack of effective systems to assess and monitor the quality of care people received. You can see what action we asked the provider to take at the back of the full version of this report.

Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The service provided personal care to people living in their own homes. People received support through scheduled care visits. On the day of our inspection 89 people were using the service.

We previously inspected the service in August 2016 and found breaches of the regulations in relation to the way the provider assessed and managed the risks people faced and the lack of person-centred care planning. The overall rating for the service was, "requires improvement." We asked the provider to tell us how and when they would make the required improvements. These actions have now been completed.

There was a registered manager in post. 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 registered manager promoted a caring culture that was reflected in the comments made by people and the attitude of staff. Staff felt valued and well supported. The registered manager had good oversight of the service.

Staff received training to ensure they had the skills and knowledge to meet people’s needs and had access to development opportunities.

Staff understood their responsibilities to report concerns relating to abuse and where any concerns were raised action had been taken to ensure people were safe. Where risks were identified in relation to people’s care needs there were plans in place to manage the risks. There were appropriate procedures in place to help ensure people received their medicines as prescribed.

There were systems in place to ensure care calls were scheduled according to people's needs and to monitor for late and missed visits. There were sufficient staff to meet people’s needs.

People’s changing needs were identified and reflected in their care plans. Staff supported people to maintain good health and to access healthcare professionals.

Staff understood the importance of promoting independence. Staff respected people’s dignity and found ways to ensure people had privacy when they were being supported with personal care.

There were effective systems in place to monitor the quality of the service and action was taken to improve the service where issues were identified.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

We previously inspected the service in March 2014. We found the provider was meeting all the legal requirements and regulations we inspected.

During this inspection we found that care was not planned and delivered in a way so as to ensure people were protected against the risk of foreseeable harm. People’s risk assessments did not identify obvious risks or give staff sufficient information on how to manage the risks identified. People's needs were assessed but the assessment process was not effective. People's care plans did not give staff sufficient information to enable all staff to provide personalised care.

There were procedures in place to protect people from abuse which staff were aware of. Staff had received safeguarding training and had good knowledge about how to identify abuse and report any concerns.

Staff were recruited using an effective procedure which was consistently applied and appropriate checks were carried out before staff were allowed to work with people alone.

People were cared for by a sufficient number of suitable staff to help keep them safe and meet their needs. Staff were appropriately supported by the provider through an induction, relevant training, supervision and appraisal. Staff were supported to obtain further qualifications relevant to their role.

People were supported to maintain good health. There were appropriate arrangements in place to help ensure people received their medicines safely. Staff supported people to have a sufficient amount to eat and drink. Staff controlled the risk and spread of infection by following the service’s infection control policy.

Staff understood the relevant requirements of the Mental Capacity Act 2005 and how it applied to people in their care. Staff were kind, caring and treated people with respect. People were satisfied with the quality of care they received and but felt there could be better continuity of care.

People were supported to express their views and give feedback on the care they received. The provider listened to and learned from people’s experiences to improve the service. There were systems in place to assess and monitor the quality of care people received but these were not always effective.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to the arrangements in place for assessing and managing the risks people face and the lack of care planning to ensure people received person-centred care. You can see what action we told the provider to take at the back of the full version of this report.

We saw that people's needs were assessed and care was planned and delivered in line with their individual care plan. We spoke with people using the service who all told us they were happy with the care they received. One person said "I am really happy with my carer. She is like a friend."

We found that people using the service were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent this from happening. The staff we spoke with were able to tell us about different signs of abuse and what they would do if they had any suspicion that abuse had occurred. One staff member said "I would speak with my manager if I had any doubt whatsoever. They always know what to do and they would act straight away."

We saw that there were effective recruitment and selection procedures in place.

Staff received appropriate professional development and were supported in undergoing further training and obtaining relevant qualifications. The staff we spoke with were all very positive about the training they had received and the opportunities they had to learn. We saw that Divine Motions Acacare Limited was an accredited training provider who also provided training to outside agencies.

There was evidence that learning from incidents took place and appropriate changes were implemented.

We looked at the information provided to people who enquired about the service. People received a 'service user guide' which gave detailed information about the service provided and what people could expect in terms of their care and support.

We saw there were procedures in place to carry out comprehensive assessments to identify people's individual care and support needs. From historic records of people who had previously used the service we saw these assessments had been used to develop a plan of care and support.

Staff employed by the service had access to suitable training and development opportunities. There were also systems and procedures in place to assess and monitor the quality of service being provided.