Archived: Dignity Care (York) Limited

This service was registered by CQC on 12 June 2011. A previous inspection had been completed on 06 January 2014 and the provider was found to be compliant in the areas we inspected at that time.

Dignity Care (York) Limited is registered to provide personal care for Older People and people with a Physical Disability. At the time of our inspection, 27 people received a personal care service. The service provides domiciliary care and support services from the registered office location, on the outskirts of the City of York.

The registered provider is required to have a registered manager in post and on the day of this inspection, there was a registered manager registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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.

Care workers were able to discuss signs of abuse and how to report their concerns. However, management of training in safeguarding for care workers was ineffective and not robustly managed or recorded. Safeguarding policies and procedures were available for care workers to read however, they required updating.

Other Quality Assurance checks included an annual survey sent to service users. We saw this was not analysed and there was no evidence of how the service used feedback from Quality Assurance to continually evaluate and improve the service provided or where this was recorded. We concluded that although there were some Quality Assurance checks in place these were not robustly implemented across the service to ensure they could be used to drive improvement.

The registered provider did not have a dedicated file or procedure to record and manage accidents and incidents. This meant that the registered provider could not demonstrate how they learned from such events to minimise re-occurrence.

The registered provider had a file with compliments and they told us these were fed back to the care workers. This showed that the service actively sought peoples feedback however, it was not evident that complaints would be addressed with actions and outcomes recorded.

The registered provider had a training record to manage training for care workers. However, at the time of our inspection the registered manager told us and we saw that the training record was not in use and had not been updated. Procedures in place to manage training for care workers including the induction programme were ineffective and it was not clear if they had the appropriate skills to undertake their role. We spoke with care workers who told us they did not have regular documented supervisions or reviews. We saw these were not recorded and it was not clear how their capability was monitored by the registered provider. The registered manager told us they did not have regular staff meetings and that information was shared with care workers using weekly emails and text messages.

Care plans we looked at contained up-to-date risk assessments for their homes, environments and for the individuals and these were reviewed and updated. This meant the registered provider had procedures in place to recognise the importance of risk management to help care workers deliver care and support in a safe way to people.

The registered provider recorded appropriate recruitment checks and these were completed before they worked alone with people. This helped the registered provider to ensure people employed were of suitable character to work with vulnerable people.

People received their medication in a safe way and care workers had received training and followed the policies and procedures that were in place for the safe management of medications.

The registered provider was working under the guidelines of the Mental Capacity Act 2005 and people were supported to make informed decisions wherever possible.

People told us and we saw they received support and care from care workers who understood the importance of treating them with dignity and respect. Care workers told us how they would maintain and respect people's confidentiality and would only share information they discussed with people where it was appropriate to do so with others directly involved with the persons care.

We saw care workers were kind, efficient and caring when they addressed people how they wanted to be. People confirmed that care workers cared for them and that they felt the care they received was personal and not just task related. Care workers told us that when required to do so they would spend additional time with people to make sure they were ok before they left.

Care plans were available in the main office and in people’s homes. These were reviewed, updated, and included people’s preferences. Care workers told us that care plans provided sufficient detailed information to enable them to provide care and support that met their current needs. Care workers also told us and people confirmed they were involved in their care planning and reviews and that their wishes were respected. We saw care plans were signed by people to demonstrate they had understood and agreed to the content.

There was a clear management structure and care workers employed by the registered provider understood their roles and responsibilities. Care workers and people who received a service spoke positively about management and their involvement with peoples care and support.

The registered provider had policies and procedures in place and these were available in the ‘Staff Handbook’ that was issued to all care workers. We saw the registered provider completed Quality Assurance audits on Medication Administration Records and care workers confirmed there was a process in place to deal with any concerns raised as a result.

We found three breaches in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to the staff training, supervisions and quality assurances procedures. You can see what action we told the provider to take at the back of the full version of this report.

All the people we spoke with confirmed they or their representatives had been involved in planning their care.

People expressed a high level of satisfaction with the care provided. Comments from people included: 'They are amazing,' 'Exemplary,' and 'They are what they call themselves; they treat people with dignity and respect.'

Staff received appropriate professional development. All of the people we spoke with told us they thought the staff were well trained. People told us 'I have seen and heard the staff with X and they are amazing,' 'They crouch down to talk at Y's level. They behave in such a dignified way,' and 'They are so professional but in such a friendly and kind way.'

We asked people who received care in their home and their relatives whether they felt safe when care staff went into their homes. All the people told us they felt safe and had no concerns regarding feeling safe. Comments from people included: 'The arrangements they [the providers] have in place are geared towards making people safe' and 'X feels totally safe when the staff visit; they actually look forward to the visit.'

Arrangements were in place for obtaining feedback from people about their satisfaction with the quality of care they received.

We did not observe any direct care being provided but spoke with people via the telephone. They told us that they were very happy with the care and that they received the care and support that was agreed in their care plan. Comments from people included 'We couldn't do without them", "It's excellent care" and "We are absolutely satisfied."

All the people receiving care told us that they felt safe when carers went into their home.

The people we spoke with told us that they would tell the managers if they needed to make a complaint. One person said "If there is a problem I just phone and it is sorted but there are no real issues." People said they had no major complaints.

Appropriate checks were undertaken before staff began work. We reviewed three staff files and viewed the recruitment procedures during our visit to the office for the service. All the files contained the relevant pre-employment checks which included references, enhanced Criminal Records Bureau (CRB) check and Independent Safeguarding Authority (ISA) First Check. This meant that the provider was assured that staff were not barred from working with adults or children.