DMC Signature Care Ltd

DMC Signature Care Ltd is a domiciliary care agency. They provide personal care to people living in their own homes. The service is registered to support older people, younger people and children. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. At the time of the inspection 3 children were receiving personal care.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

People’s experience of using this service and what we found

Right Support:

People were supported by staff who knew them well, had received sufficient training and who had been safely recruited.

Enough staff were deployed to meet people’s individual needs. Staff arrived on time and stayed the allocated amount of time to meet people’s needs.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Right Care:

Risks to people had been assessed and mitigating strategies implemented. Staff received training on people’s individual needs. People were protected from avoidable harm and staff understood how to protect people from abuse.

Infection control procedures were in place and staff wore appropriate personal protective equipment to keep people safe and reduce the risks from infections.

Staff were kind and caring towards the people they supported and engaged well with their relatives. Information was shared and lessons learnt.

Right Culture:

The registered manager had systems and processes in place to maintain effective oversight of the service. Staff received regular meetings and supervisions to share information and discuss any concerns.

Staff felt supported at work and the provider had a clear vision and expectation of good quality care. We received positive feedback on the management of the service and the attitudes of staff.

Managers and staff were open and honest with others. When something went wrong the provider had a system in place to share the information and make improvements. Action plans were put into place if any issues occurred.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was Inadequate (published 05 October 2021) and there were 4 breaches of regulation.

We then completed a targeted inspection but did not rate the service (published 13 October 2022). The provider was no longer in breach of 2 regulations.

At this inspection we found improvements had been made and the provider was no longer in breach of the 2 other regulations.

This service has been in Special Measures since 10 October 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from inspected not rated to good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for DMC Signature Care Ltd on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

DMC Signature Care Ltd provides care and support to people living in their own homes. The service supported older people, younger people and children with a learning disability. At the time of the inspection, only two people were receiving personal care.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

People’s experience of using this service and what we found

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

At the time of the inspection, the provider did not care or support anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.

The provider’s systems and processes had improved. New systems and processes were in place to support the provider to have effective oversight of the quality and safety of the service. These had not yet been embedded into the service due to the reduced number of people using the service.

The providers recruitment processes had been improved. Extensive work had been undertaken to improve safe recruitment processes. These had not yet been embedded into the service because no new staff had been employed since the previous inspection.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. However, due to only one person using the service we were unable to see how effective these procedures were in practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was inadequate (published 11 November 2021).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

Why we inspected

We undertook this targeted inspection to follow up on Warning Notices we previously served in relation to Regulations 19 (Fit and proper person’s employed) and 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and to ensure requirements had been met. The overall rating has not changed following this targeted inspection and remains inadequate.

We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

You can read the report from our last inspection, by selecting the ‘all reports’ link for DMC Signature Care Ltd on our website at www.cqc.org.uk.

Follow up

Targeted inspections do not change the rating from the previous inspection. The service continues to be in special measures. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

DMC Signature Care Ltd provides care and support to older people, younger people and children with a learning disability living in their own homes. On the first day of our inspection the service was supporting 25 people, however, only three adults and three children were receiving personal care. By the end of the third day of inspection all children had been supported to move to alternative care providers by the children’s care commissioners.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

People’s experience of using this service and what we found

The provider failed to have enough management oversight of the service to ensure all people received their care as planned in a safe way.

The provider’s failure to have systems to assess, monitor and mitigate the risks relating to the health, safety and welfare of people led to children being placed at risk of harm due to unsafe transport and environments.

Vulnerable adults and children had been placed at risk of harm from staff that had not been recruited safely. The provider failed to follow their recruitment policies.

People did not always receive their planned care. The provider did not have systems to identify when people missed their care or received care from only one member of staff where two were required for safety.

The provider failed to have systems to identify, report and investigate safeguarding concerns. Staff did not always record the care they provided. The provider did not review the daily notes for information which indicated safeguarding concerns.

The provider failed to have systems to assess, monitor and identify where there was the need to improve the service. There were no audits to check people were receiving their care in a safe way.

Rating at last inspection

The last rating for this service was Good (published 16 August 2018).

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for DMC Signature Care Ltd on our website at www.cqc.org.uk

Why we inspected

We received concerns in relation to recruitment of staff. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We have identified breaches in relation to recruitment of staff, managing risks, safeguarding and governance at this inspection.

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

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

DMC Signature Care Limited is a domiciliary care service providing personal care to older people, children and young adults in their own homes.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. At the time of the inspection two people received help with their personal care.

People’s experience of using this service and what we found

People were cared for by staff who they described as kind, caring, passionate and patient. People’s dignity and privacy was maintained, and people felt in control of their lives.

People had individualised care plans which ensured they received person-centred care. Plans considered people’s preferences likes and dislikes and their cultural and religious backgrounds. People knew who to

speak to raise concerns and were confident they would be listened to.

People were cared for safely and staff understood their responsibilities to keep people safe from abuse or harm. Risk assessments were in place which ensured that staff knew what to do to mitigate the risks

identified. People received their medicines safely and there were effective practices in place to protect people from infection.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported

this practice. Staff received the support they required and had access to training.

The provider was open and honest and strived to look at ways to improve the service. Staff felt well supported and people were confident in the service. Staff liaised with other health professionals and looked at ways to improve people's life experiences.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

When we inspected in February 2019 we were not able to rate the service as they had only been supporting one person for a short time.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

DMC Signature Care Ltd is a domiciliary care agency, providing personal care to people in their own homes. On the day of inspection, the service was providing personal care to one person.

People’s experience of using this service:

We have been unable to rate this service as they were providing personal care for only one person.

The service had a 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 and associated Regulations about how the service is run.

The provider did not have all the systems in place to assess all of people’s risks. We have made a recommendation that the registered manager sources assessment tools that are evidence based.

The provider had recruitment procedures in place, but these needed updating to ensure all staff had their pre-employment checks carried out in a timely way.

The registered manager was continuing to develop their quality monitoring systems.

The person was involved in the planning of their care. Care plans were person centred and updated as their needs changed. The person received their care as planned.

The person received their care from a consistent staff team who knew them well. Staff had been employed to meet the person’s cultural and spiritual needs.

Staff had received training and support to carry out their roles. Staff understood their roles and responsibilities to safeguard people from the risk of harm.

The person was supported to access relevant health and social care professionals. There were systems in place to manage medicines in a safe way.

The person’s privacy and dignity was protected and promoted. Staff had a good understanding of the person’s needs and preferences.

There was a complaints system in place; the registered manager was exploring how to capture complaints where these were not in writing.

Rating at last inspection:

This was the first comprehensive inspection carried out at DMC Signature Care Ltd since they registered with CQC on 13 January 2017. The service had been dormant (not providing care) for a period of time; they commenced providing personal care from May 2018.

Follow up:

We will continue to monitor the service and inspect again as scheduled.