The Diamond Care Partnership Ltd

The Diamond care Partnership Ltd is a domiciliary care agency registered to provide personal care to people living in their own homes. At the time of the inspection four people were receiving personal care support.

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 found people were not always protected from the risk of infection due to poor infection prevention and control systems. The provider had not ensured staff were being tested for COVID-19. Staff had received training on how to put on and take of their PPE correctly however the staff we spoke with did not have the knowledge of how to do this. The provider did not carry out any audits to check staff knowledge and ensure good infection control was being followed

Previous concerns found at our last inspection had not been addressed. There continued to be concerns about the lack of an infection control policy and a completed contingency plan for COVID-19. There was also lack of action taken to mitigate risk when staff did not wear face masks. Following our inspection, the provider told us all staff would wear face masks and COVID-19 testing for staff had commenced.

A person told us they were happy with the care they received, and staff always wore PPE when supporting them.

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 30 March 2021) and there were two breaches of regulation. As part of our action we issued a warning notice to the provider to make the necessary improvements. At this inspection enough improvements had not been made and the provider was still in breach of regulations.

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met in relation to specific concerns about infection and prevention control. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific 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.

Enforcement

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 will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified a continued breach in relation to safe care and treatment at this inspection in relation to infection prevention and control.

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 to monitor progress.

The Diamond care Partnership Ltd is a domiciliary care agency registered to provide personal care to people living in their own homes. At the time of the inspection four people were receiving personal care support.

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

At the last inspection we found the provider’s systems to monitor the quality and safety of the service was not consistently effective. This was a breach of Regulation 17 HSCA RA Regulations 2014, Good Governance. At this inspection we found the required improvements had not been made and the service remained in breach of regulations.

This inspection found appropriate Personal Protective Equipment (PPE) was made available by the provider, however, we found systems and processes had failed to ensure effective infection control measures were in place to keep people safe. Actions taken to implement Government Guidance COVID-19: how to work safely in domiciliary care; were not effective.

This inspection found that some people's care plans and risks assessments had not been reviewed and updated since November 2018. Therefore, we could not be assured that these records reflected people’s current support needs.

At the last inspection we found improvement was required where people were supported with ‘when required’ medication. At this inspection although we requested information on medication records for ‘when required’ medication this was not submitted, therefore we could not be reassured the required improvements had been made. People told us they received support to take their medicines.

The provider had not completed any quality monitoring records such as medication audits or spot checks for approximately 12 months. Therefore, we could not be assured that systems were in place to identify issues and ensure that action was taken in a timely way.

People were supported by staff who were aware of how to safeguard people from abuse and had good knowledge on how to recognise and respond to concerns.

People and relatives said staff were caring and they praised the service provided. Staff told us they could talk to the registered manager for advice and support and felt confident any concerns they raised would be acted on.

This is the fifth consecutive inspection that The Diamond Care Partnership Ltd has failed to reach an inspection rating of good; of the five inspections this is the fourth occasion when a breach of Regulation 17 has been found.

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 requires improvement (published 08 August 2018) and there was a breach of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made, and the provider was still in breach of regulations.

Why we inspected

The inspection was prompted due to concerns about poor infection prevention and control (IPC) and lack of effective record keeping. A decision was made for us to inspect and examine those risks.

We reviewed the information we held about the service. We only looked at safe and well led during this inspection. We did not look at the key questions of responsive, effective and caring. 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 remains as Requires Improvement. This is based on the findings at this inspection.

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

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

Enforcement

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 will continue to monitor the service.

We have identified breaches in relation to Regulation 12: Safe care and treatment and Regulation 17: Good governance at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good.

We will work alongside the provider to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The Diamond Care Partnership Ltd is a domiciliary care agency registered to provide personal care to people living in their own homes. At the time of the inspection, seven people were receiving care and support services.

People’s experience of using this service:

• Governance systems to monitor and check the quality of the service provided to people was not consistently effective and required improvement. This meant the provider was not meeting the minimum standards required by the law. You can see what action we asked the provider to take at the end of the report.

• People’s relatives told us their family member’s were safe and staffing numbers were sufficient to meet their needs. While people received their medicines as prescribed; medicine records did not always support this. Staff had access to protective equipment that protected people from the risk of infection.

• Although people were supported to have choice and control of their lives and staff supported them in the least restrictive way; documentation in the service did not support this. Staff had the knowledge to support people with their needs. Staff consulted a range of healthcare professionals to ensure their health needs were met.

• Staff treated people with kindness and respect and their dignity was respected. People and relatives felt able to approach the registered manager to discuss any concerns. Care plans although developed with people and their relatives were not always up to date and reflective of people’s needs.

• Staff felt supported by the provider and we saw that relationships had been developed with a range of health and social care professionals. Risk assessments were not always up to date and reflective of people’s needs.

Rating at last inspection:

Requires improvement (report published 20 February 2018).

Why we inspected:

This was a planned inspection based on the rating at the last inspection. At the last inspection the service was requires improvement overall. We found the required improvements had not been made and the service continued to meet the characteristic rating of ‘Requires improvement.

Follow up:

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

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

Not everyone using The Diamond Care Partnership Ltd receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

At the last announced comprehensive inspection in July 2017, we judged that improvements were required in delivering a safe, effective and well-led service. During this inspection we found the provider continued to be in breach of the regulation related to governance. This was because the registered provider had failed to establish and operate effective systems to ensure compliance with the regulations, or to monitor the quality and safety of the service. After our inspection in July 2017 we served a Warning Notice to the registered provider which required them to be compliant with this regulation by 06 October 2017. A Warning Notice is one of our enforcement powers. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question ‘is the service well-led’ to at least good.

We undertook an announced focused inspection of The Diamond Care Partnership Ltd on 03 January 2018. This inspection was done to check that improvements to meet legal requirements planned by the provider after our inspection in July 2017 had been made. The team inspected the service against one of the five questions we ask about services: is the service well led. This was because the service was not meeting legal requirements. This report only covers our findings in relation to this focussed inspection. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Diamond Care Partnership Ltd on our website at www.cqc.org.uk.

No risks, concerns or significant improvement were identified in the remaining Key Questions through our on-going monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.

At this inspection we found that improvements had been made to promote the safety and quality of the service. We found that the provider had demonstrated to us that they had met the requirements of the warning notice and although they were now compliant with Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Good governance further required improvements were planned.

There was a registered manager in post who was present throughout the 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.

Regular audits and quality assurance checks required further development in order for the service to improve. Staff told us they felt supported and people felt able to contact the office in the knowledge they would be listened to. People who used the service, relatives and care workers all spoke positively of the registered manager and their commitment to the service and people who used it.

While improvements had been made we have not revised the rating for this key question; to improve the rating to 'Good' we would require a longer term track record of consistent good practice. We will review our rating for 'well-led' at the next comprehensive inspection to make sure the improvements made continue to be implemented and embedded into practice.

The Diamond Care Partnership Ltd are registered to provide personal care. They provide care to people who live in their own homes within the community. There were six people using this service at the time of our inspection who had a variety of needs including people who may have a learning disability or mental health support needs.

At our last inspection in May 2016 we identified a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. People were not benefitting from a service that was well led, or operating effective governance systems. This was because the management of medicines was not safe which meant there was a risk that people would not get their medicines as prescribed. Staff employed by the service had not received sufficient training and assessment of competence. There were no systems in place to analyse trends when accidents, incidents and complaints had been reported to prevent the likelihood of further occurrences for people. There were no effective systems or quality audits in place to monitor the quality and safety of the service provided. Feedback was not being used effectively to support the continual drive of improvement. In addition the service was not compliant with the Mental Capacity Act (2005) in how they assessed and supported people who lacked mental capacity. Following the inspection the registered provider submitted an action plan detailing how they would improve to ensure they met the needs of the people they were supporting and the legal requirements.

We undertook this announced inspection on 04 July 2017 to check that the provider had followed their own plans to meet the breach of regulation and legal requirements. Although the registered provider had addressed some of the concerns that we had identified at our last inspection, the systems in place to ensure the quality and safety of the service were still not effective and this inspection identified a continued breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to good governance. We are considering what further action to take.

There was a registered manager in post who was present throughout the 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.

Some people who use this service were unable to tell us their views of the support they were receiving. However we spoke with a number of relatives to seek their views about the service received by their loved one. All the relatives we spoke with were happy with the care and support that was being provided by the service.

People, relatives and staff told us that people were safe. However, systems in place did not ensure that people would be protected from the risk of harm. The management of medicines was not robust and did not follow good practice guidelines. The recruitment processes did not ensure that people were supported by staff who were suitable to meet their needs. Staff knew how to report any concerns. This would help to ensure that allegations of possible abuse would be identified and reported.

Staff told us that they had the appropriate knowledge and skills to meet the needs of the people they were supporting. However records contained some gaps in key training areas and a failed to show specialist training had been provided. People told us that staff asked their consent before providing care and support. Staff we spoke with had a good understanding of the Mental Capacity Act (2005) and what it meant for the people who were using the service. However, the service had not always followed and adhered to principles of the MCA. People spoke positively about the food that staff prepared for or with them. Staff worked with other professionals to ensure that people received the health care that they needed.

People told us they liked the staff who supported them. People had developed positive relationships with the staff who supported them. People were supported to make their own decisions about how they wanted their care to be delivered. People’s dignity and privacy was respected and promoted by staff who supported people to live as independently as possible.

The registered manager had been responsive to people’s needs and had supported people as requested. People told us that they had been involved in planning and agreeing to the care and support provided. People participated in activities of their choice and ones which they enjoyed. People and their relatives knew who to raise concerns with and were confident these would be responded to.

People and their relatives were satisfied with the service they received however the service was not consistently well led. The systems in place to assure the safety, quality and consistency of the service were not effective. Checks and audits had not been effective at identifying matters that needed to improve. Despite this being brought to the attention of the registered manager at our last inspection; they had not taken timely or adequate action to improve this aspect of the service.

We identified that there was a continued breach of the Health and Social Care Act 2008. (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

The Diamond Care Partnership Ltd are registered to provide personal care. They provide care to people who live in their own homes within the community. There were seven people using this service at the time of our inspection.

The registered manager was present during our 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.

Some people who use this service were unable to tell us their views of the support they were receiving. However we spoke with a number of relatives to seek their views about the service received by their loved one. All the relatives we spoke with were happy with the care and support that was being provided by the service.

The provider had limited systems in place to monitor and improve the quality of the service provided; these were not always effective in ensuring the service was consistently well led and compliant with regulations. Audits and monitoring systems needed to be improved.

You can see what action we told the provider to take at the back of the full version of the report.

People told us that the service provided was safe. Staff had the knowledge to keep people protected from the risk of potential abuse. People and their relatives told us that there were enough staff employed to work flexibly to meet their needs. The recruitment process did not ensure that the staff appointed had been appropriately checked or confirmed as suitable to provide care. People were satisfied with the management of their medicines but improvement was needed to ensure medicines were managed safely.

Staff we spoke with told us training was provided, however training to develop staff’s knowledge in relation to specific health conditions had not been provided. Care plans in place did not reflect people’s level of capacity. Staff lacked the understanding of the Mental Capacity Act (2005) and what it meant for people using this service. People told us that they enjoyed the meals that were prepared for them and they were of their preferred choice. People’s relatives told us that staff had contacted other health professionals when required to meet people’s health needs.

People and their relatives told us that staff treated people with compassion, dignity and respect. People were supported to make decisions about what they wanted to do in their daily lives.

People and their relatives told us that the service met people’s personal preferences. Care plans were in place but they were not up to date and required staff to consult other records to find out about people’s care and support needs. Reviews to assess people’s changing needs had been completed and contained detailed information.

There was a complaints procedure in place and people told us they were confident that any concerns they raised would be dealt with in a timely manner. The complaints procedure was not accessible and inclusive for all people using the service.

We found that people's needs were assessed and care and support was planned and delivered in line with their individual care plans. People received safe and appropriate care provided by regular members of staff who knew them and who they trusted.

We spoke to people about the care staff who supported them. Comments included, 'I like the carers, they are good' and 'They look after me when I go out.'

The relatives we spoke to were complimentary about the service being provided. Comments included, 'They provide a first class service' and 'I'm 100 % satisfied, the carers know my relative really well.'

We noted that before people received any care or support they were asked for their consent and the provider acted in accordance with their wishes.

People who received care and support were safe and their health and welfare needs were being met by care staff who were fit, appropriately qualified and competent to undertake the tasks required of them. We found that internal audits had been completed regularly by the manager and that suitable checking systems were in place for the provider to monitor the quality of service delivered.

We concluded that this agency was a safe, effective and responsive care agency that delivered a good standard of care and support.

People told us, 'I trust them' and 'They are very friendly and helpful.'

Relatives of people using the service also made complimentary comments. We were told, 'My relative is happy with them' and 'It's more like a sister, mother and aunt relationship, than just carers, I can't fault them.'

Our inspection confirmed much of the feedback we had received. We found that care and treatment was planned and delivered in a way that ensured people's safety and welfare. People's care records showed that the agency completed an assessment of their needs before a service was provided.

Our observations and conversations with people using the service confirmed that the staff were attentive and polite. We noted that the manager was approachable and responsive to suggestions and feedback. It was clear that the staff had a good knowledge of all of the people who they cared for and were familiar with their preferences and health conditions.

We saw that people were safe and that their health and welfare needs were being met because there were sufficient numbers of staff with appropriate skills and experience to support them.

During our inspection we found that there were inadequate quality checking and monitoring systems and procedures in place to ensure that people remained safe and secure.