Destiny Care Support is registered as a domiciliary care agency. The service operates from a small office which is adjoined to a residential service which is also owned by the provider.

Not everyone using Destiny Care Support received the 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 consider any wider social care provided. At the time of our inspection two people were using the service, however only one was provided support with personal care.

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 2008 and associated Regulations about how the service is run.

At our last inspection, we rated the service as requires improvement with one breach to the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. During this inspection, we found significant improvements had been made and the provider is now meeting the regulations.

The person was supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. However, the provider did not always understand who could legally give consent on the person’s behalf. We have made a recommendation.

Staff had a good knowledge of how to keep the person safe and how to recognise signs of abuse. There were individual in-depth risk assessments completed, which were person and task specific. Where risks had been identified, actions had been taken to manage the risks and promote the person’s choices. Staff were aware of the person's needs and followed guidance to keep them safe. There were sufficient numbers of staff to ensure their safety.

Staff had the skills and knowledge to support the person’s needs. This was achieved through induction, training, regular supervision and team meetings. Nutritional needs were met. The person was given choice and control over what they wanted to eat and drink while still encouraged to make healthy choices. They were also encouraged be independent when preparing food. The person’s health and social well-being was promoted through regular input from professionals.

The care plan was detailed and tailored to their individual needs. Staff knew the person they cared for well and understood their specific communication and behavioural support needs. Staff had supported and encouraged the person to engage with a variety of social activities of their choice and this had improved with time and patience. Staff treated them with kindness, compassion and respect and promoted their independence and right to privacy.

From our observations and views from professionals and staff, it was clear the registered manager was thought highly of. They sought feedback from professionals and relatives to improve the service and responded quickly to any issues or concerns. The management team promoted a strong team work ethos which made staff feel appreciated in their role.

Further information is in the detailed findings below.

This inspection took place on the 8 February 2017. This was an announced inspection. This means the provider was given notice due to it being a domiciliary care provider and we needed to ensure someone was available. The inspection involved a visit to the agency’s office and conversations with people and their relatives. This was the services first inspection since being registered with the CQC.

Destiny care support is registered as a domiciliary care agency. The service operates from a small office which is adjoined to a residential service which is also owned by the provider. At the time of our inspection two people were using the service, only one of whom required support with personal care.

There was a registered manager in post, a registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

The provider had not taken appropriate actions to assess environmental risks in relation to people using another of the provider’s facilities.

Although staff had received training and were clear on their support responsibilities with day to day decisions in regard to the Mental Capacity Act; the provider had not ensured they had collected up-to-date information in regard to people’s advocacy status.

The provider could not be assured they were effectively supporting a person in line with professional health care guidance for a specific health care condition due to omissions in collecting relevant information.

The provider had failed to established robust systems which allowed them to observe care staff whilst they were undertaking care delivery. This impacted on the effectiveness of staff supervision.

Although the provider had systems to determine people and their relative’s satisfaction with the service received; we found a response to relative feedback had not been undertaken in a timely manner.

The provider had begun to engage with a range of health care professionals to ensure they were able to support a person’s with their complex sensory needs; however they acknowledged they had not fully explored all available referral options.

The providers quality assurance systems had failed to identify the areas of improvement we found during the inspection. For example there had been shortfalls in recording when there had been unforeseen interruptions to when care was not delivered in line with support plans. The provider had not ensured they had clear oversight of the service and provided adequate support to the registered manager.

Friendly and genuine relationships had been developed between people and staff. We heard staff offering clear explanations to people in ways they understood. Staff were seen to be kind and caring in their approach to people.

People were supported by, sufficient numbers of experienced staff. Robust recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work for the provider.

People and their relatives spoke positively about the leadership and said they could approach them about any issues they felt required raising.

We found a 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.