This inspection took place on 21 March 2018 and was an announced inspection. This was our third inspection at this location. At our last inspection in April 2016, the provider was rated as ‘Good’ and was found to be meeting all of the legal requirements of their registration including but not limited to the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Diverse Care Services is a domiciliary care service which is registered to provide personal care services to people living in their own homes, including adults and older adults living with physical, learning and/or mental health conditions such as dementia. At the time of our inspection they were providing personal care and support to 80 people.

The provider is required to have a register 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. A registered manager was in post at the time of our inspection.

The provider had some systems and processes in place to monitor the quality and safety of the service. However, some of these were not always implemented effectively to ensure records were robust or that information gathered was used to drive improvements within the service. The providers quality assurance practices had failed to identify the shortfalls that we found during our inspection and had the potential to compromise the safety and quality of the service. Therefore, this was a breach of Regulation 17 of the Health and Social Care Act (Regulated Activities) Regulations 2014. You can see what action we have taken at the end of the report.

The provider had not always ensured that staff had access to information regarding people’s health conditions or associated risks such as specialist diets or epilepsy. However, people were supported by regular members of staff who got to know their care and support needs well through speaking with them and/or their family. Staff knew the risks associated with people’s health and knew what action to take in order to keep people safe.

People were supported by enough members of staff who had the knowledge and skills they required to care for people safely and effectively. This included the safe management of medicines so that people received support to take their medicines as prescribed, if required. However, the provider had not always ensured that robust recruitment practices had been followed consistently to ensure only suitable people were employed to care for people.

People were protected from the risk of abuse and avoidable harm because staff received training and understood the different types of abuse and knew what actions were needed to keep people safe. The provider had also ensured effective systems were in place to report and investigate any concerns raised, which included working collaboratively with external agencies.

People were supported by staff that were kind, caring and respectful and who took the time to get to know people and their families. People were encouraged to be as independent as possible, where possible and were supported to have food that they enjoyed.

People knew how to complain if they were unhappy and they were confident that their concerns would be responded to efficiently and effectively.

Staff reported to feel supported and valued within their work and felt that the provider maintained open, honest and transparent communication systems within the service. The provider had some management systems in place to assess and monitor the quality of the service provided to people. However, some of these were not always implemented effectively to ensure records were robust and information gathered was not always used effectively to drive improvements within the service.

This inspection took place on 3 February 2016 and was announced. We gave the provider 48 hours’ notice that we would be visiting. This was because the provider offers a supported service to people living in their own homes and we wanted to make sure that people and staff would be available to speak with us.

Diverse Care Services currently provides personal care for 69 people within their own home.

There was a registered manager in post at the time of 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.

Following our last inspection on 16 and 17 February 2015, we found the provider was not fully compliant with the regulations we inspected. We had concerns that the provider’s risk assessments were not detailed enough. There were incidents of late calls to people, resulting in their care not being received on time. Staff skills required updating especially relating to the Mental Capacity Act (MCA) and Deprivation of Liberties Safeguarding (DoLS). Systems to monitor and improve the quality of service were also ineffective. Following the inspection in 2015 the provider submitted an action plan to CQC to address the issues highlighted in the report. During this latest inspection we could see that all of the previous concerns had been addressed and rectified.

We saw that people were kept safe by the staff and that they knew how to protect people and minimise the risk of abuse.

People were protected from the risk of abuse because the provider ensured that staff had received the training they needed to recognise and respond to the risk of abuse.

People were protected from the risk of harm because risks to people were assessed and the provider had put steps in place to minimise them.

People received flexible and responsive care because they were supported by sufficient numbers of staff.

People received their medicines at appropriate times and accurate records were maintained.

People felt they had good access to health care support when required and that staff responded to health care issues in a timely manner.

People and relatives we spoke with felt listened to by staff and that their requests were acted upon in a timely manner.

People felt that staff treated them with dignity and respect.

People and relatives were involved in the development of care plans and were able to express how they preferred to received care.

Staff were supportive in helping people to maintain their independence as far as was practicable.

There was a positive relationship between the people, relatives and the provider.

People and relatives were confident that the manager would respond positively to their requests and staff were happy working for the provider

Staff had regular supervision and appraisals and felt valued by the manager.

The provider had robust quality assurance and data management systems in place to ensure quality of service provision.

We undertook an announced inspection on 16 and 17 February 2015. We told the provider two days before our visit that we would be inspecting them. We did this because we needed to make sure that they would be at their office during our visit.

The agency registered with us in May 2014 to provide personal care and this was their first inspection.

The provider told us that they were supporting 65 people in their own homes.

The location is required to have 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 and associated Regulations about how the service is run. At the time of this inspection a registered manager was in post.

We found people’s risk assessments were not detailed and staff did not have the information they needed to keep people safe.

People were protected against the risk of abuse.

A medication policy was in place and staff were trained to support people with their prescribed medicines.

People experienced late calls and did not receive care and support at the agreed times.

Staff did not always have the skills and knowledge to care and support people they undertook visits to.

The Mental Capacity Act 2005 (MCA) states what must be done to ensure the rights of people who may lack mental capacity to make decisions are protected. Staff did not understand the requirements of the MCA of DoLS.

People told us that staff were caring and kind toward them and respected their privacy and dignity.

Systems in place to monitor and improve the quality of service provided to people were not effective.