Diversity Care provides a care and support service to people who live in their own homes in and around Tamworth. We inspected this service on 8 and 9 June 2017 and at the time of our inspection 39 people were receiving a service.

On our previous inspection in July 2016 we rated the service as Requires Improvement as some people did not receive their support for the agreed length of time or at the expected time. The staffing was organised in a manner which meant staff would arrive late or at a different time than planned. Where people lacked capacity to make decisions, they had not determined who could support them to make any decisions and how this was in their best interests. There were processes to monitor the quality of the service provided, although these systems had not identified these concerns. Further improvements were still needed including how new staff were recruited into the service. On this inspection we saw improvements had been made in these areas.

The service had a registered manager in place 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.

People’s care was planned to meet their needs. Potential risks were identified and management plans were in place to guide staff on the best way to reduce the risks. Staff understood their role in protecting people from harm and poor care. There were recruitment procedures in place to ensure staff were suitable to work within the service. People received their medicines when they were needed. The staff knew when to give these and what to do if they were concerned or medicines were missed.

People received care and support from staff who were well trained and knew how people liked things done. Staff had effective supervision and their work was reviewed through regular checks on their performance and their work was appraised. Staff sought people’s consent before providing care and supported people when they needed help with their decision making.

People had developed good relationships with staff, who recognised where care needed to be reviewed to reflect changes with their support. People received kind and compassionate care and were supported to maintain their dignity, independence and privacy. Staff gained information about what was important to people so that they could provide care which met their preferences.

People were provided with information about raising concerns or complaints and were happy to speak with staff about their worries. People were given opportunities to share their views of the service. There were audits in place to monitor the quality of the service to identify where improvements could be made.

People’s care was planned to meet their needs. Potential risks were identified and management plans were in place to guide staff on the best way to reduce the risks. Staff understood their role in protecting people from harm and poor care. There were recruitment procedures in place to ensure staff were suitable to work within the service. People received their medicines when they were needed. The staff knew when to give these and what to do if they were concerned or medicines were missed.

People received care and support from staff who were well trained and knew how people liked things done. Staff had effective supervision and their work was reviewed through regular checks on their performance and their work was appraised. Staff sought people’s consent before providing care and supported people when they needed help with their decision making.

People had developed good relationships with staff, who recognised where care needed to be reviewed to reflect changes with their support. People received kind and compassionate care and were suppo

We inspected this service on 19 and 20 July 2016. This was an announced inspection visit and we telephoned the provider three days’ prior to our inspection, in order to arrange home visits with people. At our last inspection in June 2015, we identified concerns with how people were safeguarded from potential harm; how medicines were managed and how the provider monitored the service to ensure quality standards were maintained. At this inspection we saw improvements had been made to ensure staff knew how to support people and minimise risks. Where concerns were identified staff knew how to take action to safeguard people against potential harm and abuse. Medicines were managed effectively to ensure people received their medicines as prescribed. The provider had made improvements to how they reviewed the quality of the service although further improvements were still required to ensure people received the care they wanted at the right time.

The service provides care and domiciliary support for older people and people with a learning disability who live in their own home in and around Tamworth and Lichfield. At the time of the inspection 27 people were receiving a service.

There was a registered manager in the service. 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.

People generally received their support visit on time but some people did not receive their support for the agreed length of time or at the expected time. The staffing was organised in a manner which meant staff would arrive late or at a different time. The provider was flexible and had accommodated people when they wanted their time changed although this impacted on other people’s care and when they received their visits. The rotas did not include the time people wanted their visit or how traveling between the calls impacted on the allocated time.. This information was shared with commissioners of the service.

People generally had capacity to make decisions about their own care and their consent was sought before staff provided any care and support. Where the provider recognised that people may need support to make decisions they had not determined who could support the people to make any decisions and how this was in their best interests.

There were processes to monitor the quality of the service provided although these systems had not identified the concerns with when people received their support visits. Further improvements were still needed including how new staff were recruited into the service.

People received support from the same staff team and they knew who was providing their support in advance. People were treated with care and kindness and they were supported to be as independent as possible. Positive and caring relationships had been developed between staff and people who used the service. People were supported to express their views and be involved in decisions related to the planning of their care and the running of the service.

People received care and support from staff who had received training to provide the support that people wanted. The staff knew people well and how they liked to be supported. Staff received supervision and had opportunities to develop their skills to meet people’s needs.

People knew how to make a complaint if they needed to. People and staff were confident they could raise any concerns or issues with staff in the office and the registered manager, knowing they would be listened to and acted on.

We found breaches 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 the report.

This inspection took place on the 17 June 2015 and was announced. The management were given 48 hours notice because the location provides a domiciliary care service and we needed to be sure that someone would be available to speak to. There were 37 people using the service at the time of the inspection.

The registered manager was not available at this 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.’

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLs) and to report on what we find. The MCA is designed to protect people who can't make decisions for themselves or lack the mental capacity to do so. We could not see how people who lacked capacity had been involved in decisions about their care, treatment and support.

When there had been an allegation of suspected abuse this was not always reported to the local authority for further investigation.

People had missed and were at risk of not receiving their medicines. Records related to the administration of records were not effective and had dates and dosages missing.

Assessments were undertaken to assess any risks to people who used the service and to the staff supporting them. Staff we spoke to knew the risks associated with individual people.

There were staff vacancies and the management team had covered care calls to ensure people received their agreed plan of care. However other areas of the management of the service had slipped due to staff having to diversify in their roles.

The provider could not be sure that staff were of good character and suitable to work. Recruitment checks had not been effectively undertaken.

People received health care if they became unwell or were supported to attend hospital appointments.

People were supported to maintain a healthy diet.

People told us that not all staff were kind and caring, that they were not always involved in the planning of their care and care was sometimes rushed.

People told us there was no consistency in the carers they had and that they were not always informed when their carer was going to be late.

Staff told us that they did not feel empowered and able to fulfil their role. There were no clear lines of management accountability.

There were limited quality assurance systems however the systems in place were not always effective.

We found three breaches 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 the report.

We spoke with two people who received support at home from Diversity Care. They described their care as: "Very good". Each person told us that the care workers were kind, attentive and respectful. They said they had: "No complaints, whatsoever". We were told that people had telephone numbers to ring in an emergency. People found this reassuring.

We saw that people or their representatives were asked to consent to their care plans. We found that people's needs were thoroughly assessed and that care plans and the delivery of care took people's preferences into account. We found evidence that people's safety and well-being were considered at every stage of the care process.

We found that there had been medication errors by Diversity Care which had prompted safeguarding investigations by the local authority. The provider responded by reviewing the medicines administration policy with all staff and by following disciplinary procedures with some staff.

The provider and the service manager had developed quality assurance systems to check that the service people received met their needs and that care workers went about their work in an appropriate way. People who used the service were asked for their views about the service.

We saw that problems with record keeping had been identified. In response, the service had developed strategies designed to prevent a recurrence of this.

We spoke with three people who received support at home from Diversity Care. They described their care as, "Excellent", "Very good". Each person told us that the care workers were kind and very pleasant. They said they had, "No complaints, whatsoever". We were told that people had telephone numbers to ring in an emergency. This was very reassuring for people. They told us that when they did need urgent help, Diversity Care always sent someone out, usually within 30 minutes.

We saw that people or their representatives were asked to consent to their plans. We found that people's needs were thoroughly assessed and that care plans and the delivery of care took people's preferences into account. We found evidence that people's safety and well-being were considered at every stage of the care process.

We spoke with two care workers and read three employee files. We found evidence that care workers underwent safe recruitment processes; they had a six-week induction period and received ongoing training and supervision. The registered manager had developed quality assurance systems to check that the service people received met their needs and that care workers went about their work in an appropriate way. People who used the service were asked for their views about the service.