The inspection took place on 19 and 24 July 2018 and was announced. We gave the service 48 hours’ notice of the inspection visit because we needed to be sure that staff would be available to meet with us.

At the last inspection on 31 May and 2 June 2017, we found that the provider was in breach of Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance). We rated the service as ‘Good’ in effective and caring and ‘Requires improvement’ in safe, responsive and well led with an overall rating of ‘Requires improvement’.

We asked the provider to complete an action plan to show the improvements they would make to the key questions of safe, responsive and well led to at least Good.

We found some improvements had been made to the service when we returned on 19 July 2018. However, the service was in breach of Regulation 18 (Staffing) and continued to be in breach of Regulation 17 (Good governance). We rated safe, effective, caring and well led as ‘Requires improvement’ as the training of staff, quality monitoring and management oversight needed action to be taken. Responsive was rated as 'Good' as care plans were person centred and up to date. We have judged their overall rating to be ‘Requires improvement.’

Divine Care Providers is a domiciliary care service. It is registered to provide the regulated activity of personal care to people in their own homes including older people, people with dementia, people with a physical and sensory impairment, mental health and younger adults. At the time of the inspection, there were 44 people using the service and 23 care staff supporting them.

There was 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 2008 and associated Regulations about how the service is run.

The system for the induction, training and supervision of staff was not sufficiently effective or robust to ensure staff had the necessary information, skills and knowledge to carry out their role effectively.

There were insufficient staff with the right skills and knowledge to care for people safely. The registered manager and other managers had to provide care to ensure the rota was covered. The management and monitoring of staffing and recruitment practices needed improvement.

A robust system to manage, monitor, measure and review the quality and delivery of the service was still not in place. The provider had not invested time and resources into making the service well led. The lack of investment and improvement did not provide evidence that the service was well led and managed.

The assessment, recording and reviews of people’s needs and associated risks had been improved in order to keep them safe.

Staff had knowledge of the safeguarding procedures and were clear about the actions they would take if they saw, heard or suspected any abuse or harm to people they supported.

People received their medicines as prescribed and the records had been improved to make the administration more effective. Infection control procedures were in place and protective equipment was available to staff.

Staff supported people with their meals and drinks so that they maintained their health and wellbeing. Staff were proactive in making sure people’s healthcare needs were met. The service worked well in partnership with other professionals and people received the health care support they needed.

The service worked in line with other legislation such as the Mental Capacity Act 2005 (MCA) to ensure that people had as much choice and control over their lives as possible. People or their representatives had consented to their care.

Staff were kind, generous and caring. People said they were listened to, involved in their care arrangements and had built up good relationships

The inspection took place on 31 May 2017 and was announced. This was because the service was a domiciliary care service and we needed to be sure someone would be in.

Divine Care Provider provided personal care and support to people who live in their own homes in the community. At the time of our inspection, 49 people were using the service. The service was run jointly by two directors, one of whom was also the 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 inspection on 7 October 2015 gave the service a rating of 'Good'. During this inspection, we found that improvement was needed in the way the service assessed and managed the risk to people's health and wellbeing and monitored the quality of the service. We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We have now given this service an overall rating of 'Requires improvement.' You can see what action we told the provider to take at the back of the full version of the report.

The service did not have robust systems in place for the overall effective management of the service. Assessment, monitoring and recording systems needed improvement as there was not effective oversight of the service to ensure people received high quality care.

Risks to people’s health and wellbeing and that of the staff had not been completed to ensure safe care could be provided. The assessment process was not sufficiently detailed to provide an accurate description of people’s care and support needs.

There were sufficient numbers of staff available to meet people’s needs and there was a consistent staff team. Appropriate recruitment checks were in place which helped to protect people and ensure staff were suitable to work at the service.

Staff had a good understanding and knowledge of safeguarding procedures and were clear about the actions they would take to protect the people they supported. People’s medicines were administered to them safely and in a timely way.

Staff had induction, training, supervision and appraisals and had the skills and knowledge to carry out their roles.

People were treated with kindness and respect by staff and their dignity was maintained. Staff gave people choices and supported their rights and independence.

The service was working within the principles of the Mental Capacity Act 2005. People gave their consent to care and support and their rights were respected.

People were supported to be able to have their meals as and when they wanted them which met their nutritional needs. Their health needs were met in a timely way as staff liaised well with health and social care professionals.

A complaints process was in place and all complaints to the service had been dealt with quickly and appropriately.

Staff understood people’s needs and provided care and support accordingly. Caring relationships had developed and people were fully involved in their care arrangements.

We carried out an unannounced responsive inspection on 21 August 2014 at which three breaches of the legal requirements were found. These related to the requirements relating to workers, staffing and supporting workers.

We undertook an announced comprehensive inspection on the 30 September 2015 to check that they had made the necessary improvements. This comprehensive inspection also looked at all five key questions to provide the service with an overall rating.

Divine Care Provider Ltd is a small domiciliary care service that provides care and support to people in their own homes. On the day of our inspection, there were 39 people using the service and 18 staff supporting them.

A registered manager was in place. 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 comprehensive inspection on the 30 September 2015, we found that the provider had followed their plan which they had told us would be completed by 31 October 2014. They had made the necessary improvements.

There were now sufficient numbers of staff available to meet people’s needs. Appropriate recruitment checks were now in place which helped to protect people and ensure staff were suitable to work at the service. Staff told us that they felt well supported in their role and received regular supervision and support.

Staff had a good understanding and knowledge of safeguarding procedures and were clear about the actions they would take to protect the people they supported. The policy and practice of prompting people with their medicines was delivered safely.

Risks to people’s health and wellbeing were appropriately assessed, managed and reviewed. Support plans were sufficiently detailed and provided an accurate description of people’s care and support needs.

People were supported to be able to eat and drink satisfactory amounts to meet their nutritional needs. People were treated with kindness and respect by staff and their dignity was maintained.

Staff understood people’s needs and provided care and support accordingly. They had a good relationship with the people they supported.

An effective system was in place to respond to complaints and concerns. The provider’s quality assurance arrangements were appropriate to ensure that where improvements to the quality of the service were identified, these were addressed.

There was good visible leadership at the service.

The Inspector gathered evidence to help answer our five key questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found based on the evidence gathered during our inspection carried out on 21 August 2014. This included speaking with people who used the service, some of their relatives and members of staff who supported them and by looking at records.

The detailed evidence that supports our findings can be read in the full report.

Is the service safe?

The provider had not operated effective recruitment procedures in order to ensure that all members of staff employed at the service were of good character and had the qualifications, skills and experience necessary for the role performed. For example, of the 10 staff files we looked at only one contained notes made in connection with a formal interview process, three did not include any documentary proof of identification or a recent photograph and only one had information about the applicant’s employment history.

The provider could not demonstrate that at all times there were suitably qualified, skilled and experienced staff available to meet the health, safety and welfare needs of everyone who used the service. This was because reasonable steps had not been taken to properly identify, assess and document the skills and abilities of staff in order to ensure they could meet people’s needs.

Is the service effective?

Learning and development plans had not been put in place for any member of staff based on either an assessment of their own skills, experience and abilities or the needs of people who used the service. Records showed that most staff had been provided with basic awareness training that did not adequately take account of their background or developmental needs and was not always relevant to the role performed.

For example, basic training included information governance, basic life support, conflict management and fire safety but did not include the administration of medicines or continence and catheter care.

Is the service caring?

We looked at surveys and feedback forms which showed that people who used the service were very positive about the staff who supported and cared for them. An entry in one record stated, ‘I am happy with the care I receive from all the carers that visit me.’ An entry in another record noted, ‘Very professional, everything is very good and I love all the staff.’

A relative of a person who used the service told us, "The staff are lovely and friendly, great with [relative] and nothing is too much trouble."

Is the service responsive?

Records showed that people who used the service had a variety of needs including basic personal and continence care, food preparation and support with taking their medicines. One person had mobility needs that required staff to provide assistance with use of a hoist and another needed support in terms of catheter care.

Of the 10 staff files we looked at, only one contained sufficient information to demonstrate that the person in question had previous experience, skills and qualifications relevant to the role when employed.

Is the service well led?

We saw that systems had not been put in place to monitor the training provided to ensure that all staff received it and were kept up to date.

Records showed for example, that five members of staff had not received formal training in relation to the safeguarding of vulnerable adults, six had not been trained in the administration of medicines and seven had received no formal training in food hygiene and safety. This meant that appropriate steps were not taken to ensure that people’s needs were met by staff who had been properly trained.