Divinus Support Limited is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community.

This was an announced, inspection which commenced on 12 February 2018. There were 40 people using the service. We gave 48 hours’ notice of this inspection to make sure that people who used the service and staff would be available to speak to us.

The service had 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.

This inspection was bought forward from the planned date due to concerns raised by the local authority regarding the care provided to people.

At the last inspection of 29 July 2016, the service was rated Good. At this inspection we found the service has deteriorated to Requires improvement.

At this inspection, we found that there was a lack of managerial oversight of the service. Effective quality assurance checks were not in place to enable the registered manager and senior staff to assess and monitor the quality of the service. The service arrangements were not robust as they had not recognised the issues we identified during our inspection. Improvements were required to ensure that all staff employed by the service received training in the Mental Capacity Act 2005.

Despite this training not being in place we found at the time of the inspection that people were supported to have maximum choice and control of their life and staff supported them in the least restrictive way possible.

Recruitment checks had been completed on all staff before they commenced working at the service. However, processes had not been recorded with regard to employing and supporting staff of the same family. Suitable arrangements were not in place to ensure that newly employed staff received suitable training opportunities, robust induction, formal supervision and an annual appraisal of their overall performance. The provision of planned staff supervision and reviewing peoples care plans had declined over the past three months. This was due to care staff leaving the service and despite attempts, the recruitment of sufficient new staff members had not been successful. The service continued to try to recruit additional staff. As a result, the senior managers of the service were frequently providing care to people at the expense of the managerial oversight of the service.

Suitable control measures were not always in place to mitigate risks to the people using the service. Risk assessments had not been developed for all areas of identified risk to people and the service had not successfully communicated with other professionals so that there were clear care plans in place.

Despite the above, people told us that they felt safe. The senior staff were providing regular care visits and people told us that there had not been any missed calls.

The medicine records were unclear as to whether people had taken their prescribed medicines. At the time of our inspection medicines audits were not being carried out but were planned for the future.

Although staff delivering care were supporting people and people told us they were well cared for, the senior staff of the service were not always acting in a way that demonstrated that they cared about the wellbeing of the people they supported. This was because they did not ensure that the service being delivered maintained people’s safety and wellbeing.

People spoke positively about the way staff treated them and reported that they received appropriate care. Staff demonstrated a good knowledge and understanding of some of the people they cared for and supported, such as people with a diagnosis of diabetes, but this information had not always been

The inspection took place on the 29 July and 2 August 2016 it was unannounced. This was a small sized domiciliary care service that provided support to around 50 people. The service provided personal care and support services for a range of people living in their own homes. These included older people, people living with dementia and people with a physical disability.

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.

People told us that their experiences of using the service were positive. People told us they felt safe, that staff were kind and the care they received was of good quality.

There were systems and processes in place to keep people safe. Assessments of risk to people’s health, welfare and safety had been undertaken and there were clear instructions for staff on what action to take in order to mitigate them. Staff knew how to recognise the potential signs of abuse and what action to take to keep people safe. There was enough staff at all times to meet people’s needs and employed new staff at the service using safe recruitment practices.

Assessments were undertaken to identify people’s support needs and care plans were developed outlining how these needs were to be met. We found that care plans were detailed which enabled staff to provide the individual care people needed. People told us they were involved in implementing the care plans and were consulted about their care to ensure wishes and preferences were met. Staff worked with other healthcare professionals to obtain specialist advice about people’s care and treatment.

The provider had arrangements in place for the safe administration of medicines. People were supported to receive their medicine when they needed it. People were supported to maintain good health and had assistance to access to health care services when needed.

The service considered peoples’ capacity using the Mental Capacity Act 2005 (MCA) as guidance. Staff were trained in understanding the MCA and observed the key principles in their day to day work checking with people that they were happy and consented for them to undertake care tasks before they proceeded.

People were supported at mealtimes to access food and drink of their choice where needed.

The service had good leadership and direction from the manager. Staff were fully supported by management to undertake their roles. Staff were given training updates, supervision and development opportunities. For example, staff were offered to undertake additional training and development courses to increase their understanding of needs of people using the service.

The service asked for feedback from the people who used the service weekly by visiting them or over the phone. The management team also carried out direct care so were in a position to assess whether people’s needs were being met and received feedback. The service also sent surveys to people and their relatives to ask their opinion of the quality of the service they received. The quality assurance policy stated that the survey results would be used to identify areas of the service that needed to be changed to improve the quality of the service. People we spoke with were aware of how to make a complaint and felt they would have no problem raising any issues. They told us that they had no complaints and if they had any problems they discussed them with the management team and they responded to them quickly and to their satisfaction.

Divinus Support Limited provides a service to people in their own homes. People are supported through personal care and household tasks to promote their health, welfare and independence.

Our inspection team was made up of one inspector. As part of this inspection we spoke with a total of five people who used the service or their relative, the registered manager and four care staff. We also reviewed records relating to the management of the service which included four care plans and four staff files.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us and the records we looked at.

Is the service safe?

There were detailed care and support plans for each person who used the service. Care plans had been reviewed. There was a phone number for emergencies out of hours and a plan in place in case of adverse weather. Care plans and risk assessments had been reviewed quarterly or sooner if a person's needs had changed.

A relative we spoke with told us, "The staff are very knowledgeable about the needs of X." This meant that people were supported by staff who knew their needs well.

Is the service effective?

The service undertook assessments with the person who used the service or a relative to identify their support needs. The service was using the skills and knowledge of staff members to provide the required service to meet people's needs. Staff had received regular supervisions and appraisal's and the staff we spoke with confirmed this. One person told us, "I received regular supervision and training updates."

Is the service caring?

People who used the service or a relative had been involved in decisions about their care and support. Staff supported people and advised them, but allowed the person who used the service to make the final decision. A relative of a person who used the service told us, "They are very kind to me." Another person said, "The staff are polite and caring."

Is the service responsive?

The service liaised with other health professionals to meet the needs of people who used the service. People's individual needs had been assessed and staff were aware of their needs. One person who used the service told us, "Sometimes I need to change the time of a visit, the agency were able to arrange this for me.”

Is the service well-led?

There were processes in place to monitor and improve the quality of service delivery. The provider had taken action to improve the quality of the service by reviewing feedback from people who used the service, staff and external organisations. Accidents and incidents were being monitored and responded to in order to protect people using the service.

People who used the service had been provided with information about how to make a complaint. People we spoke with told us that they felt able to raise any concerns with the staff that visit them or with people in the office.

Staff had received regular supervisions and appraisals and the staff we spoke with confirmed this. One person told us, "I receive regular supervision and training updates. "Staff had also received regular refresher training updates. Staff we spoke with told us that the manager was very supportive.

We carried out an inspection on two different dates. The first date we visited the office to look at some paperwork relating to the running and management of the business and looked at care records. During the second visit we visited four people using the service and met with either their care staff or relatives. One person told us, “You can set the clock by the staff. They are always on time and reliable.” Another person said they, “They are superb.” Another person showed us their timetable which showed they had a regular team of carers and always knew who to expect. They told us, “Even if the carers are just a few minutes late they call and let me know.”

We looked at six people’s care plans and found although some plans accurately reflected people’s needs and told us how they wished their support to be provided, other care plans gave us very little detail of how to meet people’s needs. We found some people did not have risk assessments in place. For people with communication difficulties there was nothing in place to tell staff how to meet their needs. However we spoke with three staff and they gave clear accounts of how to meet people’s needs and we could see the business was managed effectively which meant people using the service had regular carers who knew their needs well.

We identified some concerns about medication practices. People who required assistance with medication were not given appropriate support because the support they required was not clearly documented. There were no risk assessments in place relating to the safe storage of medication and safe administration of medication. We looked at medication sheets and saw recording gaps without explanation so we could not be assured people were getting their medication safely.

There were systems in place to ensure people received safe care and staff were supported through induction, training and professional development to enable them to meet people’s needs. We noted that staff were not supported to meet the specific needs of people so we could not be assured that they could assist people correctly.

We spoke with five people who used the service and one relative. People told us that they were generally happy with the service they received. One person told us they were impressed that their care staff had arrived during the severe weather in recent weeks. Another person said the service was very flexible and they had once been attended to at two in the morning when they were in need of urgent assistance. People told us that staff were always polite and respectful and they were very happy with the service. Another person said that they “Could not have coped without them” and “Staff can change their routine if I need extra help some days.”

We saw that people had agreed to their plan of care and were supported according to their changing needs. The provider had suitable arrangements to identify the possibility of abuse and prevent abuse from happening.

Staff were recruited appropriately and were trained to provide safe care including paying attention to cleanliness and hygiene.

The provider had systems to monitor the quality of service, to manage complaints and kept appropriate records.

We had the opportunity to talk with five of the people who use the service. Four of the people we spoke with were happy with the care they received. They told us that they were supported in the way they wanted to be and were able to make their own minds up about the decisions they took regarding their care. They were complimentary about the people who supported them.

One person’s relative told us that the care staff did not always stay as long as they were meant to and arrived late. However the quality assurance survey the service carried out showed that all but five of the people, who completed the survey, said that the staff always arrived on time and that they stayed as long as expected.

The service sent out 29 surveys, 21 people replied. Sixteen people said staff arrived on time and stayed for the full time. Four people said care staff sometimes arrived late and one person said the staff were always late and did not always stay their allotted time.