On the 01 and 10 March 2017 we inspected the offices at Dignicare and made phone calls and home visits to people and their relatives on the 08, 10 and 13 March 2017. At the time of our inspection, there were 123 people using the service. This was an announced inspection which meant we gave the provider 48 hours’ notice of our visit.

Dignicare is a home care service providing personal care to people in Bradford, Craven and Airedale.

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 and associated Regulations about how the service is run. The registered manager was present throughout the inspection.

The service was following the guidance in people's risk assessments and care plans and the risk of unsafe care was reduced. People's records were up to date and indicated that care was being provided as detailed in people's assessments. The records had been updated to reflect changes in people's care needs.

Medicines were managed safely. We saw medicines were administered by trained staff according to people’s prescriptions.

People were safeguarded from abuse because the provider had relevant guidance in place and staff were knowledgeable about the reporting procedure.

The provider's arrangements for staff recruitment and deployment helped to make sure there were staff who were of suitable character to provide care for vulnerable people.

We saw sufficient staff were deployed to support people with their needs. When staff were sick or on leave, other staff were able to fill the gap.

Staff were not always supported in their role through supervision sessions and appraisals.

We recommend that the registered manager plans and attends formal supervision meetings and appraisal meetings with staff in line with their organisational policy.

Staff understood their roles and responsibilities in caring for people.

The staff team were trained in the provider’s mandatory training courses and this was monitored by the registered manager.

The principles and requirements of the Mental Capacity Act (2005) were being met. When required, best interest processes and capacity assessments had been completed.

People were supported by staff who knew them well. Staff were aware of promoting people's safety, whilst providing information to support people to make day-to-day decisions.

People received appropriate support to manage their meals and nutrition when required. This was done in a way that met with their needs and choices.

People's health needs were met. Referrals to external health professionals were made in a timely manner.

People and their relatives told us the care staff were caring and kind and that their privacy and dignity was maintained when personal care was provided.

People and their relatives were involved in the planning of their care and support. Care documentation was changing to a new electronic system. The new system was written in a detailed, person specific and person centred way.

Complaints were well managed. The leadership of the service was praised by relatives and communication systems were effective.

Systems to monitor the quality of the service were in place and they were effective in identifying areas for improvement. Shortfalls were resolved in a timely manner and the provider had obtained feedback about the quality of the service from people, their relatives and staff.

Dignicare is a home care service providing personal care to people in the Bradford and Bingley areas of West Yorkshire and the Craven area of North Yorkshire.

A registered manager was not 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.

.As a result of the January and March 2015 inspections the Commission intended using its enforcement powers to restrict admissions and to cancel the provider’s registration. The provider was clear that the use of enforcement action was unnecessary and the justification for such action would be tested before the courts. The Commission’s inspection in June 2015 (this report) assured the Commission that enforcement action was unnecessary and that the matter need not remain before the courts.

This inspection was a comprehensive inspection where we also checked whether Dignicare had made necessary improvements. It was an announced inspection. The provider was given 48 hours’ notice because the location provides a domiciliary care service and management were not always office based.

We found improvements had been made and the service was no longer in breach of regulation.

Medicines were appropriately managed. The service had improved its systems and records were now consistently in place which provided evidence people received their medicines as prescribed. Consideration had been given to ensuring people were supported with medicines at the correct times.

We found there were sufficient quantities of staff to ensure the service delivered appropriate care that met people’s needs although currently the provider and manager were regularly delivering care. They told us they hoped to deliver care in a standby capacity only once further staff were recruited. Safe recruitment procedures were in place.

Risks to people’s health and safety were appropriately managed. The service had ensured up-to-date risk assessments were in place detailing how staff should manage identified risks.

People and their relatives all told us that the service provided high quality care. Improvements had been made to the training system with all staff now up-to-date with mandatory training. Work had been undertaken by the service to ensure new staff received induction training in line with the new Care Certificate to ensure they attained recognised standards of competency.

People’s choices were promoted through care planning and people had been asked about their preferred call times. We found that improvements to documentation were required to ensure the service could evidence that decisions made on behalf of those without capacity were made in their best interests.

People and their relatives told us they were treated well by staff who delivered a personalised and caring service. They said staff were always friendly and treated them with dignity and respect.

At previous the inspection, we had concerns about people not receiving calls at times which met their individual needs. We found improvements had been made. The timeliness of calls now showed a greater level of consistency and amendments had been made to call times where we had previously expressed concern that they were not meeting people’s individual needs. People and their relatives all said they were all now happy with the times that care workers visited.

People’s needs were assessed in a range of areas to help staff deliver appropriate care. Personal support plans were all up-to-date and a robust system of review was in place to ensure any changes in people’s needs were identified and give people the chance to make any changes to their plans of care.

A range of quality checks were now in place to help ensure the service identified shortcomings and addressed them to reduce the risk to people. Audits of call times, documentation and checks on staff practice were regularly undertaken.

People were asked for their views via periodic surveys and these showed sentiment towards the service had improved and demonstrated a high level of satisfaction with the service. This was confirmed by our discussions with people and their relatives.