What life is like for people using this service:

People were happy being supported by staff from Dolphin Care. They told us their needs were met in a personalised way by staff who were kind and caring. However, we identified significant concerns with the safety and quality of the service.

Managers had not acted promptly when allegations of abuse had been made and this had led to people suffering harm. Recruitment procedures had not been followed to help ensure only suitable staff were employed. Medicines were not always managed safely. Staff had not always completed training that was essential to their role. Governance arrangements and quality assurance systems were not robust. Managers lacked knowledge and understanding of best practice guidance and CQC were not always notified of significant events.

However, people’s rights were upheld, they were empowered to make their own choices and decisions and were involved in the development of their personalised care plans.

The service met the characteristics of Good in two areas, Requires improvement in one area and Inadequate in two areas. More information is in the full report.

Rating at last inspection:

The service was rated as requires improvement at the last full comprehensive inspection, the report for which was published on 27 January 2018.

About the service:

Dolphin Care is a domiciliary care agency providing personal care to 14 people in their own homes. It provides a service to older adults. Not everyone using the service receives the regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided.

Why we inspected:

This was a planned inspection based on the previous inspection rating.

Action we told the provider to take:

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Special measures:

The overall rating for this service is Inadequate and the service is therefore in special measures. This means we will keep the service under review and, if we have not taken immediate action to propose to cancel the provider’s registration, we will inspect again within six months to check for significant improvements.

Dolphin Care is a domiciliary care agency. It provides personal care to people living in their own houses in the community. It provides a service to 20 older adults for a total of 138 hours per week. Each person received a variety of care hours, depending on their level of need. The CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where this is provided, we also take into account any wider social care provided.

The inspection was conducted between 20 December 2017 and 5 January 2018 and was announced. We gave the provider 48 hours’ notice of our inspection as we needed to be sure key staff members would be available.

There was a registered manager 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. The registered manager is also a director of the provider’s company.

At our last comprehensive inspection, in March 2017, we identified breaches of Regulations 9, 12, 13, 17, 18 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had failed to ensure: that people's individual needs and preferences were assessed; that individual risks to people were managed effectively; that people’s medicines were managed safely; that people were protected from the risk of abuse; that sufficient staff were deployed; that robust recruitment processes were in place; that records relating to people’s care and the effective running of the service were complete and accurate; and that effective systems were in place to assess, monitor and improve the service.

We issued warning notices to the provider in respect of Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, requiring them to become compliant with the regulations by 5 May 2017 and 26 May 2017 respectively. We issued requirement notices to the provider in respect of Regulations 9, 13, 18 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Following this, the provider sent us an action plan detailing the action they would take to become compliant with the regulations. At this inspection, we found action had been taken and there were no longer any breaches of regulation.

Following our inspection in March 2017, the service was placed in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Although we did not identify any breaches of regulation at this inspection, we found further improvement was still required.

The provider had developed their quality assurance processes. However, these needed time to become fully embedded in practice. The provider used a range of methods to seek feedback from people. However, issues raised were not always addressed effectively.

Where people needed assistance to take their medicines, these were managed and administered safely. However, more robust systems were being implemented to ensure staff always received appropriate training before administering medicines to people.

Staff took appropriate action to protect people from the risk of infection. Some staff had not received infection control training, although this was being scheduled.

The provider was aware of some risks posed to staff, but had not completed individual risk assessments for staff, as required by their lone working policy. There

Dolphin Care (IOW) Limited is registered to provide personal care and the treatment of disease, disorder and injury to people living in their own homes. At the time of our inspection, they were supporting 24 people with personal care.

We had previously carried out an announced comprehensive inspection of this service on 10, 20 and 21 March 2017. Following this inspection, the service was rated inadequate and placed into special measures. Services that are in special measures are kept under review and comprehensively inspected again within six months of the published inspection report. We expect services to make significant improvements within this timeframe. For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it at its next planned comprehensive inspection and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

During the March 2017 inspection we identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These included regulations in respect of safe care and treatment; and good governance. We issued two warning notices and told the provider that we required them to take action to ensure they met those regulations by 5 May 2017 and 26 May 2017 respectively. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (location's name) on our website at www.cqc.org.uk

This inspection was not a comprehensive inspection to review special measures. We undertook this focused inspection to check that the provider had taken action in relation to the warning notices issued at the last inspection and to confirm that they now met their legal requirements in respect of these breaches. This report only covers our findings in relation to those two regulations. Therefore, we are unable to review special measures or amend the rating given at the previous inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (location's name) on our website at www.cqc.org.uk.

This inspection was announced and was carried out by one inspector on 10, 21 and 25 August 2017. The provider was given 24 hours’ notice because the location provides a domiciliary care service and we needed to be sure that someone would be in.

The registered manager had assessed the risks to people and had taken action to minimise the likelihood of harm.

People received their medicines safely and in a way that met their needs. People had access to health professionals and other specialists if they needed them.

The provider had taken action to ensure staff were supported and safe when supporting people in the community.

People’s records and those related to the running of the service were accurate and up to date.

The provider had recently established a system to monitor the quality and safety of the service provided.

Dolphin Care (IOW) Limited is registered to provide personal care and the treatment of disease, disorder and injury to people living in their own homes. At the time of our inspection they were supporting 33 people.

The inspection was announced and was carried out between the 10 March 2017 and the 21 March 2017 by two inspectors. The provider was given two days’ notice because the location provides a domiciliary care service; we needed to be sure that someone would be in.

There was a registered manager in place at the service, who was also one of the providers. 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 and their relatives told us they felt safe while being supported by care staff. However we found that the risks relating to people’s health and wellbeing, such as the risk of falls or pressure injury sores had not been documented to help staff understand those risks and the action they should take to help reduce them. Risks relating to people’s home environment were also not always identified and documented.

People’s medicines were not managed safely. The records relating to peoples medicines were not always accurate and up to date and staff did not always follow best practice guidance in respect of administering topical creams.

There were insufficient staff to meet people’s needs. This led to staff not staying with people for the length of time they had been assessed as needing. For calls where a person had been assessed as requiring two members of staff, there were occasions when only one staff member attended to support the person. The registered manager/provider did not have a robust recruitment process in place to ensure staff were suitable to support the people using the service.

The registered manager/provider failed to identify safeguarding concerns relating to people using the service and to notify the appropriate authority. Health professionals were not always called when concerns were raised in respect of people’s health and wellbeing.

The care provided to people using the service did not always reflect their preferences and individual care needs. Care records did not contain information about people’s likes, dislikes or how staff should support them in an individual way or how they preferred. Risks relating to people’s food and drink needs were not always managed effectively

People’s records of care and the records regarding the management of the service were not always accurate or up to date.

The registered manager/provider did not have an effective system in place to monitor the quality and safety of the service provided.

The registered manager/provider did not fully understand their responsibilities under their registration with CQC as a registered manager.

The registered manager/provider did not always take action to ensure that people felt supported and valued.

Staff developed caring and positive relationships with people and treated them with dignity and respect. Staff understood the importance of respecting people’s choices and their privacy.

Staff received an appropriate induction and on-going training. However, training was not always available to enable staff to meet the specific needs of people using the service.

Staff sought verbal consent from people before providing care and were aware of legislation designed to protect people’s rights.

People and when appropriate their families were involved in planning their care.

The provider sought feedback from people or their families and had arrangements in place to deal with complaints.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

The inspection was announced.  We told the provider three days before our visit that we would be coming because the service is small and the manager is often out of the office supporting staff or providing care. We needed to be sure that they would be in.  Dolphin Care provides care, including personal care, to 20 older people living in their own homes. It has been providing care for over 15 years. There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

Staff received appropriate training which was up to date in most subjects. However, training in food hygiene was not up to date. We were told one-to-one sessions of supervision were held with staff so they could talk about their work and any additional support or training they needed, but not all these sessions were recorded.

People told us their needs were met “very well”. They spoke highly of the service and said they were “very satisfied” with the care provided. One person described the service as “top notch”. Care plans provided staff with detailed information about how to meet people’s needs and people were involved in regular reviews of their care. Care plans also included risk assessments which specified action required to manage risks, such as the risk of people falling or developing infections.

When we visited people in their homes, we saw staff interacted positively with them. People and their relatives were complimentary about the kindness and friendliness of staff. Three described a lot of “banter” and “joking” which they enjoyed. One person said the staff were “very, very nice people; very polite and respectful”.

People said they felt safe with staff and appropriate policies and procedures were in place to safeguard vulnerable adults from abuse. The service followed safe recruitment practices and there were sufficient staff on duty each day to perform all the scheduled care visits to deliver care and support.

Annual surveys were conducted to gain people’s views. The latest survey showed people were satisfied with the service. One respondent said, “They do everything required and if there are any changes they listen and act accordingly.”

The service was flexible and people were able to change the times of care visits if they needed to. People told us staff were “reasonably punctual” and care visits were not “rushed”. Staff told us they were given sufficient travelling times between care visits, so did not feel pressured to leave early.

The manager told us they monitored the quality of the service by checking care plans, records of daily care and other records. Where concerns were identified, action was taken. The deputy manager conducted announced and unannounced spot checks to monitor whether staff were punctual and delivering safe and appropriate care.

Staff told us they enjoyed working for the service, took pride in their work and felt trusted. They spoke positively of the manager and deputy manager. There were plans in place to ensure the long-term continuity of the service.