SureCare Services (Wessex)

SureCare Services (Wessex) is a domiciliary care agency providing personal care to people living in their own houses and flats in the community. 42 people were using the service at the time of this inspection. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

People’s experience of using this service and what we found

At our last inspection in April 2021, the provider had failed to robustly review the risks relating to the health, safety and welfare of people and ensure medicines were managed safely. This had been a breach of regulation 12. At this inspection the provider had made improvements and was no longer in breach.

Medicines were being administered safely. Improvements had been made to the auditing system in place to review medicines.

At our last inspection in April 2021, the provider had failed to assess, monitor and improve the quality and safety of the service. This was a breach of regulation 17 and a warning notice was served. At this inspection we saw enough improvement had been taken to meet the warning notice and breach.

Quality assurance systems had been developed and implemented to ensure the service people received was reviewed and improved where required.

Accidents and Incidents were recorded and reviewed in order to drive improvement and reduce future risk. Following a recent safeguarding concern, the registered manager had ensured lessons were learnt and implemented safer operating strategies.

People told us there were sufficient staff to meet their needs. People said staff arrived on time, did not rush them and they had not experienced any missed visits.

The service had a positive culture and people and staff told us they were happy and had built comfortable and mutually trusting relationships.

People were aware of who the registered manager was and said she was available if they needed to speak with her. Staff told us they were well supported by the registered manager.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 14 May 2021) and there were two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection to follow up on the warning notice served and the action we told the provider to take at the last inspection.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for SureCare Services (Wessex) on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

SureCare Services (Wessex) is a domiciliary care agency providing personal care to people living in their own houses and flats in the community. 41 people were using the service at the time of this inspection. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

People’s experience of using this service and what we found

At our last inspection December 2018, medicines had not been managed safely for people and the provider was in breach of regulation 12. At this inspection the provider had not taken action to address these concerns and remains in breach for a consecutive time.

Risk assessments and incident reporting lacked detail. This was evidenced following incidents where it was unclear if any actions had been taken to minimise the risk of a reoccurrence.

Recruitment practices in the service had not always been undertaken safely. We made a recommendation to the provider in respect of this.

Despite areas of improvement being noted at the last inspection in December 2018, the provider had not taken the necessary action to address these concerns in a timely manner. This was a breach of regulation 17.

There were mixed indicators about the culture of the service. People spoke positively about the care and support they received, and staff were all positive about their role, the staff team and organisation. However multiple entries in care records showed disrespectful and undignified language used when evidencing people’s care and support.

People all told us they felt safe with the staff who came to support them and had no concerns.

People all knew who the registered manager was and most had met her in person. People we spoke with praised the staff for their care and kindness shown.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 4 March 2019).

At this inspection enough improvement had not been made and the provider was still in breach of regulations.

The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

The inspection was prompted in part due to concerns received about the providers response to a safeguarding incident that CQC were made aware of in February 2021. A decision was made for us to inspect and examine those risks.

The inspection was also planned to follow up on action we told the provider to take at the last inspection.

We have found evidence that the provider needs to make improvement. Please see the Safe and Well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for SureCare Services (Wessex) on our website at www.cqc.org.uk.

Enforcement

We found no evidence that people had been harmed however, systems were either not in place or robust enough to demonstrate safety was effectively managed. This placed people at risk of harm. This was a continued breach of regulation 12 (Safe Care and Treatment) and a breach of regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

Full information about CQC’s regulatory response to this is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At this inspection the rating of the service had deteriorated to requires improvement.

SureCare Services (Wessex) is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults and adults living with dementia or a physical disability, a mental health disorder or sensory impairment.

Not everyone using SureCare Services (Wessex) receives 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.

There was a registered manager in post. They had worked at the service for approximately 20 years. 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 was available throughout the inspection.

At this inspection, we found management responsibilities had not always been fulfilled effectively. This was because audits had not identified some shortfalls and sufficient action had not always been taken.

During the period of the inspection, an allegation of abuse was made. The registered manager took appropriate action regarding the alleged abuser but did not review the procedures and the support of others, in relation to the allegation. This did not ensure additional safeguards were put in place.

People’s medicines were not always being safely managed. Information was not available to staff to ensure ‘as required’ medicines were administered as prescribed. Staff had not consistently given a person their pain relief as they believed it made them sleepy. A review of the person’s medicines had not been requested.

Not all staff had completed up to date training in topics such as the safe handling of medicines, safeguarding and moving people safely. This did not ensure staff had the required skills to support people safely and effectively. Not all staff had been regularly observed whilst working with people. This lack of supervision did not demonstrate staff were working in line with management expectations.

People’s support plans, whilst regularly reviewed, varied in their content. Some information was detailed and showed people’s preferred routines. Other information was not as clear and follow up action was not always documented.

People received a reliable service, which was responsive to their needs. They were supported at a time that was convenient to them. There were no concerns about missed or late visits.

People were supported by a single member of staff or small team. This enabled established relationships to be built. Staff knew people well and were clearly aware of their needs. People were complimentary about the staff supporting them.

New staff were safely recruited. Staff received a comprehensive induction to help them become familiar with their role. Staff felt well supported and were complimentary about the registered manager and their management style.

There was a strong, caring ethos and people were treated with kindness and compassionate. Staff promoted people’s rights to privacy, dignity and independence.

People were fully assessed before being offered a service. This enabled people to discuss their requirements and be assured the service could meet their needs.

People were encouraged to make decisions and direct their support. People were supported with meal preparation and housekeeping tasks if this is what they wanted.

During the inspection, we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and we made two recommendations.

You can see what action we told the provider to take at the back of the full version of the report.

There was a registered manager in post at 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 told us they felt safe and the support they received was good. Staff knew how to assist people to maintain their safety. Staff understood their responsibility to protect people from harm and abuse and they knew how to report any safeguarding concerns appropriately. Individual risks around people's condition and their environment were assessed and recorded.

The provider had systems in place for the safe administration of medicines. People were supported to receive their medicine when needed. People were supported to maintain good health and were assisted to access to health services when required.

People were cared for by staff that were knowledgeable about their roles and responsibilities and had the relevant skills and experience. Staff received training required for their roles and they told us they were well supported by the management team. There were sufficient staff to meet people's needs and people received their support as planned.

Records relating to the recruitment of new staff showed relevant checks had been completed before staff worked unsupervised with people.

The staff followed the requirements of the Mental Capacity Act 2005 (MCA). This protected the rights of people who may not be able to make important decisions themselves. People benefitted from staff that understood and implemented the principles of the act. People told us they were involved in making decision about support they received.

People told us they were able to form caring relationships with the staff and that staff respected their dignity and privacy. People's confidentiality was respected and their independence was promoted.

People's needs were assessed prior to commencement of the service to ensure their needs could be met. People's care records contained details of people's personal preferences, likes, dislikes and health needs. People's care plans were up to date and reflected people's current needs.

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The registered manager sought people's opinions using satisfaction surveys and spot checks. People told us they knew how to raise concerns and they were confident any issues would be promptly addressed.

The management regularly audited the quality of service delivered. The registered manager had a system to monitor the accidents to identify any trends or patterns. There was an open and positive culture at the service and clear lines of accountability. Staff commented they felt valued and they enjoyed working at the

service.

All of the people we spoke with said they were highly satisfied with the service they or their relative received. They told us they usually had regular care staff who knew them and their care requirements. One person said 'top class! Excellent! The girls are so friendly. I get the care that I want. They do more than they have to.' Another person told us 'lovely. It's (the care) like heaven. They (staff) are so friendly. I'm always glad to see them come in. We have a bit of banter. They're like part of the family.' People told us they appreciated the reliability of the care staff and that they were informed if their carer was going to be late.

The staff we spoke with were knowledgeable about the people they cared for. They were able to describe people's care needs which were in line with the care plans we looked at. Staff gave us examples of how they ensured people consented to the care they received.

We saw from people's care records there was regular contact with other health care provider's to enable safe, effective care.

The provider had a system to ensure the safe administration of medicines.

Overall the provider had an effective quality monitoring system.

Overall staff were appropriately qualified although some of the training required updating. Staff understood how to recognise and report abuse. Staff told us they were well supported. and we noted staff received regular supervision and annual appraisals.

There were enough staff to provide care and for people to have their regular carer. People told us they were informed if staff were going to be late.

The provider had an effective system to monitor the quality of the service.