This inspection took place on 4, 8 and 10 August 2017. The provider was given 48 hours' notice because the location provides a domiciliary care service and we needed to ensure that the registered manager would be present. When we last inspected this service on 19 and 20 July 2016, we identified breaches of regulations 11 and 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches of regulations related to risk assessments, medicines management and compliance with the Mental Capacity Act (2005). We also identified concerns related to staff training. Surecare Enfield is a domiciliary care agency based in North London which provides home based care for adults primarily living in the London Boroughs of Enfield and Haringey. At the time of the inspection, there were 83 people using the service.
The service has 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.
At this inspection, we found that improvement had been made to how the service assessed and mitigated individual risks associated with people’s care and treatment. However, some risks to people had not been identified and risk assessments had not been updated as and when people’s care needs changed.
The provider had a quality monitoring system to ensure standards of service were maintained and improved. However, we found that there was a lack of management oversight of one complex care package.
We saw evidence of a comprehensive staff induction and on-going training programme. However, some staff had not been appropriately trained to undertake certain complex care tasks.
Medicines were now managed safely and effectively and there were regular medicines audits in place. Staff had completed medication training and regular competency assessments.
All staff had received training on the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS) and staff understood what to do if they had concerns with regards to people's mental capacity. Where decisions were made in a person’s best interests, this was documented in the person’s care assessment.
People and relatives told us they felt safe. Procedures and policies relating to safeguarding people from harm were in place and accessible to staff. All staff had completed training in safeguarding adults and demonstrated an understanding of types of abuse to look out for and how to raise safeguarding concerns.
Staff received regular documented supervisions and an annual appraisal. Staff were safely recruited with necessary pre-employment checks carried out.
We received positive feedback from people and relatives regarding the caring and supportive nature of staff.
People were supported to maintain good health and had access to healthcare services, where necessary.
The service regularly requested feedback from people who used the service.
We received positive feedback from people and relatives regarding the overall service provision received. Staff spoke positively of the support they received from management.
We identified three breaches of regulations relating to risk assessments, staff training and good governance. You can see what action we told the provider to take at the back of the full version of the report.