Senacare Ltd

Updated 27 April 2019

The inspection: ‘We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.’

Inspection team: This inspection was carried out by two adult social care inspectors.

Service and service type: Senacare Ltd is a domiciliary care agency which is registered to provide personal care and support to people living in their own home.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection: We gave the service 48 hours’ notice of the inspection visit because we wanted to make sure the registered manager and staff we wanted to speak with were available on the day of our inspection.

What we did: Before the inspection, we asked the provider to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We reviewed the completed PIR. We reviewed other information we had about the provider, including notifications of any safeguarding concerns or other incidents affecting the safety and wellbeing of people. The provider also completed an action plan following our previous inspection detailing what improvements they were making so that we could monitor this.

An inspection site visit took place on the 14 March 2019. It included speaking to the deputy branch manager, care coordinator and field care supervisor. During the inspection, we reviewed eight people's care records, which included care plans, risk assessments and daily care notes. We also looked at medicines administration records (MARs) for two people. We also looked at six staff files checking staff recruitment, training and supervision. We looked at records relating to the management of the service which included various policies and procedures, complaints, quality monitoring and audit information.

The registered manager was away on leave at the time of the inspection and therefore we were unable to speak with him on the day of the site visit. We however spoke with the registered manager after the inspection. Following the inspection, one inspector carried out telephone interviews to obtain feedback about the service. We spoke with three people who used the service and five relatives of people who received care from the service. We also spoke with four care workers. We also contacted one care professional prior to the inspection to obtain their feedback regarding the service.

Updated 27 April 2019

About the service: Senacare is a domiciliary care agency that provides care to people in their homes. There were 27 people using the service at the time of our inspection, one person did not receive support with personal care. CQC does not regulate this part of the service. Most people using the service were older adults (over 65 years of age), although some younger adults with physical disabilities received a service. Everyone using the service lived within the London Borough of Harrow and the majority had their service commissioned by the local authority.

People’s experience of using this service: People we spoke with told us that they were satisfied with the level of care they received from the service. People told us they felt safe in the presence of care workers and said they had been treated with respect. Relatives spoke positively about the service and told us they were confident people were well looked after by care workers and treated in a caring and dignified manner.

Our previous inspection in August 2018 found that the service had failed to ensure the safe and proper management of medicines and we found a breach of regulation in respect of this. During this recent inspection on 14 March 2019, we found that the service had made improvements and had taken appropriate action to address the breach of regulation. Our previous inspection found that Medication Administration Records (MARs) were not completed correctly and it was therefore not evident whether medicines were being administered as prescribed. During this recent inspection, we found that the service had addressed this issue and found that MARs were completed fully.

Our previous inspection found that where medicines prescribed formed part of a blister pack, the service had no record on MARs of what medicines formed the blister pack. It was therefore not clear from the MARs what medicines had been administered to people. During this recent inspection, we found the service had made improvements and MARs clearly detailed what medicines were in the blister pack.

Risks to people had been assessed, updated and regularly reviewed to ensure people were safe and risks to people in relation to treatment or care were minimised.

Systems were in place to help ensure people were protected from the risk of abuse. Staff records indicated that staff had received safeguarding training and staff confirmed this. Staff were aware of the process for identifying concerns and said that they would report their concerns to management without hesitation.

Our previous inspection found that there had been instances where care workers had failed to arrive at people’s home and therefore missed visits. The electronic call monitoring system had failed to identify this and therefore the system was not working effectively. We previously found a breach of regulation in respect of this. During this recent inspection, we found that the service had taken action to make improvements. They had upgraded their electronic call monitoring system so that it clearly highlighted when a member of staff was late or missed a visit. This enabled the service to monitor staff punctuality and ensure staff stayed for the duration of the visit. They deputy branch manager confirmed that since the previous inspection, there had been no missed visits.

People were protected from the risks associated with poor infection control because the service had processes in place to reduce the risk of infection and cross contamination.

People received care and support from the same team of care workers and this was confirmed by people and relatives we spoke with. This maintained consistency and ensured that staff knew people and could build friendly professional relationships with people. People and relatives spoke positively about this aspect of the service.

People and relatives told us they were confident that care workers had the necessary knowledge and skills they needed to carry out their roles and responsibilities. Staff received a range of training, which they said was useful to their role and responsibilities.

Where people received support around their nutrition and hydration this had been documented clearly in the care plan.

Where possible people were involved in making their own decisions about their care and staff sought appropriate consent. Staff understood their obligations regarding the Mental Capacity Act 2005 (MCA).

People received care that respected their privacy and dignity as well as promoted their independence wherever possible.

Our previous inspection found that the service had failed to ensure care support plans were an accurate reflection of people's needs and we found a breach of regulation. During this recent inspection in March 2019, we noted that the service had taken appropriate action to address this and made improvements. The service introduced new format care documentation and this had been implemented. New format care support plans were person centred and individualised. They addressed areas such as people’s personal care, what tasks needed to be done each day, time of visits, people’s needs and how these needs were to be met. They also included details of people’s preferences and details of their history and interests.

People and relatives spoke positively about the management of the service. There was a clear management structure in place which comprised of the registered manager, deputy branch manager, care coordinator, field care supervisor and a team of care workers. Staff also told us that there was good communication amongst staff and they were always kept informed of important information and developments.

The service had procedures for receiving, handling and responding to comments and complaints. People and relatives told us they did not have any complaints about the service but knew what to do if they needed to raise a complaint or concern.

Our previous inspection found the service did not have effective systems in place to monitor and improve the quality of the service and we found a breach of regulation. During this recent inspection, we found that the service had made significant improvements in respect of their monitoring systems. The service had introduced new format medicines audits, visit log audits and regularly reviewed care records. We saw documented evidence that the audits identified issues and the service took appropriate action.

The service had a comprehensive system in place to obtain feedback from people about the quality of the service they received through regular telephone monitoring and home visits. This enabled the service to continuously monitor this to ensure the effectiveness of the service.

The management team and office staff demonstrated compassion and commitment to the needs of the people who used the service as well as the staff who worked for them.

Rating at last inspection: Requires Improvement. The service was inspected on 13 and 15 August 2018. The service was rated ‘Requires Improvement’ overall. The service was rated as ‘Requires Improvement’ under Safe and Responsive and received an ‘Inadequate’ rating under Well-led. The service was rated as Good under ‘Effective’ and ‘Caring’.

Prior to the inspection in August 2018, the service had been rated ‘Inadequate’ at the inspections on 24 April 2017 and 13 December 2017. This was because we found that the service was not safe or well-led.

The inspection on 13 and 15 August 2018, we found that improvements had been made in many of the areas where we had concerns. However, we identified risks which had not been appropriately monitored or managed and this meant that some aspects of the service were still not safe or well-led.

Why we inspected: This was a planned comprehensive inspection that was scheduled to take place in line with Care Quality Commission scheduling guidelines for adult social care services.

Follow up: We will continue to monitor intelligence we received about the service until we return to visit as per our re-inspection programme. If any concerning information was received, we may inspect sooner.