Archived: Surround Care

Not everyone using Surround Care receives a 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.

At the last inspection on 28 September 2017, we rated the service Requires Improvement and asked the provider to take action to make improvements in the following five areas: person centred care, dignity and respect, safe care and treatment, good governance and staffing. The provider did take action to address our concerns.

During this inspection, which took place on 26, 27 and 28 November 2018, we found that progress had been made in each of these areas. We also received some very positive feedback from people using the service which confirmed the improvements that had been made so far. However, more time was needed to fully implement and embed some of the changes that had been made. We have therefore not changed the overall rating for the service on this occasion. This is the second time the service has been rated requires improvement. We will check these areas again at our next inspection.

Why we have rated the service Requires Improvement:

The provider had invested in a new electronic care system which would enable better oversight of care and support issues as they happened. However, the system didn’t support staff with recording the level of detail required to mitigate assessed risks to people. The registered manager told us they would request a change to the system to address this.

Improvements had taken place with staff recruitment checks, but some staff files did not contain details of staff member’s full employment history. This is a required check and needs to be obtained before new staff work at the service. The provider told us a new member of staff had been recruited to support them with making sure all required staff checks were in place in future.

Staff training had also improved, but some staff were not able to demonstrate they had the right knowledge to deliver effective care and support. Some staff were also not aware of changes in legislation and current good practice.

Improvements had been made to the systems used to monitor the quality of service provision. However, audits we looked at did not provide enough detail or in-depth analysis, to drive continuous improvement.

We found the service was providing a good service in other areas that we checked. For example:

Staff had been trained to recognise signs of potential abuse and knew how to keep people safe. Processes were also in place to ensure people received their medicines when they needed them, and to protect them by the prevention and control of infection.

Most people agreed that care staff arrived when they were expected and stayed for the correct length of time.

There was evidence that the service responded in an open and transparent way when things went wrong, so that lessons could be learnt and improvements made.

People were supported to have enough food and drink to maintain a balanced diet.

Staff worked with external teams and services to help ensure people received effective care, support and treatment. People received appropriate support with their on-going healthcare needs.

People received personalised care from staff who were helpful, kind and compassionate. They were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People’s privacy, dignity, and independence was respected and promoted.

Arrangements were in place for people to raise any concerns or complaints they might have about the service. These were responded to in a positive way, to improve the quality of service provided.

If needed, arrangements could be made to help ensure people at the end of their life were supported to have a comfortable, dignified and pain free death. There were plans to improve the information held by the service to ensure the care and support provided reflected each person’s individual wishes and preferences.

A registered manager was in post. 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 management team encouraged people using the service, their relatives and staff to get involved in developing the service, through regular feedback and updates.

Further information is in the detailed findings below.

The inspection took place on 27 and 28 September 2017. Surround Care provides assistance to people who require support with daily tasks and personal care in their own homes. The service was supporting about 170 people when the inspection took place.

There was a registered manager in place. A registered manager is a person who has registered with the CQC 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.

We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Some people did not have robust risk assessments, which identified and explored all the risks which they faced. Staff recruitment checks were not fully completed to ensure staff were suitable to work in the care sector.

There was a lack of systems to prompt office staff about how to consistently and routinely respond to accidents and incidents involving people who used the service. There was a lack of recording systems in place to evidence action taken when this happened.

Staff received regular training and an induction to their roles when they started working at Surround Care. However, the methods used to check staff’s competency following staff’s induction and during their time at the service were not robust. Staff were not always provided with training specific to people’s needs.

People were supported by staff to make choices with their daily care needs. However, the service did not assess if people had capacity to make certain decisions. Staff were not trained about the Mental Capacity Act 2005. People had not fully given their consent to share information to other agencies.

Staff were kind towards people. However, some staff did not engage with people or treat them and their homes in a respectful way.

People’s care assessments were centred on them as individuals. However, people’s reviews did not demonstrate that people had been fully involved and asked about their views of the care they received, in a meaningful way.

The provider and manager were not completing audits to assess the quality of the care provided, and putting plans in place to make timely improvements. Quality audits which did take place were not being checked by the manager. There was a lack of systems in place to ensure the service was monitored in a meaningful way. We found issues with elements of the governance of the service which the manager and provider were not aware of until we inspected Surround Care.

People were protected from experiencing harm and abuse by staff who were knowledgeable about how to do this. Staff were aware of the potential signs of abuse. The service had systems in place for staff to respond to concerns.