Surrey Homecare Limited

Surrey Homecare Limited provides personal care and support to people living in their own homes. Services are provided to older people, people with mental health issues, physical and learning disabilities and sensory impairment. At the time of the inspection 66 people were receiving care in their own homes.

People’s experience of using this service:

At the previous inspection there was a lack of leadership and governance at the service. At this inspection we found that the new registered manager and provider had implemented a system of robust auditing and improvements were made as a result. People told us that the service management was good and staff felt more supported and valued. The atmosphere amongst staff was more positive and they felt the teamwork had improved.

On the previous inspection we found that people’s medicines records were not being completed appropriately. We also found that staff were not always staying for the full length of the call as they were not provided with travel time. At this inspection we found, that the management of medicines was undertaken in a safe way and systems were now in place to ensure that people’s medicines were not missed. There were sufficient numbers of staff to provide care. Where travel time had been introduced in between calls it meant that staff stayed for the full time. There were more robust systems in place to monitor whether staff were late for a call or if they had not turned up for a call.

Care plans were more detailed and reflected information on the person’s background and their wishes around care. Staff were aware of the care that people needed as care plans contained detailed guidance. Staff also communicated the needs of people through detailed care notes and meetings.

Systems were in place to ensure that staff received appropriate training and supervision to ensure that safe and effective care was delivered. There was a better understanding by staff of how to ensure that people were consenting to their care and if they were in doubt they would discuss this with their manager. People fed back that staff were caring and considerate towards them. People maintained good relationships with staff and were treated in a dignified and respectful way.

Rating at last inspection:

At the last inspection the service was rated Requires Improvement (the report was published on the 12 November 2018)

Why we inspected:

This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received. We wanted to follow up on breaches of regulation that were identified at the previous inspection.

Follow up:

We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned for future dates.

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

There was a registered manager in post at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission (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.

At the previous inspection in February 2018 we found that incidents and accidents were not always analysed and that that the management of medicines was not always safe. We found that training and supervisions were lacking for staff and that staff were not staying for the full length of the call. There was a lack of robust quality assurance in place. At this inspection we found improvements around how incidents were analysed however that had not been sufficient improvements in the other areas. We found that the service continued to breach regulations.

Medicines were not always managed in a safe way, which put people at risk. Medicines audits were always being undertaken and where they were they did not always identify the shortfalls. However, people did say that they received their medicines when needed.

Staff had not all received the training and supervision necessary to carry out their role. Robust recruitment checks had not taken place before staff started work, which put people at risk. There were insufficient levels of staff to support people. Staff were not given travel time between calls which impacted on the amount of time they needed to spend at the call. People fed back that staff were not always spending the full time with them. We have made a recommendation around staff levels and allowing travel time between calls.

The principles of the Mental Capacity Act 2005 were not being followed and staff lacked an understanding of when assessments of capacity needed to take place. Some care plans lacked information on people’s backgrounds and interests. We have made a recommendation around this. Other records relating to people’s care were person-centred and care plans included detailed guidance for staff to follow.

Quality assurance was not robust and had not identified all of the shortfalls we identified. Audits did not have action plans in place to ensure that any shortfalls they identified were addressed. The provider had not met the warning notice in relation to this from the previous inspection.

People felt that staff understood the care they needed to deliver. Staff worked with healthcare professionals to ensure that people were supported with the healthcare needs. This included being supported with their food and hydration needs.

People told us that they felt safe. Relatives felt that their family members were safe with staff. Staff understood what they needed to do to protect people from the risk of abuse. Risk assessments were in place for people and staff were aware of how to reduce risks. Staff followed good infection control procedures. Accidents and incidents were recorded and analysed to look for trends. In the event of emergency there were plans to in place to ensure that care delivery was not impacted.

A full assessment of people’s needs took place before people started using the service. Staff understood people’s needs and were effective in communicating changes in people’s care. People were supported to access the community.

People and relatives felt that staff were kind and respectful. Staff supported people’s independence and included them in any decision-making about their care. People told us that they felt involved in their care. People and relatives developed positive relationships with staff.

People understood how to make a complaint. Complaints were investigated and actions taken to resolve complaints. People and staff provided positive feedback around some aspects of the running of the service. Staff said they felt supported and valued.

The service worked with other relevant agencies such as the Local Authority and health care professionals. The registered manager ensured that notifications were sent to the CQC where necessary.

The overall rating for this service is ‘Requires Improvement’ however on two consecutive inspections the service has been rated inadequate in Well Led. The service therefore has been placed into ‘special measures.’

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

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 and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

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.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of Safe and Well-led to at least good. At this inspection, we found that despite some improvements having been made the provider had not met the legal requirements. We found a further breaches of regulation in relation to risk management, medicines and consent.

Surrey Homecare Limited is a domiciliary care agency providing both live-in and hourly support to people in their own homes. The service provides support to older people, people with physical disabilities and those with long term medical conditions. They also provided support to people living with dementia. At the time of our inspection, there were 96 people receiving ‘personal care’.

Not everyone using Surrey Homecare Limited 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. 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.

There was a lack of oversight of incidents such as falls that meant that patterns and trends could not be identified. Medicines records contained gaps and these had not been addressed with staff. Some staff were not up to date with medicines training which meant that the provider could not guarantee people would receive their medicines safely.

People’s legal rights were not protected because staff did not follow the Mental Capacity Act 2005 (MCA). Staff had administered medicines covertly to one person without any documentation in place to assure that person’s legal rights. Where people were unable to consent to their care themselves, the provider had not followed the correct legal process as outlined in the MCA. There were gaps in staff training and in areas such as medicines and the MCA, staff training was not up to date. We also found that a number of staff had not had a recent one to one supervision.

We found that improvements made since our last inspection had not fully addressed our concerns. Checks of records were not always taking place and there was no system in place to robustly monitor people’s care experience. Where we identified a significant concern in relation to consent, the provider’s own checks and audits had not identified this to address it. Shortfalls in medicines records and documentation had not been robustly addressed by the provider’s auditing systems.

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

Most people told us that staff were punctual and stayed for their call times. However, we did receive feedback that some staff were rushed and noted that the provider’s system for scheduling calls did not always allow for travel time. We recommended that the provider reviews their staff deployment to address this.

Care was not always planned in a person-centred way. Whilst there were some areas of good practice, the level of detail in people’s care records was not consistent. We recommended that the provider reviews people’s care plans to achieve consistency in this area. People’s care was being regularly reviewed and care plans reflected people’s strengths, in order to promote their independence. People’s food preferences and dietary needs were recorded and they told us that staff prepared them meals in line with this.

People spoke highly of the staff that supported them and told us that they got along well. We observed pleasant caring interactions between people and staff during visits. Staff knew people’s needs well and told us that they got appropriate support from management. Staff were respectful of people’s privacy and dignity when providing support to them in their homes. Staff involved people in their care and people received an assessment that documented their needs before they received a service.

Staff liaised with healthcare professionals where required to ensure that people’s healthcare needs were met. Risk assessments reflected people’s needs and actions for staff to keep people safe. Staff responded appropriately to incidents to ensure people’s safety. There was a complaints policy in place and people told us they knew how to complain. Records showed that complaints had been responded to appropriately.

Surrey Homecare is a domiciliary care agency providing personal care to people in their own homes. They provide support to older people as well as people with long term health conditions. At the time of our inspection they were providing support to 120 people, although not all of these were receiving support with personal care.

There was a registered manager 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 provider did not complete effective monitoring of the service. Audits did not pick up the shortfalls which we identified and the provider had no system to analyse incidents and events to keep people safe and to ensure that care was of a high quality.

Risks to people were not always assessed which meant that plans to minimise risk were not always in place to keep people safe. However, people told us they felt safe when staff supported them and staff had a good understanding of people’s needs. Accidents and incidents were documented but actions taken did not always prevent a reoccurrence. There was no system in place to analyse accidents and incidents.

The provider carried out checks to ensure that staff employed were of good character. We did identify some information missing from staff records. We recommended that the provider carries out thorough checks when recruiting staff.

Records did not demonstrate full compliance with the Mental Capacity Act 2005 (MCA). Some people’s consent forms had been signed by relatives. There were no mental capacity assessments or best interests decisions documented explaining why relatives had provided consent. We recommended that the provider ensured that where people were unable to consent to care, the principals of the MCA were followed by staff.

Staff understood their responsibilities under the MCA and demonstrated a good understanding of how to offer people choice.

Staff were deployed in a way that people received care from consistent, punctual staff. People told us that they got along well with staff and staff knew them well.

People told us that staff were competent and skilled in carrying out their roles. The provider had effective arrangements in place to train, supervise and provide induction to staff. Regular spot checks were carried out to ensure good practice was followed. Staff told us they felt supported by the provider and could call for assistance at any time.

Assessments were completed prior to people receiving a service to ensure their needs could be met. Detailed care plans were in place and records were updated following reviews or changes in people’s needs. People were supported to access support from healthcare professionals where required. Trained staff administered people’s medicines in line with guidance from healthcare professionals.

People were encouraged to be independent and staff worked with people to offer choices. Staff had a good understanding of how to promote people’s privacy and dignity.

People told us they were confident to raise any issues about their care and when they had complained it had been dealt with satisfactorily. There was a complaints policy in place and there was evidence that complaints had been recorded, investigated and responded to. The registered manager planned to introduce a record of complaints.

The service had systems in place to monitor and improve the quality of the service provided through seeking people’s feedback and carrying out spot checks.

Staff felt well supported by management and team meetings were used for staff to speak openly and make suggestions that could improve the lives of the people that they supported.

We found a breach 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 this report.