Archived: Surround Care

Updated 5 January 2019

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 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 Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This comprehensive inspection was announced and was carried out on 26, 27 and 28 November 2018 by two inspectors and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

We gave the service six days’ notice of the inspection, because we needed information to assist us with our planning, such as contact details for people using the service. We also wanted to ensure key staff members would be present on the day.

Before the inspection we checked the information, we held about the service and the provider, such as notifications. A notification is information about important events which the provider is required to send us by law.

We used information the provider sent us in the Provider Information Return. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. We also asked for feedback from the local authority who have a quality monitoring and commissioning role with the service. No concerns were raised.

During the inspection we used different methods to help us understand the experiences of people using the service. The inspectors visited the office location to speak with staff and review records. The Expert by Experience made telephone calls to a random selection of people using the service; to gain their feedback about the service they received. In total, we spoke with 20 people using the service or their relatives, the provider, the registered manager, a care coordinator and five care staff - including two seniors.

We then looked at various records, including care records for three people, as well as other records relating to the running of the service. These included staff records, medicine records, audits and meeting minutes so that we could corroborate our findings and ensure the care and support being provided to people was appropriate for them.

Updated 5 January 2019

Surround Care is a domiciliary care agency providing personal care to people living in their own houses and flats. It provides a service to children above 13 years of age and adults who have a variety of care and support needs including: dementia, learning disability / autistic spectrum disorder and mental health. In addition to a personal care service, people can also choose to receive support with companionship and domestic tasks, such as shopping. At the time of this inspection there were 180 people using the service, all of whom were adults.

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.