SureCare (Preston & South Ribble, Fylde & Wyre)

At our last inspection on 18 February 2016 we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Surecare (Preston and South Ribble) is a domiciliary care agency located in Chorley, Lancashire. It provides personal care to people living in their own homes. It mainly provides a service to older adults. At the time of the inspection it provided care and support to 78 people.

The service had two registered managers in post. They knew the service well and were knowledgeable about their responsibilities with regard to the Health and Social Care Act 2014. They demonstrated good knowledge of the needs of the management and care staffing team.

We found the service had appropriate and robust safeguarding adults procedures in place and that staff had a clear understanding of these procedures. People using the service said they felt safe and that staff treated them with kindness and understanding. Staff understood how to safeguard the people they supported from abuse. There was a whistle-blowing procedure available and staff said they would use it if they needed to.

Medicine records showed that people were receiving their medicines, where required, as prescribed by health care professionals. People had access to health care professionals when required. Staff had completed training specific to meeting the needs of people using the service and they received regular supervision. The registered managers and staff had a good understanding of the Mental Capacity Act 2005 and acted according to this legislation. People’s care files included assessments relating to their dietary and other essential support needs.

Assessments were undertaken to identify people’s support needs before they started using the service. Care plans were in place detailing how people wished to be supported and people were involved in making decisions about their care. People were aware of the complaints' procedure and said they were confident their complaints would be listened to, investigated and action taken if necessary.

All of the people we spoke with told us staff turned up on time to deliver care that they were scheduled to complete. We saw that staff at the office used a comprehensive monitoring system so that they could see when staff had arrived at a person's home. Where staff were seen to be running late, they took action to reduce the likelihood of late calls. This system was also linked to people's care and support records including medicines documentation and was subject to regular monitoring in the office. This helped to ensure that people received the right level of care and support at the right time.

The provider was committed to continuous improvement and used a variety of methods to assess and monitor the quality of the service. These included implementation of technology, annual satisfaction surveys, spot checks and care reviews. We found people were satisfied with the service they were receiving. The registered managers and staff were clear about their roles and responsibilities and were committed to providing a good standard of care and support to people in their care.

Further information is in the detailed findings below.

The last inspection of the service took place on 08 September 2014, when it was compliant with all six outcome areas assessed at that time.

A visit to the agency office was conducted on 18 February 2014 by two inspectors from the Care Quality Commission. The registered manager was given short notice of our planned inspection. This was so that someone would be available to provide the information we needed to see.

The registered manager of the agency was on duty when we visited SureCare. 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 and associated regulations about how the service is run.

Records showed the staff team were well trained and those we spoke with provided us with some good examples of modules they had completed. Regular supervision records and annual appraisals were retained on staff personnel files.

Staff were confident in reporting any concerns about a person’s safety and were aware of safeguarding procedures. Recruitment practices were robust, which helped to ensure only suitable people were appointed to work with this vulnerable client group.

The planning of people’s care was based on an assessment of their needs, with information being gathered from a variety of sources. Evidence was available to show people, who used the service, or their relatives, when relevant had been involved in making decisions about the way care and support was being delivered.

Structured reviews of people’s needs were conducted, with any changes in circumstances being normally recorded. However, reviews were completed as often as circumstances dictated. Areas of risk had been identified within the care planning process and assessments had been conducted within a risk management framework, which outlined strategies implemented to help to protect people from harm.

People were supported to maintain their independence and their dignity was consistently respected. People said staff were kind and caring towards them and their privacy was always promoted.

In general, staff spoken with told us they felt well supported by the management of the agency and were confident to approach any member of the management team with any concerns, should the need arise.

Medications were, in general being well managed. Detailed policies and procedures were in place. Medication Administration Records were being completed appropriately and people told us they received their medicines on time and in a safe manner.

Below is a summary of what we found. The summary is based on speaking with relatives of those who used the service, support and administrative staff and from looking at records. The manager of the agency was on annual leave at the time of our visit to this location. However, the administrative staff were very helpful and competent in producing any additional records we requested. The two people we selected to case track were unable to talk with us on the telephone and therefore we spoke with their relative and agency staff supporting them. The relatives we spoke with gave us positive responses to the questions we asked.

If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

People we spoke with told us their relatives felt safe using the service and their dignity was always respected. Safeguarding procedures were robust and staff understood how to safeguard people they supported. Systems were in place to help managers and the staff to learn from untoward incidents, such as safeguarding concerns. This helped the service to continually improve.

People we spoke with told us the staff were kind and caring and that procedures were carried out in a safe and competent manner. Staff we spoke with were fully aware of the importance of protecting people's safety and the need to report any concerns immediately. Records showed that all workers had received a good range of training in relation to health and safety topics. This helped to ensure the staff team could protect people in their care from harm.

Is the service effective?

The health and personal care needs of those who used the service had been thoroughly assessed, with a range of people involved in their care and support. Evidence was available to demonstrate that the service responded well to concerns raised and developed appropriate action plans. This reduced the potential of untoward incidents reoccurring.

Systems were in place to ensure the service was, in general effectively assessed, so the quality of service provided could be consistently monitored. A wide range of training modules were provided for staff, with regular mandatory updates. This helped to ensure the staff team delivered effective care and support for those who used the service.

Is the service caring?

We asked relatives about the staff team. Feedback from them was positive. However, the provider may wish to note that one person discussed the appropriateness of matching staff with service users, as her relative responded better to a certain type of staff and this was reportedly not always considered when allocating care workers.

People's preferences and interests had been recorded and care and support had, in general been provided in accordance with people's wishes. Relatives we spoke with told us people's care needs were met in most instances, but when concerns were raised about care provided then the agency acted promptly and dealt with the matter in hand.

Is the service responsive?

The service worked well with other agencies and services to make sure people received care and support in a consistent way. Evidence was available to show the agency responded well to any suggestions for improvement and appropriate action was taken to rectify any shortfalls identified. Records showed evidence of examples where the service had responded well to issues raised.

Is the service well-led?

The service had a quality assurance system in place and records showed that identified problems and opportunities to change things for the better were addressed promptly. As a result, the quality of service provided was continuously monitored.

Staff spoken with had a good understanding of their roles. They were confident in reporting any concerns and they felt well supported by the managers of the service. People who used the service or their relatives completed annual satisfaction surveys. The results of these were produced in percentages and bar chart formats, for easy reference. Where shortfalls or concerns were raised these were taken on board and dealt with appropriately.

Comments from those using the service and some relatives included:

"It's 'top notch'. Absolutely first class."

"The staff are lovely. I cannot fault them at all."

"The girls in the office are very friendly and helpful when I ring up."

"If I have any concerns I just ring the office. Sarah is fantastic. Communication is great."

During our inspection we assessed standards relating to care and welfare and how people were supported to be involved in the planning of their own care. We also looked at how complaints were managed. Standards relating to staff recruitment and monitoring the quality of service provision were also inspected. We did not identify any concerns in any of the outcome areas we assessed.

Their comments included:

"This is a wonderful service. They have enabled me to stay at home and keep my independence."

"Give them a big tick. They are just great."

"I am really pleased with the service I receive. They are very, very good."

"I am very satisfied. We have had regular carers, which is good for Mum, but this last two weeks we have had some different ones. Maybe her regular ones were on holiday or something, as it seems we are back to normal now. The others were OK though, but Mum likes her regular carers very much."