Supreme Care Services Limited

Supreme Care Services Limited is a domiciliary care agency that provides personal care to people living in their own houses, flats and specialist housing in the community. The Care Quality Commission (CQC) only inspects the service received by people provided with ‘personal care’, that is help with tasks related to personal hygiene and eating. Where they do this, we also take into account any wider social care provided. At the time of our inspection there were 65 people using the service, living in the London Boroughs of Croydon and Bromley.

People’s experience of using this service and what we found

People were safe. Staff had been trained and understood how to safeguard people from abuse.

Staff understood the risks to people’s safety and wellbeing and what they should do to keep people safe. At the time of this inspection the provider was taking action to improve the quality of information for staff about risks to make this easier to read and follow.

There were enough staff at the time of this inspection to support people using the service and meet their needs. People did not have significant concerns about the timeliness of their scheduled care visits. The provider made sure the same staff attended care visits so people experienced continuity in the support they received.

Recruitment and criminal records checks had been undertaken on staff to make sure they were suitable to support people.

People were supported to take their prescribed medicines. Staff followed current practice and guidance to reduce infection and hygiene risks within people’s homes.

People had positive experiences of using the service and were satisfied with the care and support they received from staff. The provider obtained and acted on people’s feedback about how the service could continue to improve.

The provider made sure accidents, incidents and complaints were investigated and people were kept informed of the outcome. They undertook regular checks to monitor, review and improve the quality and safety of the service and addressed any issues found through these checks.

At the time of this inspection the provider was working proactively with local authorities as part of their ongoing contract quality monitoring arrangements. The provider had dealt with concerns raised in an appropriate way and was making the improvements required to the quality and safety of the support people received. The provider had also made improvements to the submission of statutory notifications to CQC of events and incidents involving people to make sure we received these without delay.

The provider worked well with healthcare professionals involved in people’s care and acted on their recommendations to deliver care and support that met people’s needs.

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

Rating at last inspection

The last rating for this service was Good (published 20 December 2018).

Why we inspected

We received concerns in relation to the timeliness of people’s care visits, missed care visits, record keeping and management and leadership at the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service remains unchanged from Good. This is based on the findings at this inspection.

We also looked at infection prevention and control measures under the safe key question. We look at this in inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service. If we receive any concerning information we may re-inspect sooner.

At our last inspection of the service in May 2016 we rated the service ‘Good’. This inspection took place on 19 November 2018. At this inspection we found the evidence continued to support the rating of ‘Good’. There was no evidence or information from our inspection and on-going 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.

People told us they were safe with staff. Staff had been trained to safeguard people from the risk of abuse and knew how to report any safeguarding concerns about people to the appropriate person and agencies. Staff understood the risks posed to people and followed current guidance about how these should be minimised to keep people safe from injury or harm. Staff followed good practice to ensure risks were minimised from poor hygiene and cleanliness.

There were sufficient numbers of staff to meet people’s needs. The provider made sure, wherever possible, people received support from the same staff to ensure continuity and consistency in the support they received. The provider maintained recruitment and selection processes and carried out appropriate checks to verify staff's suitability to support people.

People’s needs had been assessed to determine the level of support they required, and this was delivered in line with current legislation and standards and current best practice. Staff received relevant training to help them meet people’s needs. They were encouraged to continuously improve their working practices through regular supervision. Staff were aware of their responsibilities in relation to the Mental Capacity Act 2005 (MCA) and supported people in the least restrictive way possible. The policies and systems in the service supported this practice.

People were involved in planning and making decisions about their care and support package. People’s records contained current and detailed information about them and reflected their preferences and choices for how and when they received support. Staff knew people well, understood their needs and how these should be met. People’s care and support needs were reviewed with them to ensure this was continuing to meet their needs.

Staff supported people to eat and drink enough to meet their needs and keep healthy and well. People received their prescribed medicines as required. Staff communicated with others involved in people’s care so that they were well informed about people’s health and wellbeing, particularly if there were concerns about this. The provider worked closely with other healthcare professionals to ensure a joined-up approach to the support people received.

The provider promoted compassionate, respectful and empathetic behaviours within the staff team. They had introduced initiatives to reduce the risk to people, with no immediate family and friends, of becoming socially isolated. Where staff were responsible for this, they supported people to take part in activities or pursue interests that were important to them.

Staff were caring and treated people with dignity and respect. They asked people for their consent before care was provided and ensured people's privacy was maintained when being supported with their care needs. People were encouraged by staff to be as independent as they could be. Staff only took over when people could not manage and complete tasks safely.

People were satisfied with the care and support they received from staff. They had no concerns about the management of the service. Staff said they were well supported by the senior staff team. The service continued to have a registered manager in post. The registered manager understood their registration responsibilities particularly with regards to submission of statutory notifications about key events that occurred at the service.

The provider had maintained arrangements to monitor and assess the safety and quality of the service. People and staff were asked for their views about how the service could be improved. If people were unhappy and wished to make a complaint, the provider had arrangements in place to deal with their concerns appropriately. Records relating to people, staff and to the management of the service were up to date and well maintained.

The provider made improvements when these were required to enhance the quality of the service. Since our last inspection the provider had undertaken a full review of the service and implemented an improvement plan to make changes to the way the service was delivered. People and staff told us as result of these change they felt that the service had improved.

The provider worked in partnership with others to continuously improve the delivery of care at the service. Senior staff reviewed all incidents or safety concerns involving people. They used the information and learning from these to make improvements when things went wrong to ensure people’s continuing safety.

Further information is in the detailed findings below.

Supreme Care Services Limited is a domiciliary care agency providing care and support to people in their own homes. The agency supplies care staff both as direct private arrangements, and through a contract with the London Borough of Croydon. At the time of our inspection150 people use the agency, including older people and adults with physical disabilities.

A registered manager was in place. 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.

At the time of inspection the registered manager was on leave and an acting manager was in place.

At the last inspection on 29 May 2015 we found the provider was not meeting the regulations in relation to ensuring adequate staff training, supervision and appraisal. We also found there were breaches in regulations concerning the provision of person-centred care and having quality assurance systems that enabled the service to evaluate and develop the quality of their service.

We asked the provider to submit an action plan detailing the improvements to be made.

These actions have been completed and on this inspection we found that the relevant requirements were being met.

People who used the service told us they felt safe. Staff had received training about safeguarding and knew how to respond to any allegation of abuse. Staff were aware of the whistle blowing procedure which was in place to report concerns and poor practice.

There were sufficient staff employed to provide consistent and safe care to people, with people receiving care from the same small team of staff.

People received their medicines in a safe way and staff had received training in the types of medicines people received. Staff recorded medicines taken by people in an appropriate medicines record sheet.

Staff had received training and had a good understanding of the Mental Capacity Act 2005 and Best Interest Decision Making, when people were unable to make decisions themselves. They also received other training to meet people’s care needs.

Staff helped ensure people who used the service had food and drink to meet their needs. Some people were assisted by staff to cook their own food and other people received meals that had been prepared by staff.

Staff knew people’s care and support needs. Care plans were in place detailing how people wished to be supported and people were involved in making decisions about their care. There were regular visits and spot checks carried out by the service to monitor the quality of service and the care practice carried out by staff.

People told us that staff were kind, caring and efficient.

People who received care remained independent and in control of their decision making and choices. People had access to health care professionals to make sure they received appropriate care and treatment. The service maintained accurate and up to date records of people’s healthcare and GP contacts in case they needed to contact them.

A complaints procedure was available and people we spoke with said they knew how to complain, and how to contact the main office. The service maintained records of compliments and complaints and recorded how these were resolved.

People had the opportunity to give their views about the service. There was regular consultation with staff, people and/or family members and their views were used to improve the service. Regular audits were completed to monitor service provision and to ensure the safety of people who used the service.

Some of the feedback was complimentary about the care and services currently provided. People told us that the carers did a good job and were polite and respectful. One person said the carers are 'friendly and engage with mum in conversation.' Another said 'They do the best they can and sometimes they will stay a little later.'

However other people's experience of the care provided was not as positive and people told us that the care workers were sometimes late and they were not always kept informed by the office. We looked at the care records at the agency and saw that important details were not always recorded on the care plans. Staff were not always provided with sufficient guidance on how to provide care, particularly for people with more complex needs. Important details about people's health was not always recorded in the care plan. This meant at times people were at the potential risk of inappropriate or unsafe care.Some people or their relatives told us the care received had sometimes not been carried out in accordance with the care plan. People were therefore sometimes exposed to potential risk at times

Staff were aware of safeguarding policies and procedures and had received appropriate safeguarding vulnerable adults training. We found that a safeguarding issue arose in the course of our inspection which the provider failed to notify us about in accordance with the regulations.

Staff we spoke with seemed knowledgeable about infection control. There were infection control policies and procedures in place. While the provider had systems in place for quality assurance we found that there were some gaps in carrying these out and problems were not always picked up. In addition, where issues were picked up there was insufficient evidence that these were always adequately addressed.

The provider had a complaints procedure in place and although the policy was out of date they had responded to most complaints effectively. We found there were issues with the electronic recording system on the day of the inspection which were taking some time to resolve. Other records were not always accurate or available or up to date.

Some feedback was complimentary about the care provided. People felt staff were caring and treated them with dignity and respect. They told us they had regular carers and were kept informed about changes. Comments included, the 'girls (carers) that come are excellent,' 'my carer understands me,' and 'my carer does a wonderful job'. However others had experienced difficulties with late calls, particularly, at the weekends and in being kept informed of changes by the office. We were told that the service had identified an issue with weekend care and recently recruited new staff to address this.

We looked at the records at the service and spoke to the local authority commissioning and safeguarding teams. We were informed that there had been some issues in previous months about staff recruitment and response to safeguarding concerns. We saw that the service had addressed these issues with them and employed more office staff to co-ordinate care. Staff told us that they felt well supported from the office and received appropriate training. There had been some improvements made to the quality monitoring of the service.