We carried out a review of the data available to us about Sisterly Care Limited on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Sisterly Care Limited, you can give feedback on this service.
People’s experience of using this service:
• Following our previous inspection on 6 February 2018 the provider had acted to make improvements to the service and meet their regulatory requirements. An effective system was in place to monitor and assess the service, and this had been used to drive continuous improvement and deliver a good quality of care. Recruitment checks were completed to protect people from the employment of unsuitable staff.
• People and their relatives told us they received a good quality, safe and effective service. People summarised their experience in comments such as “Their (provider) service is reliable and fantastic and given with care and compassion.” Another person said, “They’re always bright and cheerful and helpful.” People said they would recommend this service to others.
• People’s needs were met by kind and caring staff and care plans described the person-centred care people required to meet their needs.
• People and their relatives spoke highly of the leadership of the service and described this as “very good”. Staff told us they were supported in their role and acted in line with the provider ethos to deliver a supportive, person centred approach which placed meeting people’s needs at the heart of the service.
Rating at last inspection: At the last inspection this service was rated Requires Improvement (23/03/2018). At this inspection the overall rating has improved to Good.
Why we inspected: This was a planned inspection based on the previous rating.
Follow up: We will continue to monitor this service and plan our next inspection in line with our methodology unless we receive any information of concern in which case we may bring this inspection forward.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
At this inspection we found some improvements had been made. However, there was insufficient improvement to meet the regulation fully and to rate the key question Well-led as Good. It therefore remains rated as Requires Improvement. We also identified a breach of Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Therefore the Safe domain is also rated Requires Improvement.
During this inspection we found two breaches of regulations. The service did not have sufficiently robust staff recruitment procedures in place and quality assurance and monitoring systems were not always effective. You can see what action we have asked the provider to take at the end of the full version of this report.
Sisterly Care Limited is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to older adults, younger disabled adults, people living with dementia and people with disabilities. Not everyone using Sisterly Care Limited receives the regulated activity. The Care Quality Commission (CQC) only inspects the service being received by people provided with personal care, which is help with tasks related to personal hygiene and eating. Where they do receive the regulated activity personal care we also take into account any wider social care provided.
The service had a registered manager in place. A registered manager is a person who has registered with 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.
Recruitment procedures were not sufficiently robust. While some checks on staff were completed fully, others were not followed up or verified. Staff files did not contain all the information required by law. Risks associated with people’s care and well-being were assessed but guidance to mitigate the identified risks was not sufficiently detailed. Staff were trained to assist people with their medicines, however there was no evidence of their competency being checked to do this safely. The medicine records we reviewed were not always completed fully.
People felt safe with the care staff who visited them. Staff were trained in protecting people from abuse and understood their responsibility to report concerns. Where necessary the registered manager had taken action to inform the appropriate authorities of reported concerns. There were enough staff to provide timely and consistent care to people using the service.
Staff were trained in the skills required to fulfil their roles and received refresher training. However refresher training was not always within the timescales recommended as best practice. We have made a recommendation that the provider refer to the current best practice guidance on ongoing training for social care staff. Staff were supported by the management and felt listened to. Staff supported people with nutrition where this was part of their care plan. People 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 told us the staff were caring and kind. They spoke about staff going over and above their duties to support them. They said they could discuss their care and make decisions or changes when necessary. People’s privacy and dignity were respected and staff were praised for doing things in the way people wanted them done. Staff encouraged people to be as independent as they possibly could or wished to be.
People’s needs were assessed prior to them using the service. Care plans reflected people’s individual and diverse needs and were kept under regular review. People knew how to make a complaint. When issues were raised they were dealt with and appropriate action taken. The service was adhering to the Accessible Information Standard.
Some improvements had been made in evaluating feedback and improving the service as a result. However, the system for auditing and monitoring the service did not always identify areas where action was required. The registered manager was committed to providing kind and compassionate care for people. They provided an open and empowering culture in the service. Staff felt valued and listened to.
This inspection took place on 6 October 2015. The inspection was announced.
Sisterly Care Limited provides personal care services to people in their own homes. They provide services to older people and people living with dementia. At the time of our inspection there were 73 people receiving support from the service, of which 44 people were receiving personal care. There were 17 care staff and six office staff which included two co-ordinators, one team leader, two administrators and a registered manager.
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.
Audits had been completed but were not evaluated to help improve practice. Surveys had been sent to staff and people but the information analysed did not match the information received in the surveys and there were no overall evaluation of the results to help the registered manager improve the service.
Prior to the inspection we had received information of concern informing us that there were not enough staff to be able to support people safely. We were told most staff were turning up late and not staying for the correct duration because the office gave staff additional calls that they had to “squeeze” in. At this inspection we found people’s care visits where sometimes provided later than planned when staff members were on planned or unplanned leave. However people did not feel rushed; there were no missed visits and staff stayed for the full duration of time.
People told us they felt safe and relatives confirmed this. Staff knew how to keep people safe from harm. Staff said they would report any concerns to the manager and were confident to inform other appropriate professionals if they felt the manager did not deal with the concerns appropriately.
Risk assessments were completed for people which identified risks to their environment and highlighted if manual handling equipment was required. Risk management plans were implemented for people who required support with manual handling equipment and staff were supported to stay safe when supporting people with the equipment.
Safe recruitment practices were followed. There were clear procedures for supporting people with their medicines. Medicine audits were also completed. There had been no medicine errors identified in the last 12 months.
People and their relatives said they received care from regular staff and felt they were well matched with care staff and they had the skills and knowledge to carry out their roles effectively. Staff received an induction programme and regular ongoing training. Staff felt supported but did not always receive supervision in line with the provider’s policy and what the registered manager told us.
The registered manager and staff demonstrated a good understanding of the Mental Capacity Act 2005 and how to put this into practice. People were supported to eat and drink and maintain good health and access ongoing healthcare support.
People and their relatives were positive about the care and support received from staff. People were involved in their care and made decisions about their care. People’s independence privacy and dignity were respected and promoted. The registered manager and staff knew people well. Compliments had been received by people and their relatives in the form of thankyou cards or phone calls to the office.
People’s needs were regularly assessed and reviewed. People’s care plans were personalised and individual, detailing how people like to receive their care. Complaints which had been received had been dealt with, responded to and actioned where required.
The registered manager demonstrated a good understanding of the service. People felt the management and office staff were good. The registered manager demonstrated a good understanding of when the commission need to be notified.
We found one 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.
During our visit to the Sisterly Care Ltd.'s office we looked at records which included care files of people who use the service, personal files of employees and information the provider used to assess and monitor the quality of the service. We visited the home of two people and spoke with two people who use the service on the telephone. We also spoke with five members of staff including the registered manager and nominated individual. During the home visits we were able to observe how staff interacted with people. We saw staff treat people in a sensitive, respectful and professional manner.
People told us told us that the staff were 'very good' and that they were 'very satisfied'. One person told us that they had a 'busy social life and staff do their best to work around me' and that they 'had no concerns or snags and were pleased with what they do'. Another person told us that they found staff 'very approachable' and that they were 'very lucky'
We saw that care plans were person centred and people's care needs were reviewed. We found that Sisterly Care Ltd had processes in place to regularly monitor the quality of the service.
We visited the office where the records were kept and spoke with five members of staff about the changes that had taken place following our visits in April and June 2012.
We looked at ten care plans and their associated records for example medicines and risk assessments. We saw records of audits that had been carried out by senior staff to ensure that planned visits by staff had taken place and that records had been completed by staff showing what support and assistance they had given. We also looked at staff files and records of training and support.
Both of these people told us that the care workers gave them their medicines which they took out of the blister packs prepared by the pharmacist.
One person told us that tea time medicines were prepared and left out to be taken later but most of the medicines were due in the morning and the care worker observed medicine administration.
Both people told us that they were happy with the care they received.
We had contact with three people that the agency provided a service to. They all said that they were happy with the service they received. They told us that the care and support they received was what had been agreed. For example, one person said, 'Things seem to be working well at the moment. I have no complaints'.
In addition to having contact with people we gathered evidence of people's experiences of the service by reviewing surveys sent to people in January to May 2012. 93 surveys were sent to people and 44 returned. These allowed people to give scores ranging from one to five depending on their level of satisfaction. The majority of people expressed satisfaction with the overall level of service received. Some people commented about difficulties contacting the agency of a weekend and visit times. As a result the agency has reissued contact details to people and is also recruiting additional staff.
We also looked at the minutes of reviews completed with people who the agency provided a service to. The majority expressed satisfaction with the care service they were receiving. For example, one person stated, 'Most of the carers arrive on time and are very nice. I have no problems with the company'.
The registered manager and nominated individual expressed the view that improvements had been made with regards to the running of the agency since we issued warning notices. The nominated individual told us, 'The service is better now as we are aware of all relevant areas and this provides continuity'. Evidence from this inspection supports this comment.
We had contact with seven people or their relatives that the agency provided a service to. People had mixed views on the service they received and many of the negative comments were substantiated with our findings.
Three of the seven people we spoke with told us of issues with late and missed visits. One person said, 'I have a regular carer most days. They are reasonably good. I cancelled the evening and Sunday visits as they never got here on time or did what was required. I had two weeks when they didn't turn up so cancelled. If my regular carer left I would stop using this agency as I don't think they could manage. I have not had a review and never seen anyone from the office'.
Three of the seven people we had contact with told us that they received support from the agency with medicines. They expressed some satisfaction with this but did raise some areas for improvement.
Six of the seven people that we had contact with expressed satisfaction with the care workers that visited them. For example, one person said, 'Oh they are lovely, really lovely'.
One person said, 'The problems are when you don't have your regular carer. It's a worry not knowing them and they don't know what they should be doing'.
Six of the seven people we had contact with knew how to raise concerns with the agency if needed. Another person told us that they knew how to raise concerns and had done this but these had not been resolved.
In addition to having contact with people we gathered evidence of people's experiences of the service by reviewing surveys sent to people in the Havant area dated January and February 2012. Twelve surveys were completed. These allowed people to give scores ranging from one to five depending on their level of satisfaction. Expressions of satisfaction varied. The majority of people expressed satisfaction with the overall level of service received. However, some people were not satisfied with review processes for their care packages, care plans not being up to date and arrangements for contacting the agency's office.
We also looked at the agency's complaints log for 01 January to 30 April 2012. During this period of time the agency provided a service to 130 people. Seven concerns were raised that all in some way related to care workers who visited people.
We spoke with seven members of staff about their roles and the support they gave to people. Some demonstrated knowledge and others did not.
All people that we spoke with said that care workers respected their privacy, dignity and independence.
Everyone said that they were happy with the support care workers provided.
People told us that in the main, they received the same staff on a regular basis and that this had helped them to build up a relationship of trust with their care worker.
People told us that they had been consulted about the times of their visits.
Some people did not know the agency's formal complaints procedure but knew of other ways to raise issues with the agency.