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Inspection carried out on 29 January 2018

During a routine inspection

The inspection took place on the 29 and 30 January 2018 and was announced. The location was previously inspected in June 2016. It was not in breach of any regulations of the Health and Social Care Act 2008 at that time, however they received an overall requires improvement rating. This was a comprehensive inspection to review the progress made and rating since the previous inspection.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to adults. At the time of the inspection they were providing a care package to 180 people whose contract of care was sub- contracted to them from another two agencies.

Not everyone using Mayfair 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.

The agency had 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.

At the previous inspection in June 2016 the service was rated as requires improvement in all domains, with an overall requires improvement rating. At this inspection we found the service provided safe, effective, caring and responsive care. The service had a committed registered manager who had made the improvements to the service. However, the lack of an electronic logging in and out system meant there was a delay in auditing if all of the care calls had been provided which has resulted in a requires improvement rating for well- led.

Staff schedules were planned in geographical areas to cut down on travel time between calls and in an attempt to reduce delays between calls. The registered manager and staff from the agency felt confident no calls were missed. However, records were not always completed to support this and some people told us they had experienced missed calls.

People were asked for feedback on the service to improve practice. The registered manager and the provider audited the service to satisfy themselves the service was running effectively. However, the task of manually auditing communication sheets for the previous month meant that gaps in care calls were not highlighted and brought to their attention in a timely manner to ensure people got the care calls they required.

Some people were happy with the care provided. They had positive relationships with staff and described staff as kind, caring, excellent, helpful and accommodating. One person described staff as like friends to them. Other people told us that the times and reliability of the calls could improve.

Systems were in place to safeguard people. Risks to people were identified and managed. People were assessed prior to the package of care commencing. They had support plans in place which outlined the support required at each call. The support plans were updated and reviewed in response to people’s changing needs.

Medicines were safely managed with people supported and enabled to self-medicate where possible. Staff were clear of their responsibilities in relation to medicine administration.

People’s privacy and dignity was promoted. Staff were respectful of the person’s home and their environment.

Staff were suitably recruited, inducted, trained, supervised and supported. This enabled them to have the right skills and training to support people effectively. Staff felt they worked well together as a team to ensure people got their required care calls.

People and their relatives knew how to raise concerns. They confirmed the registered manager was responsive to issues raised by them to offer a reso

Inspection carried out on 23 June 2016

During a routine inspection

Sevacare High Wycombe provides care and support to approximately 297 adults and older people in their own homes. This includes adults with physical disabilities and older people living with dementia. Sevacare High Wycombe does not provide services to children.

Sevacare High Wycombe has a registered manager. 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.

This announced inspection took place on 23 June and 26 July 2016. We gave the provider notice of our visits to make sure we could access the people and information we needed.

When we previously inspected the service on 30 April and 6 May 2015 we found the provider had not fully met the requirements of the Health and Social Care Act 2008 and associated regulations. This was because they did not consistently provide an effective, caring, responsive or well-led service for those people who used it.

Although we found there had been improvements made since the previous inspection, there remained areas which required further sustained improvement. People still had concerns about consistency of care, particularly of the timing and duration of their visits. There were still concerns about communication when changes in care staff took place or when care visits were subject to delay, in particular out of hours or at weekends. Records varied in completeness and detail.

Staff recruitment was ongoing and the increased numbers of staff available had made a positive impact on people’s continuity of care. Recent changes in the local authority commissioning relationship with Sevacare High Wycombe had also resulted in a more positive outlook for the service.

The registered manager and a senior manager for Sevacare told us they were currently restricting new business. This was to ensure they had sufficient capacity to cover the existing workload fully, before taking on any new commitments. Staff told us this had made their workloads more realistic and achievable.

Because this change had been relatively recent, feedback CQC received throughout the inspection reflected people’s experiences over the whole period since our inspection in April and May 2015.

Inspection carried out on 30 April 2015 and 6 May 2015

During a routine inspection

Sevacare High Wycombe provides care and support to approximately 348 adults and older people in their own homes. This includes adults with physical disabilities and older people living with dementia. Sevacare High Wycombe does not provide services to children.

Sevacare High Wycombe has a registered manager. 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.

This announced inspection took place on 30 April and 06 May 2015. We gave the provider notice of our visits to make sure we could access the people and information we needed to.

When we previously inspected the service on 13 August 2014. We found the provider had not fully met the requirements of the Health and Social Care Act 2008 and associated regulations. This was because they did not consistently provide a safe, effective, caring, responsive or well-led service for those people who used it.

We required the provider to tell us what action they would take to improve the service.

The provider wrote to us to say what action they would take and we checked progress in meeting those actions as part of our visit.

Although there were signs that there had been improvements made since the previous inspection, there remained areas which required further sustained improvement. Concerns were still expressed about consistency of care and communication when changes in care staff took place or when care visits were subject to delay.

People told us communication with the service was not always good. They cited in particular out of hours or weekends in particular.

Staff recruitment had been successful, which was beginning to have a positive impact on people’s care. Staff were also positive about recent changes which had made some of their workloads more manageable and targets achievable.

The provider had worked with the relevant local authority to reduce some of the pressures on the service and this had been reflected in a reduction in complaints, including around medicines and food.

Inspection carried out on 13 August 2014 05 November 2014

During a routine inspection

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 is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

This was an announced inspection. We gave the provider 48 hrs notice of our visits to make sure we could access the people and information we needed to.

When we inspected Sevacare High Wycombe in April 2013 we found they were not meeting the regulations which applied to staffing. We carried out a follow up inspection in September 2013 and found they had taken steps to address this and met the relevant regulations.

Sevacare High Wycombe provides care and support to approximately 341 adults and older people in their own homes. This includes adults with physical disabilities and older people living with dementia. Sevacare High Wycombe does not provide services to children.

Sevacare High Wycombe has a registered manager. 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 and associated regulations about how the service is run.

There were concerns expressed about the consistency of care staff. People told us they often had different care staff to provide their support. They were not always told this was to be the case and had to keep explaining to care staff how they wanted their care provided. Where people had the same care staff regularly, they were overall very satisfied with their care. Where they did not they were very dissatisfied.

There were concerns also about the timing of calls. People told us there were significant variations from one day to another, with little communication about when their care would be delivered. In some cases calls had been missed altogether, which meant people had not received meals or medicines as they should have done. This put them at significant risk of harm. Where people had calls at a consistent time they were overall very satisfied with their care. Where they did not they were very dissatisfied.

Concerns were also raised about the duration of calls. People told us their care was rushed on occasions. Care staff did not always stay the time the person who received care expected. Care staff told us they sometimes had ‘unrealistic’ schedules which put them under increased pressure. Where people consistently received calls of the duration they expected they were very satisfied with their care. Where they did not, they were very dissatisfied.

Care staff were provided with training and supervision to support them and team meetings were held regularly. Training included safeguarding and the implications for care practice of legislation about mental capacity and people’s right to take decisions for themselves. This meant staff knew what to do if they saw or suspected abuse was taking place and understood how to support people make decisions.

The pressures on time and care delivery meant staff felt they could not always provide care to the standard they would like. People who received care, even when it was not from a consistent team of care staff, at the expected time or of the expected duration were mostly positive about the quality of the care staff.

Pressures on staff had meant records, including those for medicines, had not always been completed. Whilst the provider had a quality assurance process which had identified this problem, the pressure on existing staff was continuing and included those staff responsible for the scheduling and monitoring of care calls. In some instances administrative and supervisory staff who were appropriately trained, had provided care for people to address care staff shortages.

Communication between people who received a care service and the provider was said by some people to be good and by others to be poor. There was a complaints procedure in place which some people had used and found helpful whilst others had found it less helpful. Some people did not want to make use of the complaints process out of fear their care would be adversely affected if they did. We found no evidence this would or had been the case.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

Inspection carried out on 4 September 2013

During an inspection to make sure that the improvements required had been made

When we visited Sevacare High Wycombe on 11 April 2013, we found there were not always enough qualified, skilled and experienced staff available to meet people's needs appropriately. We set a compliance action and required the provider to tell us how and when they would become compliant.

We received an action plan in May 2013 and carried out a further visit to the service on the 04 September 2013 to see if this had been implemented and the necessary improvements made.

We found there had been a number of new staff recruited and recruitment was continuing. We were told by local authority stakeholders Sevacare High Wycombe were now able to accept the appropriate level of work either through their own resources or by agreed sub-contracting arrangements with other approved providers of care.

We found the number of complaints about late calls and missed visits had significantly reduced since our visit in April 2013.

This provided evidence the provider was compliant as there were now enough staff to meet people's needs appropriately.

Inspection carried out on 11 April 2013

During a routine inspection

People told us care workers were kind and caring. They said they felt safe with them. One person said "They keep an eye on me and make sure I am ok." Where people required two care workers, they told us they had sometimes experienced delays when they did not arrive together. Three people told us there were now more consistent teams of care workers providing their care. However, one person told us the times of their evening visit could be any time between 7.30 pm to 9.30 pm. "The evening carers are good, but unreliable with time" was their comment. When we visited the offices of Sevacare on the 11 April 2013 we saw out of two complaints received the previous week, one had been about lack of consistency with care workers over the preceding two week period.

We looked at care plans and assessments for four people who received care. They showed evidence of the involvement in the assessment process of the person who was to receive care or the person responsible for them. We found there was a process to review care packages and ensure they remained relevant and appropriate, for example if people's needs or circumstances had changed. This showed people’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

We looked at the recruitment records for two recently recruited care workers. We found there was an effective recruitment and selection procedure in place.

Inspection carried out on 20 December 2012

During a routine inspection

People told us they were satisfied with the care and support they had received from Sevacare. They agreed care staff treated them with respect. When we asked about the way personal care was provided, they told us they felt their dignity was appropriately protected. People said they felt able to express their views about their care.

We saw a copy of the provider's Statement of Purpose and Service User Guide. This clearly set out the assessment process, the services which could and could not be provided and terms and conditions relating to payment. There were details of how the quality of service would be monitored and how concerns or complaints could be raised. Full contact details were provided for independent bodies to whom representations could be made if the person using the service was dissatisfied with their care.

People told us they felt safe with their care workers. They said they would speak to their family or contact the office if they had any concerns at all.

Care staff told us they had received training on the safeguarding of vulnerable adults. We were able to confirm this from training records seen. When we spoke with the manager and a member of the care staff team they had a good knowledge of what constituted abuse, how it could be recognised and what to do if it was seen or suspected.

Inspection carried out on 19 July 2012

During an inspection to make sure that the improvements required had been made

Between the 19 and 27 July 2012 we spoke to five people who used the service.

We spoke with two people who had previously said that they were not satisfied with their care.They told us that since May 2012 this had improved and they now had a more settled pattern of call times and care workers.This meant they experienced a more consistent and reliable service.

We also spoke with three other people who used the service.They said they were satisfied with their care and the way it was provided.They were in particular pleased with the individual care workers; "They are nice and cheerful" one person told us.

Inspection carried out on 23 April 2012

During an inspection in response to concerns

When we spoke on the telephone between the 23 April 2012 and the 26 April 2012 with people who receive a care and support service from Sevacare High Wycombe, or those responsible for them, we received very different views and assessments of the quality of the care being experienced.

The views expressed ranged from; "very poor at times" and "rubbish" to "absolutely wonderful" and "They actually care" (speaking about their care workers). All of the people we had conversations with told us that they had been contacted by the agency to ask their views about the quality of the service.

When we talked with people who receive care and support specifically about the number of different carers they have, they told us that this has been a significant concern in the past twelve months and whilst three people told us that they thought it had recently improved and that they now had a more consistent team of care workers, four other people told us that it still remained a problem and that some of the care workers,( but not all), didn't know what they were supposed to be doing and had to be told.

When we asked people who receive a care and support service and who require two care workers to provide support each visit, one person told us that there are always two care workers provided and another two people told us that sometimes, including in one case the week previously, they had only had one care worker instead of two.

In conversations with people who receive a care service from Sevacare High Wycombe the highest levels of satisfaction were expressed by those people who received a consistent service in terms of time and care workers and the lowest levels of satisfaction were expressed by those who received an unreliable or inconsistent service from a large number of different care workers.