Secure Healthcare Limited

Secure Healthcare Limited is a care agency providing personal and complex nursing care to 65 people at the time of the inspection, some of whom where children. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

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

People did not always have regular staff to enable them to build relationships with staff and to ensure staff knew them well. The provider had recruited more staff to make improvements to this area. People and their relatives found communication within the service to be poor. People were not always able to contact staff out of hours where there were concerns and office staff did not always return people's calls.

People were supported by staff who were trained and recruited safely. People had care plans in place which detailed their needs and gave staff clear guidance to meet them. People were supported to receive their medicines as they were prescribed. People were safeguarded from potential harm and abuse.

Quality assurance tools were in place and were effective at identifying where improvements were required to people's care. People and their relatives were encouraged to give feedback about their care. Staff worked alongside external professionals, where required to support people's care.

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

Rating at last inspection

The last rating for this service was good (published 04 April 2019).

Why we inspected

The inspection was prompted in part due to concerns received about the quality and continuity of care, communication and the management of 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 has remained the same. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvements. Please see the well led section of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Secure Healthcare Limited on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People's experience of using this service:

•There was not a registered manager in place at the time of our inspection visit, however, an acting manager had been appointed who had applied to be registered with CQC.

•The provider was updating risk assessments and care records at the time of our inspection visit, following their own quality assurance checks, to make them more comprehensive and person centred.

•People's safety had been considered.

•Medicines were managed safely.

•Staff had received training in relation to safeguarding and knew how to protect people from harm.

•Staff were recruited safely and in accordance with best practice to ensure they were suitable to work with people in their home.

•People needs were regularly assessed so the service could meet their individual care needs.

•People received care from well trained staff, and were supported to have maximum choice and control of their lives; the policies and systems in the service supported this practice.

•Where people required support with their health, people were signposted or referred to health professionals.

•People were treated kindly and compassionately by staff.

•People and their relatives were supported to express their views and make decisions about the care and treatment they received.

•Staff respected people's privacy and dignity.

•Information was provided in a range of formats to support people’s understanding.

•The provider had a complaints policy and process in place; people and their relatives told us they would feel comfortable raising complaints.

•When people were at the end of their life, the provider had policies in place to assess their wishes and preferences.

•The provider had quality monitoring arrangements through which they continually reviewed evaluated and improved people's care.

•People, stakeholders and staff had an opportunity to shape the service.

Rating at last inspection: Requires Improvement in Safe, Effective and Well Led. The last report for Secure Healthcare was published in March 2018. At this inspection we found the service had made some improvements and was rated Good in Safe, Effective, Responsive and Caring. Well Led continues to be rated as Requires Improvement.

Why we inspected: This was a planned comprehensive inspection that was scheduled to take place in line with Care Quality Commission scheduling guidelines for adult social care services.

Follow up: We will continue to monitor the service to ensure it meets its regulatory requirements. More information is in the 'Detailed Findings' below.

This service 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 and children. At the time of our inspection there were 12 people using the service.

This is the first time the service has been rated Requires Improvement.

People did not always receive support from consistent staff. Medicines administration records were not always as detailed as they should be. Risk assessments and management plans lacked detail. People’s needs were assessed; however, care plans lacked detail.

The systems in place to monitor the quality of the service were not consistent in identifying concerns. A registered manager was in post; however people felt they were not easy to communicate with. Improvements were needed in how the registered manager and provider used information to drive improvements.

People were safeguarded from abuse. People were protected from the risk of infection. There were enough suitably skilled staff to meet people’s needs. The registered manager had systems in place to learn when things went wrong.

The principles of the MCA were followed but not always documented sufficiently. Staff were trained to deliver effective support to people and had their competency checked. People were supported to maintain a healthy diet. People were supported to access health professionals when required.

People were supported by caring staff that protected their privacy and dignity. People had support to make decisions and choices about their care and maintain their independence.

People’s preferences were understood by staff. People understood how to make a complaint but felt their concerns were not addressed. People received support with care at the end of their life which allowed them to have a dignified and pain free death.

There was a registered manager in post at the time of the inspection. 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.