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Inspection carried out on 23 June 2021

During an inspection looking at part of the service

About the service

SQ Carers is a domiciliary care agency. People had individual packages of care in their own homes. At the time of this inspection SQ Carers supported 23 people with personal care. 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 and their relatives told us people received care and support that was safe and staff treated people well. People had care plans and risk assessments that reflected their health and welfare needs. Care staff had knowledge of safeguarding and whistle blowing procedures to ensure people’s ongoing safety. The provider carried out checks before new staff started to ensure only suitable staff were employed. People received their medicines in line with their prescribed instructions. The provider had a system in place to manage accidents and incidents to maintain people’s safety.

People and relatives told us they were treated with dignity and respect and people’s choices and preferences were reflected in the care provided. People knew how to make a complaint. Arrangements were in place to support people’s end of life care when needed.

There were systems and processes to assess, monitor and improve the quality and safety of the service and these had resulted in improvements to the care and support people received. There was a clear management structure, and staff were aware of the roles of the management team.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 25 June 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve staffing and recruitment and their governance systems. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We carried out an announced comprehensive inspection of this service on 25 June 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve Fit and proper persons employed and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Responsive and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for SQ Carers 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.

Inspection carried out on 23 May 2019

During a routine inspection

About the service: SQ Carers Limited is registered to provide personal care to people living in their own homes, including older people and people living with dementia. At the time of our inspection visit, the service supported 21 people.

People’s experience of using this service:

We last inspected SQ Carers Limited in May 2018 when we rated the service as 'Requires Improvement' in Safe, Caring, Responsive and Well Led, together with a breach of the regulations. At this inspection we found key questions of ‘Safe', 'Responsive' and 'Well-led' remain 'Requires Improvement' and there are continuing breaches of the regulations, with one new breach.

The registered manager and compliance manager completed regular audits and checks on the quality of the service. However, shortfalls found at this and the previous inspection in May 2018, had still not been addressed.

The registered manager had not ensured they had effective systems to manage care calls and call timings, to people’s preferred choices. Their action plan following the last inspection said this would be rectified by 2 July 2018, however, improvements were not made. Most people continued to tell us they did not receive their care calls when they wanted. People knew what to do if they had a concern or complaint, but in two cases, people said when they had raised concerns about the call timings, nothing had changed. They did not feel listened to or that their opinions mattered.

There was a system in place to manage risks associated with people’s care needs, however some assessments did not always provide staff with consistent information to manage those risks. In addition to this, staff were not consistent in their recording and monitoring of some people’s needs. There was a potential for changes in people’s physical and emotional wellbeing not be identified.

Safe recruitment policies were not followed. Five out of six staff recruitment files failed to evidence necessary employment checks on people’s character, fitness and ability to support vulnerable people, because they were not completed. The provider failed to follow their own recruitment policies and procedures.

People said they were confident in the staff's skills and abilities to look after them and keep them safe.

People's needs were assessed before they started using the service to make sure staff could deliver the care that they needed. People and relatives said they had agreed to the care and support they received. Care plans were not all up to date and did not include person-centred information.

Most people and relatives said staff were kind, compassionate and caring and took their time to carry out their duties and did not rush. However, some people said staff had limited time with them and when concerns had been raised, they felt no action had been taken to reduce their anxieties.

Most people self-administered their medicines or had relatives to help them. Where staff supported with medicines, records showed risks of error where kept to a minimum.

People were supported people to access health care professionals when they needed them. The staff worked with other agencies to provide joined up care.

Staff followed safe infection control practices.

Care and support was given in line with legislation and guidance, such as following the principles of the Mental Capacity Act 2005. People's personal information was still accessible on staff’s personal mobile telephones, although less information limited potential for unwanted sharing of personal information.

We reported that the registered provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were:

Regulation 17 Regulated Activities Regulations 2014 - Good governance

Regulation 19 Regulated Activities Regulations 2014 – Fit and proper persons employed.

Rating at last inspection: Requires Improvement (The last report was published on 16 June 2018).

Why we inspected: This was a pla

Inspection carried out on 16 May 2018

During a routine inspection

The inspection visit took place on 16 May 2017 and was announced. SQ Carers Limited is registered to provide personal care to people in their own homes. We returned announced on 21 May 2018 to collect documents we had requested, and to see further records of people’s care. At the time of this inspection visit, 23 people received personal care and the service employed 10 care staff.

SQ Carers are located in Stratford upon Avon and provide long and short term care packages with care calls ranging from 30 minutes to one hour. Care calls are provided across Warwickshire and Gloucestershire and SQ Carers also provides a live in service. No one was using the live in service at the time of our visit.

SQ Carers registered with us in May 2017 and this was the first inspection of this service. Before providers are registered, part of our registration process is to check those providing care, are of suitable character and have effective systems and processes to provide people with a service that meets their needs. At this inspection visit we found improvements were needed to their quality assurance systems and how they retained important information that supported their regulatory responsibilities.

The owner was the registered manager and in the report, we refer to them as the 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.

People who required support to take medicines received these mostly from family members. However, where staff administered medicines, staff were trained and assessed as competent to do so. The provider’s recruitment process ensured pre-employment checks were made, prior to staff starting work, to ensure they were suitable to support people who used the service.

People had an assessment of care completed before they used the service to make sure staff could meet people’s care and support needs. People felt safe using the service and staff understood how to protect people from abuse and harm.

There were procedures to keep people safe and manage identified risks to people’s care, although risk assessments were not always detailed enough to provide staff with the information to manage those risks efficiently. Staff told us they had not always supported people in line with their risk assessments. People said care staff usually arrived around the time expected, but for some people they did not stay for the full amount of time and did not always provide the care outlined in people’s care plans. Care plans provided information for staff about people’s care needs, but they were not always specific in providing details of what they needed to do on each call.

People and their relatives told us they usually received care from staff who knew them well and from staff who were kind and caring to their needs. However, some people gave us examples that showed us some staff were not always considerate, such as leaving people without telling them,

or arriving earlier than planned without advanced notice. People said staff treated them with dignity and respect and relatives were confident their relations were safe and looked after.

The registered manager and staff followed the principles of the Mental Capacity Act (MCA). People and relatives told us staff respected their decisions and they felt involved in how their care package was put together.

People’s care needs were regularly reviewed. The registered manager and office staff were in contact with people, or their relatives, to check the care provided was what people needed and expected, although they had not identified the issues with the call times and call durations that we found. The registered manager completed observed practices on staff and they completed ca