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Inspection carried out on 23 April 2019

During a routine inspection

About the service: Surecare Hillingdon Limited provides personal care and support to people living in their own homes in the community. The service is a privately-run organisation and the majority of people receiving care were over the age of 65 years. The service also provided care to younger adults with disabilities. At the time of our inspection, nine people were using the service.

The service was a franchise. The franchisor SureCare offered support to develop policies, procedures and quality monitoring systems.

People’s experience of using this service:

People using the service and their relatives were happy with the service they received. They were cared for in a way which reflected their preferences and needs. They had been involved in planning and reviewing their care and had consented to this. They liked the care workers who supported them and found them kind, caring and compassionate. They also had good relationships with the registered manager and team leader who they knew well and were happy to discuss their care with.

The staff felt supported. They were given the training and information they needed to care for people. They told us they were able to speak with the registered manager whenever they wanted and had regular meetings with them. There were effective processes for recruiting new staff, making sure they had a thorough induction and assessing their competencies.

People's needs had been assessed and planned for. Plans were regularly reviewed and updated when people's needs changed. Risks to their safety and wellbeing had been assessed and they were supported in a safe way. People's medicines were administered in a safe way and as prescribed. The staff monitored people's health and had responded appropriately when people became unwell.

There were procedures to investigate allegations of abuse, complaints, accidents and incidents. The registered manager analysed these to make sure improvements could be made to the service. People using the service and their relatives told us they felt confident raising concerns and that these would be addressed.

The registered manager had a very good knowledge of all the people using the service, their needs and the needs of staff. They had worked with people and provided additional support, such as helping people to access the community and take part in leisure activities. There were effective systems for assessing the quality of the service and making sure improvements were made to reflect people's feedback and experiences.

Rating at last inspection: The service was rated requires improvement at the last inspection on 15 April 2018 (Published 22 May 2018).

Why we inspected: We inspected the service as part of our planned programme of inspections based on the rating given at the last inspection.

Follow up: We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. We may inspect sooner if we receive any concerning information regarding the safety and quality of the care being provided.

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

Inspection carried out on 16 April 2018

During a routine inspection

This comprehensive inspection took place on 16 April 2018 and was announced. We gave the provider two working days’ notice as the location provided a service to people in their own homes and we needed to confirm there would be someone available when we inspected.

This was Surecare Hillingdon Limited’s first inspection since the service registered in February 2017.

This service is a domiciliary care agency. It provides personal care to people living in their own homes in the community. It currently provides a service to older people and adults with physical disabilities. People either fund their own care or receive funding through direct payments where they can then decide which care service to employ. There were three people currently using the service.

There was a new manager in post who was in the process of applying to become 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.

The provider had quality assurance systems in place, however not all aspects of the running and monitoring of the service were recorded. The checks that were in place needed to be more effective to ensure people received a quality safe service.

We found a breach of one 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 the report.

The provider had considered if people were able to make daily decisions about their lives and had provided care workers training on the Mental Capacity Act (MCA). However, we recommended the provider seeks national guidance on following the principles of the MCA for people living in their own homes to ensure no-one is restricted unlawfully.

The provider had not completed risk assessments for some of the practices they followed. Where a person was potentially at risk of harm they had not considered carrying out risk assessments to be certain the action taken during the visits to people posed a risk to the person and/or others.

There were procedures for the safe management of medicines but improvements needed to be made to ensure the care workers followed these and recorded when they had been a part of any medicines tasks.

There were sufficient numbers of care workers employed to meet people's needs. Recruitment checks were carried out on new care workers to make sure they were suitable to work with people using the service. We found one unexplained gap in a care worker’s employment history which the provider addressed shortly after the inspection.

Feedback from people using the service and their relatives was positive. They described care workers as caring and that there was good communication between them and the office. They also told us that care workers arrived on time and stayed the agreed length of time. They explained that care workers did everything they asked and offered them choices.

Care plans were clear and showed the support people needed. Individual preferences were included within the plans. There was evidence that the plans had been discussed with the person, and/or their representative and they had consented to how they were to be supported.

The provider had systems to safeguard people from abuse. Care workers completed safeguarding training and knew how to report any concerns.

Care workers confirmed they were well trained and supported by the provider. Support was provided through one to one and group meetings. Training was provided on various topics to provide care workers with information and guidance on how to support a person effectively.

The provider had arrangements to help protect people from the risk of the spread of infection as the care workers wore protective equip