Supreme Care Services Limited

Supreme Care Services Limited (Greenwich) is a domiciliary care agency registered to provide personal care to people living in their own homes. At the time of this inspection the agency was providing a service to 54 people. 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

During this inspection, we found some risk assessments contained limited information on what the potential risks were to people's safety and measures in place to mitigate the risks. Although the majority of people and relatives told us staff were punctual, there was some feedback where this was not the case. Feedback received also showed instances where staff did not always follow appropriate infection control practices. There were systems in place to monitor the quality of service, however some feedback indicated improvement was needed with communication.

The majority of people and relatives spoke positively about the quality of service they received. They told us they felt safe and staff knew their needs well. The provider had systems in place to record and respond to accidents and incidents. Any lessons learnt were used as opportunities to improve the quality of service.

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 18 September 2019).

Why we inspected

This was an ‘inspection using remote technology’. This means we did not visit the office location and instead used technology such as electronic file sharing to gather information, and video and phone calls to engage with people using the service as part of this performance review and assessment.

We received concerns from the local authority in relation to late and missed calls, accidents and incidents/complaints not being followed up or dealt with adequately, lack of reporting to relevant bodies and management deployment leading to a lack of oversight.

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 changed from good to requires improvement. This is based on the findings at this inspection.

You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement

We have identified a breach in relation to risk assessment.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Supreme Care Services Limited [Greenwich] is a domiciliary care agency registered to provide personal care to people living in their own homes. At the time of this inspection the agency was providing a service to 39 people. 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 they felt safe. The service had safeguarding and whistleblowing policies and procedures in place and staff had a clear understanding of these procedures. Appropriate recruitment checks had taken place before staff started work and there were enough staff available to meet people’s care and support needs. People’s medicines were managed safely. Risks to people had been assessed to ensure their needs were safely met. The service had procedures in place to reduce the risk of infections.

People’s care and support needs were assessed before they started to use the service. Staff had the skills, knowledge and experience to support people appropriately. Staff were supported through induction, training and regular supervision. People were supported to maintain a healthy balanced diet and had access to health care professionals when they needed them. 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 and their relatives spoke positively about the care and support they received. They said they had been consulted about their care and support needs. The service supported people to develop and maintain relationships to avoid social isolation. The service had a complaints procedure in place. There were procedures in place to make sure people had access to end of life care and support if it was required.

The registered manager and deputy manager had worked in partnership with health and social care providers to plan and deliver an effective service. Social care professionals’ feedback was positive confirming good partnership working. The provider took people, their relatives and staffs view’s into account through satisfaction surveys. Staff enjoyed working at the service and said they received good support from the registered manager and deputy manager.

Rating at last inspection

The last rating for this service was Good (published 27 March 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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.

At our last inspection on 14 and 16 March 2016 we found breaches of our legal requirements. We found that action had not always been taken to manage risks to people using the service safely. We found that the provider had not notified the CQC when the previous registered manager stopped running the service. The provider had also failed to notify the Care Quality Commission about three allegations of abuse in relation to people using the service.

At this inspection we found the provider had made the required improvements and that appropriate procedures were in place to support people where risks to their health and welfare had been identified and notifications, including safeguarding concerns were being submitted to the CQC as required by law.

The service had a registered manager in post. 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 and associated Regulations about how the service is run.

People said they felt safe and staff treated them well. The service had appropriate safeguarding adults procedures in place and staff had a clear understanding of these procedures. There was a whistle-blowing procedure available and staff said they would use it if they needed to. Appropriate recruitment checks took place before staff started work. People’s medicines were managed appropriately and people received their medicines as prescribed by healthcare professionals.

The registered manager and staff had a good understanding of the Mental Capacity Act 2005 and acted according to this legislation. Staff had completed an induction when they started work and they had received training relevant to the needs of people using the service. People’s care files included assessments relating to their dietary support needs. People had access to health care professionals when they needed them.

People and their relatives said staff were kind and caring and their privacy and dignity was respected. People had been consulted about their care and support needs and care plans were in place that provided information for staff on how to support people to meet their needs. People and their relatives were provided with appropriate information about the service. They were aware of the complaints procedure and said they were confident their complaints would be listened to, investigated and action taken if necessary.

The provider recognised the importance of monitoring the quality of the service provided to people. They took into account the views of people using the service through satisfaction surveys and telephone monitoring calls. The provider carried out unannounced spot checks to make sure people were supported in line with their plans of care. Staff said they enjoyed working at the service and they received good support from the registered manager and office staff. There was an out of hours on call system in operation that ensured management support and advice was always available for staff when they needed it.

Supreme Care Services Limited is a domiciliary care agency which delivers care and support to older people and children in their own homes. The agency is based in Woolwich, South East London. At the time of this inspection 80 older people and 12 children were using the service.

The service did not have a registered manager in post. 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 previous registered manager left the service in June 2015. The current manager had been working at the service since September 2015. They had begun the process of applying to the CQC to become the registered manager.

At this inspection we found breaches of the Care Quality Commission (Registration) Regulations 2009. These related to information the provider is required by law to notify the CQC about. The provider had failed to notify the CQC when the previous registered manager stopped running the service. The provider had also failed to notify the Care Quality Commission about three allegations of abuse in relation to people using the service.

We also found a breach of the Health and Social Care Act 2008 Regulated Activities) Regulations 2014. We found that action had not always been taken to manage risks safely. We saw information was recorded in peoples care plans on how they should be supported with their care needs however there were not always risk management plans or guidance in place advising staff how to support people where risks to their health and safety had been identified. You can see the action we have told the provider to take at the back of this report.

We found the service had safeguarding adults and children’s procedures in place and that staff had a clear understanding of these procedures. There was a whistle-blowing procedure available and staff said they would use it if they needed to. Appropriate recruitment checks took place before staff started work. People had access to health care professionals when they needed them and were supported, where required, to take their medicines as prescribed by health care professionals.

The manager had a good understanding of the Mental Capacity Act 2005 and acted according to this legislation. Staff had completed an induction when they started work and they were up to date with their training. People had been consulted about their care and support needs. Care plans provided information for staff on how to support people to meet their needs. People’s care files included assessments relating to their dietary support needs. People were aware of the complaints procedure and said they were confident their complaints would be listened to, investigated and action taken if necessary.

The provider was introducing a call monitoring system at the service. We were not able to assess the impact of the system on people's care as the system was not fully in place at the time of inspection. We will assess this at our next inspection of the service.

The provider recognised the importance of monitoring the quality of the service provided to people. They took into account the views of people using the service through telephone monitoring calls and satisfaction surveys. The provider carried out unannounced spot checks to make sure people were supported in line with their care plans. Staff said they enjoyed working at the service and they received good support from the manager. They said there was an out of hours on call system in operation that ensured management support and advice was always available when they needed it.

Below is a summary of what we found. If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

People told us they felt safe with care staff coming into their homes. The provider had safeguarding vulnerable adult's policies and procedures in place and staff we spoke with were aware of their responsibility to safeguard the people they supported.

There were systems in place which ensured that managers and staff learnt from events such as accidents and incidents, complaints, concerns and investigations. This reduced the risks to people and helped the service to continually improve.

The registered manager informed us that they took peoples care needs into account when setting the rota and matched staff skills and experiences to ensure that people's needs were met.

Is the service effective?

People's health and care needs were assessed with them, and they were involved in writing their plans of care. Where people needed two staff to support them, this had been identified and the appropriate support was provided. People said that their care plans were up to date and reflected their current needs.

People told us that their family members had been involved in the care and support they received.

Is the service caring?

We spoke with about 20% of people who used the service and their relatives and they told us that they were satisfied with the care that they were receiving. For example, people told us that 'the staff are always on time', 'I have a regular carer', 'they do what I ask them to do', 'My carer has time to do everything she has to do'I don't feel rushed'. Staff we spoke with knew about the care needs of people and it was clear they genuinely cared for the people they supported.

People using the service, their relatives and / or friends had completed an annual satisfaction survey. Where shortfalls or concerns were raised these were taken on board and were being dealt with at the time of our inspection.

Is the service responsive?

People knew how to make a complaint if they were unhappy. Most people we spoke with told us that they were satisfied with the service they received and therefore had nothing to complain about. The provider's complaints log showed that people had made complaints in the past and the provider had responded to their complaints in line with their policy. However, one person told us that they had made a complaint in the past and although this was dealt with they felt that more could have been done.

The service worked well with other agencies and services to ensure people received care and support that was safe and met their individual needs.

Is the service well-led?

The service had a quality assurance system in place including an annual customer satisfaction survey, telephone monitoring and spot checks. We saw that where issues were identified, the provider took action to address these promptly. As a result the quality of the service was continuously improving.

Care staff we spoke with informed us that they felt supported by office staff. They told us that they felt comfortable to discuss any concerns they had with their line manager and knew their concerns would be looked into. Staff told us they were clear about their responsibilities and the provider's policies and procedures. This helped to ensure that people received a good quality service at all times.

We found that care staff sough consent before delivering care to people. People's needs were assessed and care was planned, however sometimes care plans did not reflect the care provided. People's medication arrangements did not always match their care plan and we found staff sometimes administered medicines they were not sufficiently trained to. The provider had made improvements to recruitment checks to ensure staff were appropriately vetted before working with people, and it had carried out and followed up on quality assurance.

We found that people were involved in their care and their privacy and dignity was maintained. People's care needs were assessed and care was planned and delivered to meet their needs. The provider had safeguarding procedures in place which staff were aware of and people who used the service knew how to complain. The provider did not follow effective recruitment procedures to ensure its staff were checked before delivering care to people. Staff felt supported and were adequately inducted and trained. The provider carried out some quality checks and sought people's feedback on the service, but it did not always ensure learning from incidents took place or changes were implemented when issues had been identified.