Supreme Care Services Limited

Supreme Care Services is a domiciliary care agency providing personal care and support to people in their own homes. Not everyone who used the service received personal care. At the time of the inspection 315 people were receiving personal care. The Care Quality Commission 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

Some people told us that their care was delivered on time, and they had no concerns with staff calls, however one person told us “the service was unreliable, as their care staff are late.” We reviewed the monitoring call systems, which showed late calls were recorded and actions taken for example the office called the person to inform them that their care staff were running late and offered another staff, which people declined as they wanted their regular staff. However, we found that people did not always get their visits at the agreed time.

People and their relatives told us they felt safe with the care staff who visited them. Staff were recruited safely. People were protected from the risks associated from the spread of infection. Medicines were managed safely. People had risk assessments to protect them from harm.

People's needs were assessed before they used the service. The service worked together with healthcare professionals to ensure people's needs could be met. People were supported with their nutritional and hydration needs. Staff were supported with training and supervision.

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.

Staff demonstrated they knew people well and understood the way people wanted to be cared for. Staff obtained people's consent before delivering care. Staff understood how to provide personalised care. Care records were in place and contained information about people's preferred method of communication.

We found that people’s crisis plans were not always personalised in some areas. We have recommended the provider review their crises plans.

We found that the provider’s monitoring systems did not always pick up some errors in people’s care files and review notes. We recommend the provider refers to current guidance in relation to their quality monitoring system.

The registered manager spoke positively of their plan for improving the service to ensure they gave people good quality care. Staff told us they felt supported by the management team.

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 27 August 2021). The provider completed an action plan after the last inspection to show what they would do and by when to improve. Although we found some improvements at this inspection, the provider remains in breach of regulations.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led key question sections of this full report.

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

We will continue to monitor the service and will take further action if needed.

We have identified a breach in relation to staff deployment due to late calls at this inspection.

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 from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Supreme Care Services is a domiciliary care agency providing personal care and support to people in their own homes. Not everyone who used the service received personal care. At the time of the inspection 335 people were receiving personal care. The Care Quality Commission 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 did not always feel the support provided was safe. Not all staff understood the provider’s procedure to keep people safe from abuse.

Staff were not always deployed effectively to ensure care visits were carried out on time. When this happened people told us there was not enough time to wash and they felt stressed. People who needed care from two members of staff told us staff would always wait until both members had arrived to ensure care was delivered safely.

People and their relatives told us they were treated with kindness by their regular care staff, however, the service did not always provide people with care staff who spoke their language. Staff told us how they developed compassionate relationships with people and used body language and pictures to better communicate with people.

The service was not always well-led. People and their relatives told us communication with the office was unsatisfactory and they had not been contacted about their views of the care provided. The service’s monitoring system did not always identify concerns with care delivery. External professionals told us that the service did not always work with them effectively to keep people safe.

Staff told us the management of the service was effective and they felt they were kept up to date with any changes. We were assured by the service’s measures to prevent and control the spread of infection.

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 24 September 2019).

Why we inspected

We undertook this targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about keeping people safe from abuse. A decision was made for us to inspect and examine those risks.

We inspected and found there was a concern with keeping people safe and good governance, so we widened the scope of the inspection to become a focused inspection which included the key question of well-led.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified two breaches in relation to safeguarding people from abuse and good governance at this inspection.

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 is a domiciliary care agency providing support to 264 people. Not everyone who used the service received personal care. At the time of the inspection 215 people were receiving personal care support. The Care Quality Commission 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

Some people and their relatives provided negative feedback about their experience with contacting the branch office and the quality of communication with staff at the branch.

We have made a recommendation for the service to improve office communication with people and relatives who use the service.

People and their relatives told us they felt safe with the care workers and punctuality had improved greatly. The provider had put arrangements to help protect people from coming to harm as they had put in place clear risk assessments, guidance and support for care workers to follow when providing people with support.

People told us they received their medicines on time however where medicines needed to be given on an “as needed basis” there was not always a clear protocol to follow. This meant staff were not able to support people to have medicine support in this area.

We have made a recommendation for the service to address this issue in line with national guidance.

People received an in-depth initial assessment of their needs which looked at all areas of their life and existing health conditions. This meant people received a care package to meet their needs.

People told us staff had the skills and knowledge to perform their job well and staff received training and support to understand people’s needs and the different types of health conditions they faced.

People told us they received support to have food and drink of their choice.

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.

People said staff were kind and compassionate and respected their privacy and dignity.

People were encouraged to maintain their independence and care plans focused on ensuring people were supported to do tasks for themselves where possible.

People were involved in planning their care and care plans met each person’s needs. We found the service reviewed people’s care regularly to ensure changes were identified and care plans updated.

The service requested feedback from people using the service to improve care.

Quality monitoring took place and the service worked with the local authority and other health professionals to share and learn best 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 15 August 2018). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

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 15, 16 and 17 August 2017 we identified six breaches of the regulations around staffing, safe care and treatment, person centred care, safeguarding adults from abuse and good governance. At our current inspection improvements had been made however we still found breaches in safe care and treatment and good governance.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve all the key questions to at least good and to bring them out of special measures.

The service had appointed a new registered manger since the last 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.

The service had recruited new staff which had improved staffing levels however verbal feedback we received highlighted there were still issues around timeliness of visits and missed calls. This meant people were missing mealtimes and their medicines.

The service had improved how they assessed risk by introducing a risk stratification tool which captured important information about people who presented with high risk and management reviewed this on a weekly basis. Risk assessments were now robust and provided information to staff to understand all the different risks people faced and how to mitigate against them. Staff were more vigilant to risks in people’s homes.

Staff received updated training in safeguarding and understood their responsibilities to report allegations of abuse to management and whistleblow if needed. The service also acted promptly upon receipt of allegations of abuse and worked with the local authority. Relatives felt confident their family member was safe with staff as they had observed improvements in how staff treated them and comments we received were positive about safety.

Medicines management had improved and the serviced had amended the medicine administration records (MAR) they used to a format that ensured staff could accurately record the medicines given and avoid errors. However, staff understanding of the different levels of support provided to people was not consistent.

Staff received a comprehensive training programme and service had appointed field supervisors to be leads in particular areas to support care staff.

Care plans had improved and were person centred.

The service followed the principles of the Mental Capacity Act 2005 and people confirmed they were encouraged to make their own decisions and maintain independence.

We received positive feedback in relation to how people were now being treated by staff from the service. Relatives stated that staff cared about their family member and showed respect and compassion. People were forming good relationships with staff and where there had been long standing care arrangements, these working relationships had just become stronger. Staff were responsive to people’s changing needs and moods and would raise concerns with the office straight away.

The service had completed work around inclusion in the community and had commenced a quarterly coffee morning with people who used the service. They had also introduced an LGBT inclusion and equality policy to include people who identified as LGBT whether it be staff or people who used the service.

The culture and atmosphere at branch level had improved and staff felt more welcome. Management of the service acknowledged they had to make changes to improve and staff confirmed they could see the changes taking effect. A number of audits were introduced and were being completed in line with the audit schedule. Information from the audits was being used to drive improvement and ensure people were receiving care as they should.

Staff were kept informed around best practice and information was shared with them in a timely manner.

The service sought feedback from people, their relatives and external stakeholders and feedback was overall positive. Improvements were needed when it came to sharing information with people about changes in the branch office.

We found two breaches of the regulations relating to safe care and treatment and good governance. The overall rating is requires improvement and no key question is inadequate therefore the service is no longer in “special measures.”

We have made four recommendations.

You can see what action we told the provider to take at the back of the full version of the report.

There was a registered manager at the service at the time of our 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.

There were not sufficient numbers of staff deployed to meet people’s needs. There were high levels of calls to people’s homes that were missed or where staff arrived early or late or did not stay for the allocated amount of time. This meant that people missed meals and medicines.

People were not protected from risks to their health and wellbeing because risks had not always been identified and were not detailed enough to guide staff about how to manage specific risks. Not all staff were aware of the risks people faced and people’s relatives did not always feel their loved ones were safe and expressed concern about risk management.

Medicines were not managed properly. People reported that medicines were sometimes missed and there was not an effective monitoring system in place to check they were being administered safely.

The provider did not ensure that people were treated with dignity and respect. People and their relatives told us that this affected their wellbeing.

The service was not organised in a way that promoted safe and quality care through effective monitoring systems. People and their relatives were not confident with the management of the service and told us they were not always able to raise complaints and did not always feel their concerns were listened to.

The provider had not done all that was reasonably expected of them to promote good practice following a serious allegation of abuse. Staff were aware of the safeguarding adults procedure however, the policy did not contain relevant contact details for outside agencies. The provider could not be assured that staff were suitable to work in the caring profession as criminal record checks had not been obtained prior to staff starting work at the service.

People were not always supported to eat and drink enough when visits to people’s homes did not take place as planned for staff to support people with their meals. Relatives reported staff did not always prepare meals safely. People’s care plans did not always contain enough guidance with staff about nutrition.

The provider followed the latest guidance and legal developments about obtaining people’s consent to care. People or their relatives had signed care plans to indicate their involvement in care planning.

People’s relatives reported that staff were not adequately trained to work with people with dementia. Staff received the provider’s mandatory training and also completed the Care Certificate. Newly appointed staff were supported in their role by an induction period.

People were supported to access healthcare professionals when they became unwell.

We found six breaches of the regulations around staffing, respect and dignity, safe care and treatment, person-centred care, safeguarding adults from abuse and good governance. We made three recommendations in relation to complaints, training and meeting nutritional and hydration needs. Full information about CQC’s regulatory response to any concerns found during inspections is added to the back of the full version of the reports after any representations and appeals have been concluded.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.