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We are carrying out a review of quality at Surbiton. We will publish a report when our review is complete. Find out more about our inspection reports.

Reports


Inspection carried out on 1 October 2019

During a routine inspection

About the service

Surbiton is a is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults.

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

People did not receive care and support from a service that was well-led. The registered manager was not a visible presence at the service. There were on-going systematic failings in the oversight and management of the service. Audits did not always identify issues found at the inspection, identified actions were not always followed through.

People did not receive a service that was safe. People’s medicines were not managed safely. The provider had failed to ensure robust recruitment procedures were in place to ensure suitable staff members were deployed. People did not receive timely care as the provider failed to adequately deploy staff. The provider failed to ensure staff members did not work in excess of the restrictions placed on their student visas. Risk management plans were not comprehensive and did not always give staff clear guidance to mitigate identified risks. The provider failed to learn lessons when things went wrong.

People did not always receive care and support from staff that underwent training to enhance their skills and experiences. Training records confirmed staff training was not up-to-date with no pre-booked training to rectify this. People did not always receive care and support from staff that had undergone an induction or reflected on their working practice through regular supervision and annual appraisals. People’s fluid and food intake was not monitored effectively and care plans did not clearly detail people’s preferences. Pre-admission assessments were not as comprehensive as they could be.

People’s end of life wishes were not always documented and when they were, they were not comprehensive. Care plans were not as person-centred as they could be.

The provider failed to continue to ensure continued learning and failed to drive improvements.

People were protected against abuse as staff had sufficient knowledge on how to identify, respond to and escalate suspected abuse. People continued to be protected against the risk of cross contamination as staff had access to sufficient amounts of personal protective equipment.

People’s health and well-being was monitored, where concerns were identified healthcare services were notified.

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 told us they received care and support from staff that were kind and supportive. People’s privacy was respected, and their dignity encouraged and maintained. People continued to be encouraged to share their views on the care provided. Staff were aware of the importance of encouraging people to maintain their independence and did so where possible.

People’s communication needs were met. The provider had an Accessible Information Standard policy in place which staff were familiar with. Complaints were investigated and responded to in a timely manner.

People were encouraged to share their views with the service. The provider sought partnership working to improve the service, records confirmed this.

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 Requires Improvement (published 1 May 2019) and there were multiple breaches of regulation. This service has been rated Requires Improvement for two consecutive inspections. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

This was a plann

Inspection carried out on 2 April 2019

During a routine inspection

About the service: Surbiton is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults. At the time of the inspection the service was providing personal care to 19 people.

People’s experience of using this service:

¿ There were systematic and widespread failings in the oversight and management of the service. Records were not always easily accessible and issues identified during the inspection had not always been picked up during audits.

¿ The service did not have a registered manager that was an active presence within the service on a day-to-day basis.

¿ Care and treatment was not always delivered in line with people’s preferences. End of life care and support was not always in line with people’s wishes.

¿ People were protected against abuse as staff knew how to identify, respond to and escalate suspected abuse. Risk management plans that were in the new format were detailed and robust.

¿ There were sufficient numbers of staff deployed to keep people safe. Improvements in the rota system meant almost all staff were given adequate travel time between visits.

¿ People received their medicines as prescribed, however medicines audits did not always identify issues found during the inspection.

¿ People received care and support from staff that underwent training, however during the inspection we identified that not all staff had completed training and the training matrix was not up to date.

¿ Staff were knowledgeable about and adhered to the principles of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. People’s consent to care and treatment was sought and respected.

¿ Staff supported people to access food and drink that met their dietary needs and preferences, where agreed in their care plans. Staff also supported people to make and attend healthcare appointments to monitor and maintain their health.

¿ People and their relatives confirmed they were supported by staff that were caring, compassionate and treated them with respect. Staff had up to date information on people’s dependency levels and encouraged people to remain independent where safe to do so.

¿ There had been an improvement in the personalisation of people’s care plans, which detailed people’s preferences, life history, wishes and needs. Care plans were regularly reviewed to reflect people’s changing needs.

¿ People and their relatives were aware of how to raise a concern or complaint.

¿ People spoke positively about the management of the service, stating they felt their views were taken on board and could access the provider when needed.

¿ The provider encouraged working in partnership with other healthcare professionals and stakeholders to drive improvements.

Rating at last inspection: The service was previously inspection on 19 and 24 September 2018 and was given an overall rating of Requires Improvement. This was because we rated the key question, ‘is the service safe’, as Requires Improvement and is the ‘service well-led’ as Inadequate. The service was rated Good in the key questions effective, caring and responsive. We also identified breaches in the Health and Social Care Act (Regulated Activities) Regulations 2014 around staffing and good governance.

Why we inspected: Prior to this inspection we were made aware of an on-going safeguarding concern that had placed people at risk.

Enforcement: At this inspection we identified two breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 around care and treatment received in line with people’s wishes and oversight and management of the service.

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

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

Inspection carried out on 19 September 2018

During a routine inspection

This comprehensive inspection took place on 19 and 24 September 2018 and was announced.

Surbiton was registered with the Commission on 3 August 2017 and has not previously been inspected.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults. At the time of the inspection there were 19 people using the service.

The service had a registered manager in place. 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.

At this inspection we identified breaches of the regulations in relation to safe care and treatment and good governance.

People did not always receive care and support that was safe as the provider failed to deploy staff in a timely manner and staff were not given sufficient travelling time to arrive at their allocated visits at the agreed time. This meant that people had to wait for their allocated visits and impacted negatively on them.

There were systematic failings in the overall oversight and management of the service. Auditing processes were not in place which meant issues were not identified in a timely manner and action to address the issues was delayed or did not take place.

People were not always protected against the risk of identified harm as risk management plans did not clearly identify the control measures to mitigate the risks. We raised our concerns with the provider who sent us an updated risk assessment and confirmed all risk management plans would be updated shortly.

People did not always receive their medicines in line with good practice. Medicine administration records were unclear, did not use key codes to identify when and why medicines were not administered as prescribed and were not audited. We raised our concerns with the provider who sent us an updated medicine administration record. The provider confirmed this is being rolled out throughout the service and would be in place by 28 September 2018.

People received care and support from staff that had undergone pre-employment checks to ensure their suitability for the role.

People were protected against the risk of cross contamination as the provider had systems and processes in place to safely manage infection control.

People received care and support from staff that reflected on their working practises and received training to enhance their skills and knowledge. Although training and supervisions had taken place, the provider had failed to adequately document these. After the inspection the provider sent us an updated training plan and staff supervision record. However, this was still not completed sufficiently.

Staff were aware of their roles and responsibilities in line with the Mental Capacity Act 2005. People confirmed their consent to care and treatment was sought prior to care being delivered.

People were supported to access sufficient amounts of food and drink that met their dietary needs and preferences in line with their care package. Where required people were supported to make appointments with healthcare professionals.

People received support from staff that demonstrated kindness and compassion. People confirmed where required they were provided with emotional support and guidance.

People were encouraged to participate in the development of their care plans. Although care plans were in place and reviewed to reflect people’s changing needs, they were not as person centred as they could be.

People were aware of how to raise a concern or complaint. Complaints were managed in such a way to reach a positive resolution in a timely manner.

People spoke positively about the provider and told us they found her approachabl