Archived: Surbiton

Surbiton is a domiciliary care agency. The service provides personal care to older people. At the time of our inspection there were 2 people using the service. Not everyone who used the service received personal care. In this service, the Care Quality Commission can only inspect the service received by people who get support with personal care. This includes help with tasks related to personal hygiene and eating. Where people receive such support, we also consider any wider social care provided.

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

People continued to receive unsafe care and support from a service that was not well-led. Medicines were not managed properly and assessed risks weren’t always mitigated against by staff.

Staff provided support without having the appropriate training to keep people safe. The provider continued to fail to deploy enough staff to ensure people received safe, high-quality support as agreed in their care packages.

The provider continued to fail to ensure a service that was well-led, with appropriate governance and oversight of the care people received. Issues noted in previous inspections weren’t acted upon. The registered manager did not ensure that the service monitored and improved the quality and safety of the service people received. The provider's conditions of registration with CQC were not met.

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

Last rating and update

The last rating for this service was inadequate (published 18 November 2022) and there were breaches of regulations. The provider completed an action plan after the last inspection to show what they would do, and by when, to improve. At this inspection the provider remained in breach of regulations.

Why we inspected

We carried out an unannounced focused inspection of this service on 18 October 2022. Breaches of legal requirements were found in relation to safe care and support, staffing, safeguarding people from abuse, and good governance.

We undertook this focused inspection to check if the provider had made improvements and if they were now meeting the legal requirements. This report only covers our findings in relation to the key questions safe and well-led.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has not changed following this inspection.

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

Enforcement

We have found breaches in relation to safe care and support, staffing, safeguarding people from abuse, fit and proper persons employed and good governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

The overall rating for this service is inadequate and the service remains in special measures. This means we will keep the service under review and will re-inspect within six months of the date we published this report to check for significant improvements. If the registered provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question, we will take action in line with our enforcement procedures. This usually means we will start processes that will prevent the provider from continuing to operate the service.

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

Surbiton is a domiciliary care agency providing personal care to people in their own houses/flats. The service provides support to older people. At the time of our inspection there were three people using the service. 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 continued to receive a service that wasn’t safe. People’s medicines were not managed in line with good practice. Staff were not confident in the steps they should take should they identify poor practice. Risk assessments did not give clear guidance for staff to mitigate identified risks. The provider failed to deploy sufficient numbers of staff to ensure people received care and support as agreed in their care package. The provider failed to learn lessons when things went wrong.

The provider continued to fail to provide a service that was well-led. The provider had failed to take sufficient action to address the concerns identified at their previous inspections. The provider had an inadequate understanding of the gravity of our concerns. Audits undertaken were not robust and did not identify issues found at this inspection. The provider failed to ensure there was an embedded culture that learned and improved the care provided. The registered manager did not have an adequate understanding of the duty of candour. The registered manager failed to ensure there was effective oversight and monitoring of the service.

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 inadequate (published 19 May 2022) and there were breaches of regulation. 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 the provider remained in breach of regulations.

Why we inspected

We carried out an unannounced focused inspection of this service on 7 April 2022. 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, safe care and treatment, safeguarding service users from abuse and improper treatment, staffing, good governance, failure to comply with a condition of registration, notification of other incidents and requirements related to the registered manager.

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 and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained inadequate. 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 Surbiton on our website at www.cqc.org.uk.

Enforcement and Recommendations

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 monitor the service and will take further action if needed.

We have identified breaches in relation to medicines management, staff deployment, safeguarding people from the risk of abuse, good governance and continuous learning and improvement at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

Surbiton is a domiciliary care agency providing personal care to four people living in their own houses and flats in the community. This is help with tasks related to personal hygiene and eating. The service provides support to adults over 65 years and people with dementia. At the time of our inspection there were four people using the service.

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

People did not receive care and support from a service that was safe. People’s medicines were not managed safely or in accordance with good practice. People were administered medicines which weren’t recorded on their medicines administration records. The registered manager failed to ensure identified risks were mitigated against.

People did not always receive their care delivered on time and in agreement with their care package. The registered manager failed to ensure suitable numbers of staff were deployed to keep people safe. Staff members did not arrive to visits on time or stay the full duration of the visit. The registered manager failed to ensure robust recruitment checks were undertaken prior to offering staff employment. The registered manager failed to ensure lessons were learned when things went wrong.

People continued to receive care and support from a service that wasn’t well-led. The registered manager failed to comply with the conditions imposed on their registration in an open and honest manner. The registered manager failed to notify us of reportable incidents in line with legislation. The registered manager failed to ensure there was robust oversight of the service to ensure issues were identified and acted on in a timely manner and failed to ensure there was continuous learning and improvement to improve the service.

We did find some more positive aspects. 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 followed best practice guidelines regarding COVID-19 and the prevention and control of infection.

People’s views were sought through regular questionnaires.

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 8 April 2021) and there were breaches of regulation. 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 the provider remained in breach of regulations.

At our last inspection we recommended that the service review their process for the deployment of staff. At this inspection we found the provider had not taken sufficient action.

This service has been in Special Measures since 13 November 2019. During this inspection the provider failed to demonstrate that improvements have been made. The service is rated as inadequate overall. Therefore, this service remains in Special Measures.

Why we inspected

We received concerns in relation to the management of the service, staffing levels and the registered manager failing to notify the CQC of reportable incidents. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection.

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

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 Surbiton on our website at www.cqc.org.uk.

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 monitor the service and will take further action if needed.

We have identified breaches in relation to staff deployment, safeguarding people from abuse and improper treatment, medicines management, the registered managers competency and skills to carry out their role, lack of oversight and governance of the service; and the registered manager failing to meet the requirements of a condition at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request a specific 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.

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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 if it is no longer rated as inadequate for any of the five key questions, it will no longer be in special measures. Due to the COVID-19 pandemic we agreed to place restrictions on the provider’s registration and for them to remain in special measures until their next inspection.

Surbiton is a domiciliary care agency. It provides personal care to older people living in their own houses and flats in the community. At the time of the inspection, there were seven people receiving the regulated activity 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 did not always receive medicines in line with good practice. Medicine administration records were not always completed appropriately. The deployment of staff did not always ensure staff had adequate time off.

Records were not always completed appropriately and there were instances of the wrong name being recorded in people’s documents. Audits did not always identify the issues found during this inspection.

Systems were in place to protect people from abuse. Pre-employment checks were carried out prior to staff commencing to ensure they were suitable for the role. Accidents and incidents were monitored, and action taken to minimise repeat incidents. Infection prevention and control (IPC) measures were in place.

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 were supported to access healthcare services when appropriate. People received care and support from staff who underwent training to enhance their knowledge. Staff were supported to undertake an induction on commencing their role and had their competencies assessed. Where agreed in people’s care package, people were supported to access food and drink that met their dietary requirements and preferences.

People continued to be supported by staff that treated them with respect and encouraged their independence where safe to do so. People’s diverse needs were embraced. Relatives confirmed they were involved in the decision-making process and pre-admission assessments were robust.

There had been a significant change in the management of the service with the recruitment of a care consultant, which had made a positive impact on the running of the service. People’s relatives’ spoke positively about the new changes and confirmed they were happy with the level of care provided. Records confirmed the provider worked in partnership with stake holders. The provider sought to continuously improve.

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

Rating at last inspection

The last rating for this service was inadequate (published 15 June 2020) 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.

At this inspection enough improvement had not been sustained and the provider was still 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 have found evidence that the provider needs to make improvement. Please see the Safe and Well-led sections of this full report.

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 Surbiton on our website at www.cqc.org.uk.

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. 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 breaches in relation to safe medicines management and records management.

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.

Special Measures:

The overall rating for this service is ‘Requires improvement’. However, the service have been placed in special measures since 13 November 2019 and will remain in 'special measures'. We do this when services have been rated as 'Inadequate' in any Key Question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

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 planned inspection based on the previous rating. We have found evidence that the provider needs to make improvements. Please see the Safe, Effective, Responsive and Well-led sections of this full report.

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 Surbiton on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to person-centred care, safe care and treatment, good governance and staffing at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of the 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.

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

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 approachable, respectful and keen to deliver good care and support.