Surrey

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

At the last inspection the agency did not always provide a service that was safe for people to use and staff to work in. This was because recruitment procedures were not robust, and we were not assured that staff were recruited in a safe way to keep people as safe as possible. Staff files were not fully completed and were missing some pre-employment key documents.

At this inspection staff files were fully completed including pre-employment key documents.

The agency provided a safe service for people to use and staff to work in with sufficient staff to meet people’s needs and support them appropriately. This meant people could live in a safe way and enjoy their lives. There were enough staff who were appropriately recruited with required checks carried out. People using the service and staff had risks to them assessed, monitored and updated as required. The agency reported, investigated and recorded accidents, incidents and safeguarding concerns. Medicines were safely administered. The agency met shielding and social distancing rules, used Personal Protection Equipment (PPE) safely and effectively and the infection prevention and control policy was up to date.

The agency culture was open, honest and positive with transparent management and leadership. The statement of purpose clearly defined the agency vision and values, that staff understood and followed. Staff were aware of their responsibilities and accountability and they were willing to take responsibility and report any concerns they may have. Service quality was regularly reviewed, and changes made to improve the care and support people received. This was in a way that best suited people. The agency had well-established working partnerships that promoted people’s needs being met outside its remit to reduce social isolation. Registration requirements were met.

Rating at last inspection

The last rating for this service was requires improvement (published 20 August 2019) and there was one breach of regulation. The agency completed an action plan after the last inspection to show what they would do to improve and by when. At this inspection we found improvements had been made and the agency was no longer in breach of regulations.

Why we inspected

We undertook this focused inspection to check the agency had followed their action plan and to confirm they now met legal requirements. At the last inspection staff recruitment files were incomplete. A decision was made for us to inspect and examine the risks associated with this issue.

CQC has introduced focused/targeted inspections to follow up on previous breaches and to check specific concerns. We undertook a focused inspection approach to review the key questions of Safe, Effective and Well-led where we had specific outlined above.

As no concerns were identified in relation to the key questions is the service Effective, Caring and Responsive, we decided not to inspect them. Ratings from the 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 requires improvement to good. 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 Surrey on our website at www.cqc.org.uk.

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.

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

Surrey is a domiciliary care agency. It provides personal care to people living in their own houses and flats. At time of the inspection there were 12 people were receiving a regulated activity, most people using the service were older people.

People’s experience of using this service:

There were some areas where safety needed to be improved. For example, staff recruitment procedures were not consistently robust with regard to ensuring up to date checks on applicants when they applied for a job. Record keeping around recruitment needed to be improved. However, we did not find any impact on people’s care or experience of the service related to these concerns. Staff were closely monitored, and people told us that they felt safe using the service.

The service had made improvements to the management and recording of medicines and in their procedures for carrying out assessments for people as part of their care plans. The service was reliable and had enough staff to cover calls. People told us that calls were always covered, and that staff timekeeping was good. Staff had the training they needed which meant that they knew how to support people safely and effectively.

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. The registered manager and staff were aware of policies and procedures to ensure that people were safe from harm and knew how to report safeguarding concerns to the appropriate authorities.

Staff had received training to ensure they had skills and knowledge to meet people's needs.The staff we spoke with were positive about the support they received and the management of the service. People and their relatives were also positive about how the service was run and that they were responsive to people’s individual requests.

The management learnt lessons from any accidents and incidents and used this learning to make improvements to the service.

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 12 September 2018) and there were multiple breaches of regulation. The registered 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 in the majority of areas. However, the service remains rated requires improvement because of an outstanding breach. This service has been rated requires improvement for the last two consecutive inspections.

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

Enforcement

We have identified breaches in relation to safer recruitment procedures at this inspection.

Follow up:

We will request an action plan for the registered provider to understand what they will do to improve the standards of safety. We will work alongside the registered provider and the 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.

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.

Not everyone using Surrey receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

At the time of our inspection there were 19 people receiving personal care, which had been in operation for a short time, with earliest delivery having commenced in March 2018. The service covered the geographical areas of Slough and Kingston.

Both the director of the service, and the care co-ordinator were operating as a 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 director told us the registration of both managers was an interim measure until the care co-ordinator was settled in post, and told us they would be applying to cancel their registration in due course.

At this inspection we found that the provider was in breach of the regulations relating to safe care, staffing, person-centred care and good governance. You can see the action we have told the provider to take about these breaches at the back of the full version of this report.

Some improvements were required to ensure that systems at the service were safe and effective. The provider needed more time to embed quality assurance systems, and enable full audit of how people’s needs and care delivery were recorded. The governance framework was clear, however this was not always adhered to ensure that performance was appropriately monitored. The provider did not always ensure that regular staff competency checks were conducted and fully recorded to reflect staff compliance.

Staff recruitment checks did not include records of staff employment history, details of professional and/or character references or records of staff recruitment interview outcomes.

The service was not always able to attend all visits in a timely manner to ensure that all duties were carried out when people needed them. People’s capacity and ability to understand and consent to the requirements of their care was not always clear. People are not supported to have maximum choice and control of their lives and staff do not support them in the least restrictive way possible; the policies and systems in the service do not support this practice People’s care plans did not always fully reflect what people could do for themselves, nor did they always reflect people’s views on how they wished for their care to be delivered.

People’s risk assessments did not cover all potential areas of risk, such as skin integrity and nutrition.

People’s care plans did not include a record of people’s medicines and what they were for, therefore there was not always clear guidance in place to support staff. We found gaps in people’s medicines administration records (MAR), and that they did not always reflect full details of the medicines that people were prescribed.

We also made a recommendation for the provider to streamline their care plan and risk assessment paperwork to ensure that all areas of presenting need were covered.

The provider had appropriate systems in place to support staff to raise any safeguarding concerns, and the provider was open in learning lessons from incidents and improving the service. Staff had access to appropriate personal protective equipment (PPE) to help prevent the spread of infection.

Systems were in place to ensure that staff received appropriate supervision and appraisal to support them in their roles. People were supported to eat meals of their choosing, and were supported to access healthcare professionals.

People and their relatives felt that staff cared for them well, and that their privacy and dignity was respected. People were supported to express their views through phone questionnaires.

The provider had a complaints policy in place to manage any concerns as they presented. Records were available to reflect people’s wishes in relation to end of life care.

Management had mechanisms in place to support staff and spoke of their plans to develop the service. The provider was clear in how they wished to expand their service provision, and had built positive relationships with service commissioners. Staff and people were encouraged to share their views on the service.