Sagecare Fulham

Sagecare Fulham is a domiciliary care agency. It provides personal care to mostly older people living in their own homes in the London Boroughs of Hammersmith & Fulham, Westminster and Chelsea. It also supports some adults who are living with dementia and adults who have physical disabilities. At the time of our inspection the service was providing care and support to 472 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

We received mixed feedback about the timeliness and duration of people’s care visits.

People’s care plans set out their care needs and preferences and communication support. Sometimes this information was not recorded in a consistent manner.

People told us they felt safe. Staff supported people with their medicines appropriately.

There were procedures for responding to and learning from accidents and incidents.

There were recruitment processes in place to help make sure only suitable staff were employed.

Staff received regular training, supervision and competency checks. This included safeguarding awareness training so staff knew how to report potential abuse concerns.

Staff treated people with dignity and respect and were caring.

The service worked in partnership with other professionals to meet people’s needs and help them to access healthcare services.

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.

There were systems in place to monitor the quality of the service and recognise when improvements were required. People and staff were asked to give feedback about 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 6 September 2021). 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 inspection was carried out to follow up on action we told the provider to take at the last inspection.

Follow up

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

Sagecare Fulham is a domiciliary care agency. It provides personal care to mostly older people living in their own homes in the London Boroughs of Hammersmith & Fulham, Westminster and Chelsea. It also supports some adults who are living with dementia and adults who have physical disabilities. At the time of our inspection the service was providing care and support to 494 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

We received mixed feedback from people and their relatives about using the service.

The service did not ensure people’s care visits were always arranged to reduce the risk of people experiencing late or missed care visits. Some people’s medicines support was not always managed in a safe way. Some people's care plans did not provide personalised information about their care preferences or up to date information about their agreed care arrangements. There was a complaints handling process, but some people found it difficult to contact the office when they needed to.

There were assorted quality monitoring systems in place. These had identified some of the issues we found but had not always been effective as they had not enabled the provider to take timely action to address some of the areas for improvement.

There were procedures in place for preventing and controlling the spread of infection. This included ensuring staff always had sufficient personal protective equipment. Risk management plans considered risks to people's safety and actions needed to mitigate those risks.

The provider had arrangements in place to respond to safeguarding concerns and work with statutory agencies to protect people from the risk of abuse. The service worked in partnership with other agencies, such as social workers, nurses and GPs, to help those agencies provide coordinated care to people.

There were safe staff recruitment processes in place. Staff felt supported in their roles by approachable senior care staff and managers.

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 29 December 2017).

Why we inspected

This was a planned inspection based on the previous rating and was also prompted in part due to concerns received about safeguarding people from harm and care staff visiting people on time. As a result, we undertook a focused inspection to review the key questions of safe, responsive 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. Please see the safe, 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 Sagecare Fulham 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 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 providing medicines support, the deployment of staff, care planning and 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.

The service has recently moved to its current address. Prior to that it was in the London Borough of Hammersmith and Fulham. The service was last inspected on 15 and 18 August 2016, when we rated it ‘Requires improvement’ and found breaches of Regulations in relation to the notification of incidents, need for consent, safe care and treatment and good governance. Following this, the provider sent us an action plan detailing how they planned to make improvements. At this inspection we found the provider had made the necessary improvements.

Sagecare Fulham provides a range of services to people in their own home including personal care. Most people using the service were older people, some of whom were living with the experience of dementia. At the time of our inspection 430 people were receiving a service in their home, including personal care, shopping, cleaning and companionship. All the people using the service were funded by their local authority.

There was 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.

Staff followed the procedure for the management of people’s medicines and regular medicines audits indicated that people were receiving their medicines as prescribed.

The risks to people's wellbeing and safety had been assessed, and there was information on people’s records about how to mitigate these risks.

There were procedures for safeguarding adults and staff were aware of these. Staff knew how to respond to any medical emergencies or significant changes in a person's wellbeing.

The provider had systems in place to manage incidents and accidents and took appropriate action to minimise the risk of reoccurrence.

The service employed enough staff to meet people's needs safely and had contingency plans in place in the event of staff’s absence. Recruitment checks were in place to obtain information about new staff before they were employed to care for people.

The registered manager was aware of their responsibilities in line with the requirements of the Mental Capacity Act 2005 (MCA) and staff had received training on this. People had consented to their care and support and had their capacity assessed prior to receiving a service from Sagecare Fulham.

People's health and nutritional needs had been assessed, recorded and were being monitored.

Care staff received an induction and shadowing period before delivering care and support to people. They received the training and support they needed to care for people.

Feedback from people and their relatives was mostly positive. Most people said they had regular staff visiting which enabled them to build a rapport and get to know them.

People we spoke with and their relatives said that they were happy with the level of care they were receiving from the service.

People's needs were assessed prior to receiving a service and care plans were developed from the assessments. Care plans contained the necessary information for staff to know how to support people and meet their needs, and were written in a person centred way.

There were systems in place to monitor and assess the quality and effectiveness of the service, and the provider ensured that areas for improvement were identified and addressed.

There was a complaints procedure in place which the provider followed. People felt confident that if they raised a complaint, they would be listened to and their concerns addressed.

People, staff and relatives told us that the registered manager and the senior team were approachable and supportive. There was a clear management structure to operate the agency, and they encouraged an open and transparent culture within the service. People and staff were supported to raise concerns and make suggestions about where improvements could be made.