Sagecare (Southwark)

About the service

Sagecare (Southwark) Limited is a domiciliary care agency registered to provide personal care to people living in their own homes. The service provides support to a wide section of the community, people living with dementia, older people, people with physical disability, learning disability, younger adults, mental health and sensory impairment. All of these people resided in the London Borough of Southwark. At the time of the inspection 227 people were being supported with personal care.

Not everyone who used the service received personal care. The 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

Right Support: The provider was not following the principles of the Mental Capacity Act. People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice. The provider was unable to provide any evidence where decisions were made in people's best interest and where people may lack capacity.

People were not always notified when care workers were running late. We made a recommendation to the provider to review their practices to ensure people received their calls in line with their agreed care plan.

People told us the care workers were kind and caring. People told us that their dignity, and privacy was maintained.

Right Care: Medicines were managed safely. Risk assessments were in place to guide care workers on how to care for people safely. There were appropriate processes for the recruitment of care workers. The provider had effective processes in place to safeguard people from the risk of harm.

People were assessed prior to care packages starting. People’s nutritional needs were recorded however at times guidance was generic for care workers to follow.

The provider was migrating all care plans to a new electronic system, and we found people’s nutritional and hydrational plans were at times generic. We made a recommendation for the provider to ensure care plans were personalised. Care workers received an induction before they started delivering care and support. People told us that care workers had the necessary skills to carry out their role.

Right Culture: The quality assurance and governance processes in place needed to be strengthened as they had not addressed issues, we found with the care people received. The service was without a registered manager and people and care workers felt the service was not always well managed. Care workers spoke about a culture of favouritism and people felt communication needed to be improved to ensure people received their care safely.

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 the service was good (published 20 September 2020).

Why we inspected

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

Enforcement and Recommendations

We have identified breaches in relation to the need for consent and good governance. We made three recommendations to the provider. We asked the provider to ensure their systems were robust to ensure people received their care calls on time. We recommended that the provider ensure all care plans were personalised and to ensure the complaints policy is followed.

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.

Sagecare (Southwark) Limited is a domiciliary care agency registered to provide personal care to people living in their own homes. 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. At the time of the inspection approximately 340 people who resided in the London Borough of Southwark were receiving personal care.

People’s experience of using the service

The provider had noticeably improved how the service operated. Improved processes were in place to safeguard people from abuse or harm, mitigate risks to their safety and ensure their medicines were properly administered.

People were supported by safely recruited staff who worked in a punctual and reliable way. People's personal care needs needs were understood by staff with suitable training, supervision and support for their roles.

People were supported to be involved in the planning and reviewing of their care. Comments from people demonstrated they had noticed the positive changes in the service. One person told us, "I am happy with my carers, they cooperate professionally and do what I expect."

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's views about the service were regularly sought and there were clear processes in place to respond to complaints.

People commented the service was well managed and responsive to their needs and wishes. One person stated, "[Registered manager] listens and does things, he has improved the service."

Rating at last inspection

This last rating for this service was requires improvement (published 8 June 2019). There were breaches of regulation in relation to the quality of people’s individual risk assessments and person-centred care planning, medicine management, staff training and development, and the systems in place for monitoring the standard of the service. 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 conducted to follow up on the action we told the provider to take at the last inspection. Therefore, we carried out this focused inspection to review the key questions of safe, effective, responsive and well-led only. We reviewed the information we held about the service. No areas of concern were identified in the key question of caring; we therefore did not inspect this. The rating from the previous comprehensive inspection for the key question not looked at on this occasion was used in calculating the overall rating at inspection. The overall rating for the service has changed from requires improvement to good.

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

Follow up

We will continue to monitor information and intelligence we receive about the service. We may re-inspect this service sooner than our scheduled programme if we receive any concerning information.

Sagecare (Southwark) Limited is a domiciliary care agency registered to provide personal care to people living in their own homes. The Care Quality Commission only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. At the time of our inspection approximately 377 people were using the service. Of those 377 people, 350 received personal care and the remainder received domestic assistance only.

People’s experience of using the service:

People reported they felt safe with staff and had developed positive relationships where they received a consistent service from regularly assigned staff. However, some people had experienced disruptions with the delivery of their care and support due to unforeseen changes to staff they were not advised about in advance, late visits, missed visits and visits that felt rushed if care workers were late.

Recruitment practices were safely conducted to ensure new staff had suitable backgrounds and experience to support people who used the service. However, the provider had not ensured that all staff were up to date with their training and received support through regular formal supervision and team meetings.

The provider had not ensured that all people who used the service had suitable care plans, so that their needs and wishes were properly identified and addressed. Some people did not have appropriate risk management guidance in place to reduce risks and promote their safety, health and wellbeing. Although staff had received medicines training, the provider did not have sufficiently robust processes in place to observe and audit how people were supported with their prescribed medicines.

People received care and support to meet their health care needs, and their nutritional needs where required. Although people's mental capacity was assessed and they were supported to make day to day choices about their personal care where possible, the provider's system for recording whether people had appointed attorneys to act on their behalf was not sufficiently detailed.

Most people stated they were happy with the caring attitudes of their regular care staff and they felt that staff promoted their entitlement to dignity, respect and confidentiality. There were mixed views from people in relation to how the provider dealt with complaints. We noted that since the appointment of the new manager there was a focused approach to addressing complaints and the underlying reasons why people expressed their dissatisfaction.

Staff did not feel they had been supported well by the management but felt that the new manager was progressing with improvements in relation to how information was communicated, staff training and support, and the systems used by office staff to plan the visits schedules.

People and relatives had experienced difficulties with the quality of the service and the professional performance of the management team. Some people expressed optimistic views that their care had recently improved. The provider had analysed in a detailed manner where the service was not functioning well and had developed an action plan. Progress was being achieved with the action plan at the time of the inspection. However the provider's own quality monitoring systems had not been properly used, which had resulted in people receiving a service with significant shortfalls.

Rating at last inspection:

This is the first inspection of the service since it was registered by the Care Quality Commission on 16 March 2018.

Why we inspected:

This was a scheduled inspection of the service.

Enforcement:

We found five breaches of regulation. These were in relation to the management of risks to people's safety, the safe management of prescribed medicines, training, supervision and support to enable staff to effectively carry out their duties, detailed care planning to identify and meet people's needs and wishes, and the implementation of robust systems to monitor and improve the quality of the service. Please refer to the ‘action we told the provider to take’ section at the end of full report.

Follow up:

We will ask the provider to inform us how they will make changes to make sure they improve the rating of the service to at least good. We will continue to monitor information and intelligence we receive about the service until we return to visit in line with our re-inspection scheduling guidelines for services rated requires improvement. We may inspect this service sooner if we receive any concerning information.

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