Sagecare (Biggleswade)

Updated 2 April 2020

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

The inspection team consisted of two inspectors and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.

The service did not have a manager registered with the Care Quality Commission, although the manager had submitted their application to register. The manager had previously been the registered manager but had left to take up a different post in the provider organisation. They had recently returned to the service. As the manager was not registered the provider alone is legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

We gave the service 24 hours’ notice of the inspection visit to the site office. This was because we needed to be sure that the provider or manager would be in the office to support the inspection.

Inspection activity started on 13 January and ended on 5 February 2020. On 13 and 15 January the Expert by Experience began to make telephone calls to people who used the service, and their relatives. On 5 February 2020 two inspectors carried out a visit to the agency’s office.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

We spoke with telephone with 14 people who used the service and/or their relatives. We spoke with nine staff during our visits to the office. These staff included care staff, a field-care supervisor, a care coordinator, the training lead, the manager, and the provider’s regional manager.

We looked at a range of records. These included care records for six people, including medication records and daily care notes. We looked at three staff files in relation to recruitment and folders relating to complaints and accident and incidents. We also looked at other records relating to the management of the service such as call monitoring logs.

After the inspection we reviewed information the manager sent to us.

Updated 2 April 2020

About the service

Sagecare Biggleswade is a domiciliary care agency providing personal care to people in their own homes. At the time of the inspection 250 people were receiving a 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 had experienced a drop in the quality of the service provided to them in the late summer and autumn of 2019, when the provider had merged another branch of Sagecare with the Biggleswade branch. During this period, care visits were not monitored effectively, and people experienced high levels of late and cut short calls. Complaints had not been managed well and management oversight was poor. People had not always enjoyed positive relationships with staff based in the office and some felt communication was poor.

In recent months the provider had taken steps to address these issues and improvements had been made, with further work to do.

Staff had received training in safeguarding people from harm and understood their responsibilities to report concerns. The management team reported concerns appropriately to the required external bodies. Risks were assessed and regularly reviewed, and people felt safe. However, risk assessments for one person had not been updated to reflect a change in their needs. This was addressed before the end of the inspection.

Staff did not have a good understanding of the provider’s systems and processes to report and record accidents and incidents at the service. As a result, individual staff were making their own judgement about whether an incident needed to be reported. This meant some risks to people or incidents of harm were not identified and acted upon.

People’s medicines were managed safely, and they were protected from the risk of infection. Where they needed support with this, people were assisted to have enough to eat and drink and staff took action to ensure their healthcare needs were met.

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 were up to date with most training and people said staff knew their jobs well, with some people feeling less confident about new and unfamiliar staff. People reported that care staff were caring and treated them with respect, maintaining their dignity and encouraging them to be as independent as possible.

Newly developed care plans were person centred, written in respectful language and people were aware of their contents, having been involved in their development. We have made a recommendation about improving care planning in relation to people's end of life wishes.

A manager who had previously worked at the service had returned to the role. This was welcomed by people, who had confidence in the manager’s ability to stabilise the service.

The manager was ensuring systems and processes were used to effectively monitor the quality of the service, and this was resulting in a reduction in late and cut short calls.

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’ (report published 21 July 2017)

Why we inspected

The inspection was prompted in part due to concerns received about late and cut short calls, inaccurate record keeping, how the service responded to complaints and about how conflicts of interest between management and staff were managed. A decision was made for us to examine those risks at this inspection.

We found evidence that most of these concerns had been warranted at the time they were raised and voicing them had prompted the provider to take steps to make improvements to the service. At the inspection, we found the provider and the manager had made good progress with addressing the shortfalls identified, although there was still work to be done to raise the overall rating of the service to Good.

Follow up

We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.