Background to this inspection
Updated
29 December 2022
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 Health and Social Care Act 2008.
Inspection team
The inspection was completed by an inspector 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 and specialist housing.
Registered Manager
This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.
At the time of our inspection there was a registered manager in post. They were also the provider of the service.
Notice of inspection
We gave the service 48 hours’ notice of the inspection. This was because the service is small and we wanted to ensure a member of the management team would be available.
Inspection activity started on 10 November 2022 and ended on 25 November 2022. We visited the location’s office on 10 November 2022.
What we did before the inspection
We reviewed information we had received about the service since they registered. We sought feedback from the two local authorities who commissioned care. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used all this information to plan our inspection.
During the inspection
During the site visit we met the managing director, who was the registered manager’s business partner. We reviewed 3 staff recruitment files and records relating to the management of the service.
Following the site visit, we reviewed 4 people’s care plans and care records in full and partially reviewed a further 4 people’s records. We spoke with 3 people, 13 relatives and 1 person’s representative. We spoke with 7 staff, the registered manager and 3 professionals.
Updated
29 December 2022
About the service
Surrey Care - Fleet is a domiciliary care service providing personal care. The service provides support to younger and older adults, people with a physical disability or a sensory impairment, people with dementia, people with an eating disorder and people with a learning disability or autism. At the time of our inspection there were 39 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
The provider had not ensured all potential risks to people were assessed and mitigated, nor had staff always reported incidents as required. Staff did not always maintain accurate and complete records of the care provided. The provider had not ensured the proper and safe management of medicines for people.
People had not always received their care for the time commissioned and staff were not all sufficiently competent and skilled. The registered manager had not always ensured staff were competent before they worked alone with people. The registered manager had not ensured any potential risks associated with the completion of criminal record checks in the UK for staff recruited from overseas were fully mitigated.
The registered manager who worked in partnership with their business partner, the managing director, had failed to fully assess, monitor and mitigate risks arising from the provision of the regulated activity or to ensure governance systems were operated robustly.
Staff had completed safeguarding training and policies and processes were in place. However, the registered manager had always recognised potential risks to people. Staff had completed infection control training and checks were made on their practice, however, feedback from people and relatives showed there was inconsistency in staff’s practice.
The provider was registered to provide care to people with a learning disability or autism or an eating disorder. However, they had not and did not intend to provide care to people with these care needs. They had updated their statement of purpose to reflect this change. However, they also needed to notify CQC of this change to their registration.
Staff supported people to eat and drink sufficient for their needs. Staff identified if people needed to be referred to professionals and referrals were completed. Staff worked with professionals in the delivery of people’s care. 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 and relatives provided positive feedback overall about how staff treated people. Staff treated people with dignity and respect. People were supported to express their views.
We have made 2 recommendations about the need to ensure staff are appropriately matched to people who have additional communication needs and to consider how they record who was involved in people’s care planning.
People received care which was planned with them, taking into account their protected characteristics, in order to identify their needs. People’s concerns and complaints were logged and required actions were taken. The service was not commissioned to provide end of life care to people.
Processes were in place to seek people's feedback about the service. A range of aspects of the service were audited, to identify potential areas for improvement.
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
This service was registered with us on 7 January 2022 and this is the first inspection.
Why we inspected
The inspection was prompted in part due to concerns received about people’s safety, the quality of care provided, staff training, duration of care calls, medication administration and staff’s use of personal protective equipment (PPE).
You can see what action we have asked the provider to take at the end of this full report.
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 safe care, staffing and governance at this inspection.
Please see the action we have told the provider to take at the end of this report.