Sagecare (Biggleswade)

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.

The service provided personal care for people in their homes. At the time of our inspection the service provided care and support to 180 people which amounted to 1700 hours care per week. .

The service had 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 feedback we received from people who used the service and their relatives was mostly positive although some people felt the timing of their visits required improvement. They had confidence in the management and individual staff to provide safe, compassionate care that met their needs, in the way they liked to be supported.

Staff demonstrated commitment to protecting people from possible harm, and were knowledgeable about how they should do this. Systems were in place to identify and minimise any risks to people.

Staff received relevant training and had a good understanding of people’s care needs. The registered manager offered high level support to staff, ensuring they were familiar with people’s needs, and had the skills and knowledge to meet them before they started to provide support. The service was working towards each person being supported by a consistent team of staff to ensure that they received care from staff who knew them and that they felt safe with. The recruitment process for new staff was robust and all pre- employment checks were completed to ensure as far as possible that only suitable staff were employed. There were sufficient staff employed to meet people’s needs safely.

The provider demonstrated a person centred approach to care and people told us they enjoyed positive relationships with their regular staff that were friendly and respectful. They confirmed staff took care to protect their dignity and privacy.

The service provided to people was based on their individual needs and was flexible to accommodate any changes that were required. People felt able to express their views and the provider sought feedback from people to support continuous improvements to the service.

There were effective processes in place to monitor the quality of the care provided to people who used the service.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

The service provided personal care for people in their homes. At the time of our inspection the service provided care and support to 359 people.

The service had 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 registered manager was also the provider’s regional manager and was not at the service on a daily basis. Day to day management of the service was the responsibility of the branch manager. It was following the sudden departure of a newly appointed branch manager that we saw an escalation of the number of concerns that were raised with us.

People felt that they were safe using the service and trusted the staff that cared for them but there was an insufficient number of suitably trained staff to provide the care that people needed. There had been numerous occasions when people’s care calls had been late or missed altogether. The call monitoring records showed that, where people required two care workers to provide the care they needed, often only one care worker was scheduled to attend their call. This had resulted in people being unable to receive the care they required. The records also showed that many calls were shorter than the length of time scheduled. Care workers were not allocated sufficient time to travel between calls and this had resulted in people’s care being rushed as care workers tried to make up the travelling time. A new call monitoring system was to be introduced with effect from 7 November 2016. The provider was confident that this would enable calls to be better managed and monitored.

The recruitment process for new staff was not robust. The recruitment documentation did not always contain evidence of the staff member’s right to work in the United Kingdom or have validated references from previous employers.

Risk assessments had not been completed accurately and did not always reflect all the risks that people were exposed to because of their health and care needs. Neither accidents and incidents nor complaints had been recorded in the appropriate systems during 2016 so the provider was not aware of these and action to reduce recurrence could not be identified. Complaints were not resolved to people’s satisfaction.

Staff had been trained in safeguarding but the acting branch manager had failed to notify CQC of a number of safeguarding incidents. People had mixed opinions as to the skills of the care workers. There had been a number of occasions when staff had provided inappropriate care to people. Staff had positive relationships with people they cared for on a regular basis. People were less happy with the attitude of staff when they did not have regular care workers or when their regular care workers were not available.

People’s care plans were not updated following changes to their needs and services commissioned on their behalf. The documentation was not sufficiently detailed or always filed correctly. The quality assurance systems in place had failed to identify many of the concerns and where these had been identified no action had been taken to address the concerns.

During this inspection we identified breaches of a number of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We took urgent action to impose a condition on the provider's registration to prevent the service from taking on any new packages of care without the CQC's written agreement to protect people from the risk of harm.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Sage Care (Bigglewade) is a community based service providing home care support for people living in their own homes. At the time of the inspection, there were approximately 300 people being supported by the service.

The service has a registered manager in place. 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.

There were risk assessments in place that gave guidance to staff on how risks to people could be minimised and how to safeguard people from the risk of possible harm.

The provider had effective recruitment processes in place and there were sufficient staff to support people safely. Staff understood their roles and responsibilities and would seek people’s consent before they provided any care or support. Staff received supervision and support, and had been trained to meet people’s individual needs.

People were supported by caring and respectful staff who knew them well. Staff were given the opportunity to get to know the people they supported and relatives we spoke with said that staff were caring.

People’s needs had been assessed, and care plans took account of their individual, preferences, and choices.

The provider had a formal process for handling complaints and concerns. They encouraged feedback from people and acted on the comments received to continually improve the quality of the service. The provider also had effective quality monitoring processes in place to ensure that they were meeting the required standards of care.

We found that people had provided consent to be supported with their care and the provider acted in accordance with legal requirements. People's needs had been assessed to ensure the care they received was safe and effective.

The agency had procedures in place to ensure that people were safeguarded against the risk of abuse and staff had been provided with appropriate training. There were effective systems in place to reduce the risk and spread of infection.

We found that the agency had a system in place to assess and monitor the care provided to people. This ensured people were listened to and concerns were acted on and addressed in a timely manner.

A new care planning system was being introduced, which gave staff detailed guidance on the way in which each person preferred their care to be delivered. Risks to people were assessed and actions to manage any identified risks had been put in place. Medicines were managed well so that people were given their medicines safely and as prescribed.

Staff recruitment ensured that only people suitable to work with vulnerable people were employed and staff were trained and supported well so that they were equipped to do their job. People told us that they almost always got on well with the staff. One person had written to the agency: 'They [the staff] were professional, compassionate and a great source of comfort at a time that was fraught with anxiety and fear of what lay ahead'.'

The provider had processes in place to monitor the quality of the care provided and people we spoke with knew how to make a complaint if they needed to.