Sylvian Care Reading and Wokingham

Sylviancare Reading & Wokingham is a domicillary care agency providing personal care to people. The service provides support to younger adults or older people who may also have a sensory impairment, physical disability, learning disability, dementia or a mental health condition. At the time of our inspection there were 86 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

Medicines were managed safely and risk assessments were completed for each person to ensure that they were provided with safe care by staff. The provider recruited staff in accordance with regulations and ensured only staff suitable to support people living in their own home were appointed.

Care plans were person centred and included the input of the relevant person. 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.

The registered manager and staff had an open and transparent way of working to ensure the safety of the people using the service. The registered manager was able to demonstrate that quality assurance systems ensured the quality of the service was maintained. Staff knew people they supported well and cared about their wellbeing. The provider was able to demonstrate their compliance with legal obligations and any learning from incidents or accidents was undertaken effectively.

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 4 February 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.

At our last inspection we recommended the provider considers documenting actions taken as a result of reviews and investigations in order to continue to improve the service. At this inspection, we found the provider had acted on the recommendation and improvements had been made.

Why we inspected

We carried out an announced focused inspection of this service on 15 January 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve good governance, fit and proper persons employed and notification of incidents.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Sylviancare Reading & Wokingham on our website at www.cqc.org.uk.

Follow up

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

Sylviancare Reading & Wokingham is a domiciliary care agency providing support to people in their own homes. People with various care needs can use this service including people with physical disabilities, older people and people with dementia. At the time of inspection, 90 people received personal care from this service.

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.

People’s experience of using this service and what we found

Breaches of legal requirements were found at this inspection. The registered person had not made sure staff employed were of good character and that all required information and checks were carried out. CQC was not notified, as required by law, of all notifiable incidents. The provider had not operated an effective system to assess, monitor and improve the quality and safety of the service provided.

We found that medicines management was safe. Where people were prescribed 'as required' (PRN) medicines, the service had protocols or guidance in place to support staff with knowing when to administer PRN medicines.

Incidents and accidents had been documented however; details of the actions taken was not always reported. Staff training records were reviewed and all mandatory training was completed.

Care plans were compiled in a person-centred format and people reported being involved in the process. Complaints had been recorded and the registered manager responded to complaints in a timely way. People told us that they knew how to complain and when concerns were brought to the provider, they acted promptly to rectify the concern.

Records of satisfaction questionnaires completed by people receiving personal care were reviewed. Results indicated that those completing the questionnaires were happy with the support they received.

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.

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 15 June 2019) and there were multiple breaches of regulation. At this inspection not enough improvement had been made and the provider was still in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for two consecutive inspections. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

We will describe what we will do about the repeat requires improvement in the follow up section below.

Why we inspected

We carried out an announced inspection of this service on 15 January 2021 to follow up on previous breaches. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, good governance and notification of incidents.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions Safe, Responsive and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has not changed. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Sylviancare Reading & Wokingham 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 monitor the service 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 notification of incidents, safe recruitment of staff and good governance of the service.

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

This inspection took place on 8 and 9 April 2019 and was announced. Sylviancare is a domiciliary care service providing care and support to people in their own homes to promote their independence and well-being. At the time of the inspection personal care was provided to 108 people.

The service had a registered manager in place at the time of inspection.

During the inspection we looked at people’s experience of using this service. We found that medicines management was not always safe, not all daily notes were legible, where people were prescribed 'as required' (PRN) medication, the service did not have protocols or guidance in place to support staff with knowing when to administer medicines. The provider had not evidenced a full employment history across and all care plans viewed did not detail how to support people’s risks. The Commission was not notified, as required by law, of all notifiable incidents. The governance audits did not always illustrate discrepancies, actions taken and how quality assurance processes helped to drive service improvement, but relatives knew how to complain and knew the process to follow if they had concerns. However, it was not clear how the service used complaints to identify patterns of concern and lessons learnt.

Staff received regular supervision and appraisals and could demonstrate a knowledge of safeguarding and the processes. People and their relatives told us staff were caring.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

There is more information about this in the full report.

Rating at last inspection: Good (Report published 28 September 2016)

Why we inspected: This was a planned announced inspection based on the rating at the last inspection.

Follow up: We will continue to monitor all information we receive about this service. This informs our ongoing assessment of their risk profile and ensures we are able to schedule the next inspection accordingly.

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

The day to day management of the service was carried out by one of the directors of Sylviancare who was the registered manager and a newly appointed manager who was in the process of applying to be registered with the Care Quality Commission. 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.

People felt safe and well cared for, they received care and support from familiar and regular staff. There were sufficient staff to provide safe and effective care.

People were involved in planning their care and staff sought consent before they provided support.

People were treated with kindness and dignity and staff spoke about people with respect. Staff supported people to remain as independent as they wished.

Staff had received training in safeguarding people and understood their responsibilities in keeping people safe. They were knowledgeable about what should be reported and felt confident any issues regarding people’s safety were dealt with appropriately by the provider.

Staff received an effective induction and ongoing training. They received support through one to one supervision meetings and annual appraisals. Staff felt they could discuss any issues openly and they received guidance when they needed it.

The provider had a robust recruitment procedure which helped to ensure suitable staff were employed at the service. However, we found one staff recruitment file did not have a full employment history, this was immediately dealt with by the manager.

Medicines were managed safely and people received their medicines when they required them.

The provider sought people’s views on the service in a variety of ways and used this to make improvements to the service. People knew how to raise concerns or make complaints. They felt confident their views were listened to and acted upon.

Staff were provided with information concerning people and changes to their care in a prompt manner. When necessary staff contacted healthcare professionals to seek advice regarding people’s well-being.

The provider had systems to assess and monitor the quality of service that people received. This enabled them to identify areas for improvement.