Supreme Care Services Limited

Supreme Care Services is a domiciliary care agency which provides personal care to people living in their own home.

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. At the time of our inspection, the agency was providing the regulated activity of personal care to 51 people. People receiving the care were either living with dementia or elderly and frail.

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

We have made a recommendation that the provider has a system by which they can be assured people’s care is delivered in accordance with their care plans.

We have made a recommendation that the provider ensures their audits identify shortfalls identified during inspection.

The provider did not have an effective system in place to monitor care worker call times. Some people who used the service told us they did not receive a rota to let them know which care worker would visit them, or for how long and they were not always informed of changes to the care provided.

Some audits were inconsistent and did not always address issues identified by us. Medicines administration was not always in accordance with the provider’s ‘recording the administration of medication’ policy.

These issues had not impacted on people but there were possible risks as a result of the absence of effective oversight and records.

People and their relatives told us they felt safe with the care provided and said care workers took increased infection prevention and control measures to keep them safe during the COVID-19 pandemic.

Care workers described how they would respond to a service user who might deteriorate during their care. They said the office staff and the registered manager were accessible and always responded to their requests for support and guidance.

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 (published 25 September 2018)

Why we inspected

We received concerns in relation to missed or late calls; poor infection prevention control practice and inaccurate record keeping. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service remains unchanged. This is based on the findings at this inspection. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the Safe and Well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Supreme Care Services Limited on our website at www.cqc.org.uk.

Services Limited on our website at www.cqc.org.uk.

Not everyone using Supreme Care Services Caterham receives regulated activity; CQC only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided.

The registered manager was present during the inspection. 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 received a safe service from the Supreme Care Services Caterham. Staff understood their duty should they suspect abuse was taking place, including the agencies that needed to be notified, such as the local authority safeguarding team or the police.

Hazards to people’s and staff’s health and safety had been assessed. Information on how to manage and minimise the risk of harm were in place and understood by staff.

Staff recruitment procedures were safe. The provider had undertaken appropriate safety checks to ensure that only suitable staff were employed to support people in their own home. There were sufficient numbers of staff who were appropriately trained to meet the needs of the people who used the service.

Staff managed the medicines in a safe way and were trained in the safe administration of medicines.

Prior to people joining the service a detailed assessment of their needs was completed. This enabled Supreme Care Services Caterham to ensure they were able to meet those specific needs, such as people’s faith, or specific medical conditions.

Where people did not have the capacity to understand or consent to a decision the provider had followed the requirements of the Mental Capacity Act (2005). Staff understood that they had to gain people’s consent before they provided care, and that they could not make decisions for people.

People were supported to have enough to eat and drink. They received support from staff with this where a need had been identified. This varied from buying and preparing meals for people who needed help eating. to just checking that people had eaten something for those who were more independent.

People were supported to maintain good health. Staff understood that if people’s health deteriorated they would respond quickly. They would make sure they contacted the appropriate professionals to ensure people received effective treatment. Emergency plans were in place to deal with situations that may stop the service running, such as adverse weather.

Staff had a positive and caring attitude about their jobs. People told us that they were happy with the care and support they received. People told us that the staff were kind and caring and treated them with dignity and respect. The staff knew the people they cared for as individuals, and had a good rapport with relatives. All the staff we spoke with were happy in their work and proud of the job they do.

People received the care and support as detailed in their care plans. Care plans were based around the individual preferences of people as well as their medical, psychological and emotional needs. They gave a good level of detail for staff to reference if they needed to know what support was required. People were supported by staff to maintain as much independence as possible.

People knew how to make a complaint, and told us they would feel comfortable doing this. Staff knew how to respond to a complaint and welcomed them as an opportunity to improve the service.

The provider had effective systems in place to monitor the quality of care and support that people received. The provider had ensured that accurate records relating to the care and treatment of people and the overall management of the service were maintained. We did highlight that there were a large quantity of records waiting to be archived at the office and recommended that this be done as soon as is practicable.

The registered manager regularly visited people in their homes, or office telephoned them to give people and staff an opportunity to talk, and to ensure a good standard of care was being provided to people.

Records for checks on health and safety, and medicines audits were all up to date. Accident and incident records were kept, and were analysed and used to improve the care provided to people.

The service was last inspected in November 2013, at that inspection we found that the service did not meet all the regulations we inspection. We found the provider was in breach of regulation 13 and regulation 22 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. The breaches concerned medicine management and staffing.

At this inspection we found the provider had made improvements, however we found a new breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Records did not confirm that people always received their medicines as prescribed because the medicine administration records (MARs) were not always complete. We found several gaps on people’s MARs and staff had not signed when they had given medicines or had not used the appropriate code if medicines were not given. The registered manager told us that regular medicine audits took place to monitor the administration of medicines. We received 10 medicine audits after the inspection. However the medicine audits did capture the errors we found.

The service has 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.

Staff had an understanding and an awareness of the provider’s safeguarding processes. Staff were trained in and had the knowledge of the signs of abuse. Staff were confident in raising a safeguarding allegation to protect people from the risk of abuse. There was a whistleblowing policy in place that staff were familiar with and understood its use to raise a concern about the service.

Staff identified risks to people’s health and well-being. Plans were developed with people to safely manage a risk whilst keeping people safe and reducing the likelihood of the risk occurring. The registered manager had employed sufficient numbers of staff to care for people and meet their individual care needs. The service had regular staff available to provide care and they were familiar to people and their needs.

Staff received support from the registered provider with training, induction, a yearly appraisal and supervision that supported them in their caring role. The support gave staff the opportunity to identify their training, personal and professional development needs.

Care and support was provided to people once they gave their consent. Staff gave people their care plan information in a way that they understood so they were able to agree to receive the support they needed. The registered manager and staff had an understanding of their responsibilities within the principals of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

People’s nutritional needs were met for the maintenance of their health. Staff supported people with their meals which met people’s needs and preferences. Carers supported people to have meals they enjoyed when they wanted.

Staff ensured people’s care needs were addressed when they changed. Staff made appropriate referrals to health care professionals for support and advice. When people’s health need changed staff used professional guidance to assist them and help people maintain their health.

People’s personal histories, likes and dislikes were recorded and this enabled staff to develop their care and support plans. People and their relatives were involved in making care decisions. Staff provided care to people in a way that was person centred and included people’s preferences, and choices while respecting their dignity and privacy.

People’s care records were regularly reviewed to ensure their care needs were appropriately met. Care reviews took place with the contribution of people so they remained appropriate and relevant. People took part in activities of their choice which met their interests and hobbies. People were encouraged to take part in activities that interested them and met their needs. Staff supported people to maintain relationships with people that mattered to them.

The registered provider had a system in place for people to make a complaint. Each person was provided with a service user’s guide and this contained the complaints policy within. People and their relatives knew how to make a complaint of the service. The registered manager understood the process for effectively managing complaints in a timely manner.

The registered manager demonstrated clear leadership and established a positive culture within the staff team. The registered manager had developed a working relationship with external health and social care staff to enhance the support people received.

At the time of this inspection Supreme Care Service Limited was providing an active service to 135 people.

People who used the service told us 'I am very satisfied with the service', 'I am quite happy with them.' And 'The agency should recruit more staff with a car so that staff can come on time.'

One relative told us that 'The agency seems to have greatly improved."My mum knows who's coming at what time. She likes all the girls and looks forward to their call. She chats to them while they're working and they are all very friendly and personable.' Another relative commented that 'Carers are friendly and patient and supportive. I am extremely satisfied with the care my mother receives.'

People we spoke with told us they were involved in making decisions about their care and treatment. People who used the service told us they felt safe with the staff who looked after them and that if they had any concerns they could ring the acting manager's office and speak to her.

The agency had a robust recruitment procedure in place, this meant that people were cared for by people who had been checked to work with vulnerable people.

We found that the provider had a system in place to monitor the quality of the service they provided and we found that people were generally satisfied with the care and treatment they received.

People were not protected against the risks associated with medicines because the provider did have appropriate recording system in place to manage medicines.

We found that people who used the service were involved in making decisions about the care they needed or made aware of their plan of care.

We found that the provider assessed the level of care people needed and the availability of staff to provide the care, before they agreed to deliver a care package.

People we spoke with told us that they were involved in the assessment and planning of their care, but some of them told us they could not remember signing a plan of care. They also told us that they were regularly contacted by telephone from the agency office to ask if they had any queries or had any problems or concerns.

People we spoke with told us that the carers usually arrived on time and if the carer was delayed they received a telephone call from the office or the carer themselves.

Representatives of people who used the service told us that they were advised when a review of their relatives care plan had taken place, or if any changes were required.

We spoke to staff who told us that they liked working for the agency and felt well supported. One staff member said, 'I like that I can ask for specific training so that I can deliver better care'.