The inspection took place on the 8 and 19 March 2018 and was announced. We gave the provider 24 hours’ notice of our intended inspection. This is because the service is a domiciliary care agency and we needed to make sure the provider and registered person would be available at the office location to facilitate our inspection.

At the last inspection in October 2017. The service was rated as overall requires improvement. The service was in breach of three regulations 11, 12 and 17 of the HSCA 2008 (Regulated Activities) Regulations 2014. People had experienced late and missed visits. Staff had not always been supported consistently or received training in a timely way and the service was not effectively managed.

We received an improvement action plan following the last inspection, which the provider regularly updated so we could monitor the progress. The action plan told us how they would make the required improvements. At this inspection we found the provider had made significant improvements in the key areas required. At the time of our inspection, the provider and registered manager were continuing to implement strategies to ensure sustained compliance with the regulations.

SKL Bushey is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older people and adults with physical disabilities, including people living with dementia who live in their own homes. At the time of our inspection there were thirty eight people being supported by the service.

People, their relatives and staff felt that the registered manager was approachable and supportive. Quality assurance checks were not always evaluated effectively. There were some inconsistencies in the way records were maintained. The registered manager demonstrated a good knowledge of the people who used the service and the staff they employed. People’s views were sought and feedback evaluated as part of the provider’s quality assurance system. People were contacted by phone and visited by members of the management team to check that they remained happy with the service they received.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 using the service. The management and staff team demonstrated a good understanding of the different types of abuse and knew how to protect people from potential harm and abuse. There were enough staff available to meet people’s needs safely and effectively. Staff were recruited through a robust process and pre-employment checks were completed prior to staff working at the service.

People and their relatives told us that the care and support provided was appropriate to meet people's needs. Staff received training to help them to provide people’s care and support. Staff sought people's consent to care. People received support to access support from healthcare professionals when required. People were involved in making decisions about their own care, where they were able and it was appropriate. People felt that they were treated with dignity and respect by staff.

People and their relatives told us they had been involved in developing people's care plans and felt that their opinion was respected. The provider had policies in place to help ensure that any concerns or complaints raised by people who used the service or their relatives were appropriately investigated and resolved.

The inspection took place on 10 and 13 October 2017 and was unannounced. SKL Bushey is a domiciliary care agency providing care and support to people who lived in their own homes. At the time of our inspection 60 people were being supported by the service.

When we last inspected the service on 29 March 2017 we rated the service as overall requires improvement. At the last inspection we found that people had experienced late and missed visits. Staff had not always been supported consistently or received training in a timely way and the service was not effectively managed. Since the last inspection there had been changes in the management of the service and the service had moved to a new premises. Some improvements had been made however further improvements were required. We found the provider to be in breach of regulations 11, 12 and 17 of the HSCA 2008 (Regulated Activities) Regulations 2014.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 were knowledgeable about the risks of potential abuse and knew how to report any concerns. People had their individual risks assessed and where possible these were mitigated. However we found that risk assessments in people’s care files did not always relate to the correct person as they had been copied from other risk assessments so the information provided may have increased the potential risk of harm to people. Staff were recruited through a process which was not always robust and information contained in staff recruitment files was inconsistent. Although there were enough staff employed to meet people’s needs, they were not always deployed effectively to ensure they arrived at the expected time, and people reported staff were often late. People were supported to take their medicines safely and although records were kept these were inconsistent and required improvement.

Staff had received training in a range of topics and had the necessary skills to support people. However training records indicated that updates were not always provided on time and some were overdue. The registered manager told us the training had been completed but the record had not yet been updated. Staff received some support through individual supervision with their line managers but this needed to be developed to ensure it was consistent and effective.

People had been asked to consent to their care and treatment. However we found that people had not always had their capacity assessed where they either lacked capacity to make day to day decisions or people who capacity fluctuated.

Staff and the registered manager were aware of the principles of MCA but did not fully understand how this related to their work and the steps to follow to ensure people received care that was both in their best interest and any restrictions were as least restrictive as possible. People were assisted to eat and drink sufficient amounts to maintain their health and wellbeing and were supported to access health care professionals when required.

People did not always receive personalised care from staff. We found that care plans were ‘task’ focused and lacked personalisation. The process for responding to changes was disjointed and required development to help the service be more proactive when dealing with changes and providing a flexible and person centred service People said they did not always have the same staff in particular at the weekend. Staff did not always arrive at the expected time and people were not always advised if staff were running late. Where people required the assistance of two people staff did not always arrive at the same time.

People were able to raise complaints if they we

This inspection visit took place on 20, 24 and 29 March 2017 and was unannounced. SKL professional Recruitment agency Bushey is registered as a domiciliary care agency and provides personal care and support to people in their own homes. At the time of our inspection 60 people were being supported by the service.

When we last inspected the service on 02 August 2016 we found that they were not meeting the required standards. At this inspection we found that some improvements were made but the provider was still not meeting the required standards. There were still areas that required further development.

There was a registered manager in post who was also the provider. 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. A new manager had recently been recruited as the previous branch manager who was not registered was leaving the service on 31/03/20017. The provider told us that the new manager would be registering with CQC to become the registered manager.

People were kept safe by staff who had an understanding of their responsibilities with regards to protecting people from harm or possible abuse. There were sufficient numbers of staff employed at the service and staff had been recruited appropriately with pre-employment checks completed before staff commenced working at the service. However, we found that full employment history had not been completed for two of the staff whose recruitment files we reviewed. People were supported and prompted to take their medicines by staff who had received training in the safe administration of medicines.

Staff did not always arrive at the service user’s home at the expected time and did not always stay for the time scheduled. Staff members had received training, however some was out of date and required updating to help ensure staff followed best practice and current guidance. This was an area that was being reviewed by the provider at the time of our inspection. There had been some staff turnover since the last inspection and this had impacted on the consistency of care people received.

The registered manager had a clear understanding of the Mental Capacity Act 2005. They were knowledgeable about protecting legal rights of people who did not have the capacity to make decisions for themselves. The service acted in accordance with legal requirements to support people who may lack capacity to make their own decisions. Staff required further development to enable them to properly understand MCA principles in relation to obtaining consent from people.

Staff knew the people they were supporting well along with their needs and routines. Work was in progress to develop care plans and make them more personalised. There was evidence that some people had been involved in the development and review of their care plans but this was not a consistent approach.

There was a complaints policy and procedure in place and we saw that complaints had been recorded and investigated with an outcome recorded. However we found that the response to complaints was defensive and no apology was provided, despite clear evidence that the complaint was substantiated. People felt that raising a concern was not viewed as a means of improving and learning from issues that were raised.

There were quality monitoring systems in place these included satisfaction surveys, spot checks and internal audits. However these were ineffective because they had not been analysed and actions had not been put in place to address issues and concerns that people had raised. The registered manager acknowledged that this was an area which required further development and steps were in place to address this as a matter of priority. We found that people had

The inspection took place on the 2, 8, 16 and 17 August 2016 and was in response to concerns received by CQC. At the previous inspection on 7 October 2015 the service was assessed as requires improvement in the areas inspected. At this inspection we found the provider was in breach of regulations 17 and 18 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the registered person had not ensured sufficient staff were available at all times to support people in a timely way and the quality assurance systems were inadequate in identifying the issues we identified at our inspection. The recruitment process was not robust to ensure fit and proper staff were employed. The provider sent us an action plan to tell us the improvements they were going to make following this inspection.

At the time of our inspection SKL professional recruitment agency were supporting 65 people with support in their own homes.

People who were being supported by the service had various needs including age related frailty, dementia and physical health conditions.

The service had a registered manager in post. The registered manager had been away from the service for three months. However the branch manager had recently submitted an application to CQC to become the registered manager and the application was in progress at the time of our 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 did not always have their visits at the agreed times and they were not usually informed when care staff were running late. We found records were not completed fully. Electronic call monitoring systems were not effectively monitored and staff did not always comply with the requirement to log in and out of the system to register their arrival and departure times. People who required the assistance of two staff did not always receive safe and effective care as the two staff members did not arrive at the same times.

Staff had received some training in relation to Mental Capacity Act 2005 (MCA) however did not always understand their responsibilities in relation to MCA. Staff sought people’s consent before assisting them and consents were recorded in some of the care plans we saw and were reviewed periodically. However, not all care plans we reviewed had people’s consent recorded.

People’s needs were assessed prior to receiving a service from SKL Professional Recruitment Agency. However some of the care plans were incomplete and did not always ensure people’s individual needs, preferences and choices were taken into account and implemented. People told us that most of the care staff were very kind and caring however they did not always have a consistent care worker.

There were risk assessments in place that gave guidance to staff on how the risks to people could be minimised. The systems in place to safeguard people from the risk of harm were reviewed annually and also in response to a change to people’s abilities.

Recruitment processes were not robust. We found the policy was very basic and did not detail the actual requirements that the manager told us were in place. We found that while there were sufficient staff employed to meet people’s needs people often received late visits and care staff were often changed at short notice.

Staff were supported by the manager and had received up to date training. However staff were not always able to demonstrate their competency. We found that although records indicated that staff had their competency assessed, we could not be assured that individual competency in a range of topics had been assessed as records had been signed collectively. The training was not in depth, we no

The service provided care to adults in their own homes. People who were being supported by the service had different levels of requirements. The service assisted people with age related fragility and various health conditions as well as people living with dementia. At the time of the inspection, 98 people were being supported by the service.

The service had a manager, who was in the process of registering 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. The provider also worked at the service.

People’s needs had been assessed, and care plans were in place detailing their individual needs, preferences, and choices. However these were not always met in the way people preferred and or in a timely way. There were risk assessments in place that gave staff appropriate information on how to manage and where possible minimise risks to people. There were systems in place to safeguard people from the risk of avoidable harm.

We received mixed feedback from people who used the service about the quality of care they received and from staff about the support staff received. This is detailed in the main body of the report under the responsive domain.

The provider had effective recruitment processes in place and there were sufficient staff to support people safely. Staff understood their roles and responsibilities. Staff obtained people’s consent prior to care being provided in line with MCA legislation.

Staff received support, supervision and appropriate training, relevant to their roles. They were able to demonstrate through telling us about how they supported people and also told us that their competency had been monitored.

People were supported by staff who were caring and respectful. People who wished to were also supported to pursue hobbies and interests. People were supported to access health services including GP, opticians and dentist appointments when they needed.

The provider had a procedure for handling complaints, comments and concerns. They encouraged feedback from people as a way to improve the standards within the service.

The provider had effective quality monitoring processes in place. This included a telephonic monitoring system to make sure care and support staff attended client visits in a timely way and stayed for the duration of the visit. Records were stored securely in locked cabinets in the office and computerised records were also kept, which were backed up daily to ensure there was always up to date information available.

We consider all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask, Is the service safe, Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

This is a summary of what we found.

Is the service safe?

Not assessed during this inspection

Is the service effective?

During this inspection we found that the provider had ensured that all staff received an annual appraisal and staff were receiving supervisions every three months. We saw evidence of the supervisions that had taken place. We spoke with four staff over the phone and they all confirmed they had recently received their supervision. One member of staff said, “I feel supported and if I have anything I need to ask, they [Management] help me.” Another said when asked if they felt supported, “Yes I feel supported, I am happy because things run smoothly.”

Is the service caring?

Not assessed during this inspection

Is the service responsive?

Not assessed during this inspection

Is the service well led?

Not assessed during this inspection

The inspection team was made up of one inspector. We set out to answer our five questions; Is the service caring?? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, their relatives, the staff supporting them and looking at records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People we spoke with all said that they felt that the carers provided safe care. People told us that they felt their privacy and dignity were respected by the care staff. We saw evidence that the new style care plans were person centred and risk assessments had been undertaken to help minimise potential risks to people and staff. The manager had regularly undertaken announced and un-announced spot checks to ensure that staff were providing a good service.

Most staff had received training in safeguarding vulnerable adults from abuse and understood how and where they could report allegations of abuse.

Is the service effective?

We looked at the care records of eight people who received care from the agency. We found these provided details of what support people needed and that the care plans were user friendly. We noted that the care plan showed people’s preferences, likes and dislikes. People told us that they were happy with the care that they had received.

Is the service caring?

People we spoke with all stated that staff were caring and supportive. One person said, “The carers are really good”. Another person said, “My carer is a massive help to me, I am so grateful”.

Is the service responsive?

People we spoke with were asked if they had made a complaint about the service they had received. Where people had made a complaint we were told that the provider had responded appropriately and concerns had been addressed and that measures were in place to try and prevent the problem from re-occurring.

Is the service well-led?

The provider had a quality assurance system in place that sought the views of people who used the service. Records of accident and incidents were kept and were appropriately followed though by the manager.

We found that staff did not receive regular one to one supervision as stated in the provider’s policy and procedures for one to one supervision and the provider did not have a system in place to ensure that all staff were made aware of changes that affected the service and people who used the service.

We asked the provider to tell us what they would do to meet the requirements of the law in relation to supporting staff.