We carried out an announced comprehensive inspection of this service between 02 and 26 June 2017 to check whether sufficient improvements had been made since our last inspection in October 2016. The inspection in October 2016 was carried out in response to concerning information received by the Care Quality Commission (CQC) about the service. We identified breaches of a number of the Health and Social Care Act 2010 (Regulated Activities) Regulations. The service was rated as inadequate and placed into special measures. We took enforcement action to place a condition on the registration of the service to restrict new packages of care until such time as sufficient improvements were made. At this inspection we found the service had made significant and sustained improvements.

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.

We carried out an announced comprehensive inspection of this service between 6 and 13 June 2016. After that inspection we received concerns in relation to medicines administration, missed and late care calls, poor care, poor communication and unacceptable attitude of office and senior staff. As a result we undertook a focused inspection to look into those concerns. This report only covers our findings in relation to those topics, although the topics affected each of the five areas we look at, safe, effective, caring, responsive and well led. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Sagecare - Biggleswade on our website at www.cqc.org.uk.

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

We carried out an announced inspection on 06 June 2016 and made telephone calls to people who used the service and staff on 07, 09 and 13 June 2016.

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.

Overall, people we spoke with made positive comments, stating that they were satisfied with the service. A number of people had written to the agency to thank them. Some of their comments included, “Thank you all for the wonderful care you gave him….and me” and “We would like to record our gratitude for the sensitive and professional approach shown….during the last days of our [relative’s] life.” People said staff treated them well, respected their privacy and dignity and encouraged people to retain their independence.

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.

As part of our review, we sent surveys out to people using the service and their relatives/friends; to ask them about their experience in relation to Sagecare Ltd. We also spoke to people on the telephone. In total, we received feedback from 37 people.

The majority of the people that we spoke to or surveyed, told us that they were satisfied with the service. Almost half, were very satisfied.

People told us that care workers were dedicated, friendly, helpful and treated them with respect. They said that care workers showed care and consideration and carried out tasks efficiently and effectively.

One person said they were extremely pleased with the care most of the time and that they liked the fact that the agency tried to send the same carers out to them.

Other people told us that their main care worker was "a brilliant social contact" and "she genuinely cares". And that they could not be treated any better if they were the "Queen of England".

But they also told us that carers did not always turn up when they were meant to. And that they were not always told when care workers were going to be delayed; and this caused anxiety for them. People said that they might have to wait to get up in the morning, had missed breakfast because calls were too late or they had been left feeling sore because they were "soaked through".

Comments were made about some calls being missed due to care workers being off sick or on holiday, and care workers often rushed and as a consequence they felt rushed too.

Some people who needed more than one carer did not always get the number of carers required.

And people did not always feel that the agency listened to their concerns or that care workers had enough experience.

People said that the service would be better if care workers were more patient and paid more attention to requests made by them such as taking them out, cutting up food, turning lights on and off and drawing curtains.

We spoke with 11 people who use the service by telephone and four family members. We also visited a person who use the service in their home and spoke with eight staff members and the registered manager. People said that they were happy with the care provided and that staff respected their privacy and dignity. They told us they were regularly contacted by the agency and asked for their views on the care provision. A person who used the service said, “If I have any queries I get on the phone to them. They do regular checks. There is always someone on call at weekends; also there is a number at the back of your book that you can call. I have had to use it once.” A second person said, “I am not easily pleased but I am happy with the 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.