This inspection of Sagecare (Peterborough) took place between 21 June 2018 and 4 September 2018. Our visit to the office was announced to make sure staff were available.

Sagecare (Peterborough) is a domiciliary care agency that provides personal care to people living in their own houses and flats in the community. It provides a service to older adults. At the time of our visit 158 people were using the service.

Not everyone using Sagecare (Peterborough) received a 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.

There was a registered manager at this agency who was supported by an office manager and other senior staff. 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.’

At our previous inspection between 7 and 9 June 2017 we rated this service as Requires Improvement in relation to medicine management and care plans. The rating has improved to Good at this inspection. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions Well-led to at least Good. They told us that they would meet the legal requirements by 30 September 2017.

The provider’s monitoring process looked at systems relating to the care of people, where issues were identified action was taken to resolve these. People’s views were sought and action put into place to improve issues that were raised.

Medicines were administered safely and there was clear information and guidance in people’s care plans for staff to follow when giving medicines in specific ways. Care plans were written in detail and contained guidance for staff to follow.

Staff knew how to respond to possible harm and how to reduce risks to people. Lessons were learned from accidents and incidents and changes to practise were shared with staff members to reduce further occurrences. There were enough staff who had been recruited properly to make sure they were suitable to work with people. Staff used personal protective equipment to reduce the risk of cross infection to people.

People were cared for by staff who had received the appropriate training and had the skills and support to carry out their roles. Staff members understood and complied with the principles of the Mental Capacity Act 2005 (MCA). People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. People received support with meals, if this was needed.

Staff were caring, kind and treated people with respect. People were listened to and were involved in their care and what they did on a day to day basis. People’s right to privacy was maintained by the actions and care given by staff members.

There was enough information for staff to contact health care professionals if needed and staff followed the advice professionals gave them. People’s personal and health care needs were met and care records guided staff in how to do this.

A complaints system was in place and there was information available so people knew who to speak with if they had concerns. Staff had guidance to care for people at the end of their lives if this became necessary.

Further information is in the detailed findings below

Sagecare (Peterborough) is registered to provide personal care to people living in their own homes. At the time of our inspection a service was being provided to older people, people living with dementia, younger adults, people living with mental health conditions and people living with physical disabilities or sensory impairment. The service has its office in Peterborough and covers the Peterborough and surrounding areas. There were 182 people receiving personal care from the service and there were 71 care staff employed, at the time of this inspection.

This comprehensive inspection took place on 7, 8 and 9 June 2017 and was announced.

At the last inspection on 9 November 2016 there was a breach of the legal requirements found. We found that improvements were needed to ensure that people were protected against covert medication administration and that risks were assessed and managed effectively. The provider told us that they would take the required action by 15 February 2017.

During this inspection we found that the provider had made some improvements in relation to the previous breach. Authorisation of covert medication had been agreed, but clearer information was needed from the GP to ensure people were kept safe. Risks had been assessed and managed effectively. Staff understood the risks and how to minimise them.

There was 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.

Most people had their needs assessed and reviewed so that staff knew how to support them to keep their independence. Staff treated people with care and respect and made sure that their privacy and dignity was respected all of the time.

The provider's policy on administration and recording of medication had been followed by staff. Audits in relation to medication administration had been completed but were not robust, as they did not always identify all areas of improvement required.

People had had their needs assessed and reviewed so that staff knew how to support them and meet their requirements. Most people's care plans contained person centred information which detailed people’s likes and dislikes and how they wished to be supported. However, other care plans we saw did not include details of people’s preferences.

There was a system in place to record complaints. These records included the outcomes of complaints and how the information was to be used by staff to reduce the risk of recurrence.

Staff understood the principles of the Mental Capacity Act 2005 (MCA) and could describe how people were supported to make decisions. Training had been provided by the service and staff were aware of current information and regulations regarding people’s consent to care. This meant that there was a reduced risk that any decisions, made on people's behalf by staff, would not be in their best interest and as least restrictive as possible.

The provider had a recruitment process in place and staff were only employed in the service after all essential safety checks had been satisfactorily completed. Staff received an induction when they started work and further training was available for all staff which provided them with the skills they needed to meet people’s requirements.

People and their relatives were involved in how their care and support was provided. Staff checked people’s health and welfare needs and acted on issues identified. People were supported to access health care professionals when they needed them. People were provided with a choice of food and drink.

People, relatives and staff were able to provide feedback and information. The management provided an open culture. There were systems in place to monitor and audit the quali

We carried out an announced comprehensive inspection of this service on 26 and 27 May 2016. A breach of legal requirements was found. This was in relation to medication, where staff had not followed the provider’s policies in recording prescribed medicines that had been administered and audits of medicines had not been completed effectively. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach.

We undertook this focused inspection on 9 and 23 November 2016 to check that the provider had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Sagecare (Peterborough) on our website at www.cqc.org.uk.

Sagecare (Peterborough) is registered to provide personal care to people who live in their own homes in Peterborough and the surrounding area. At the time of our inspection 200 people were receiving personal care from the service and there were 59 care staff employed.

At the time of this inspection there was a registered manager in post. 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 and associated Regulations about how the service is run.

At our focused inspection on 9 and 23 November 2016, we found that the provider had followed most of their action plan in relation to the risks of medication administration. They had told us the actions would be completed by 30 September 2016. Legal requirements had been met.

Staff had recorded in the medication administration record charts when creams had been applied for people who required them. Some training had been provided to show the impact and consequences if staff did not administer medication as prescribed. Staff competency in the administration of medication had been checked. Audits of medication records had been completed monthly and action had been taken where necessary.

People were at risk because information and authorisation for staff to administer covert medication was not available in people’s files.

People’s risks were not assessed and measures were not in place to minimise the risk of harm occurring.

Safeguarding referrals had been made to the local authority safeguarding team and concerns had been or were in the process of being investigated.

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

Sagecare (Peterborough) is registered to provide personal care to people who live in their own homes in the Peterborough and surrounding area. At the time of our inspection 200 people were receiving personal care from the service and there were 40 care staff employed.

This unannounced inspection took place on 26 and 27 May 2016.

The service had 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.

The provider’s policy on administration and recording of medicines had not been followed, which meant that people may not receive their prescribed medicines. Audits had not always identified issues with medicines management.

People had their needs assessed and reviewed so that staff knew how to support them to maintain their independence. People’s care plans contained person focussed information, and this information was up to date for most people.

There was a sufficient number of staff available to ensure people’s needs were met safely. The risk of harm for people was reduced because staff knew how to recognise and report abuse. Staff were aware of the procedures for reporting concerns and systems were followed and concerns were investigated.

Staff were only employed after the provider had carried out comprehensive and satisfactory pre-employment checks. Staff were well supported by the registered manager and senior staff through supervisions and staff meetings.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and report on what we find. We found that staff were trained in the principles of the Mental Capacity Act 2005 (MCA) and could describe how people were supported to make decisions.

People did not always receive care and support from staff who were kind, caring and respectful to them. Most staff treated people with dignity and respected their privacy.

People knew how to make a complaint. The provider investigated any complaints and as a result made changes to improve the service.

The registered manager was supported by a staff team that included a regional manager, a care manager, two care co-ordinators and care workers. The service had an effective quality assurance system in place. People and relatives were encouraged to provide feedback on the service and their views were listened to and acted on.

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

An adult social care inspector carried out this this inspection on 28 August 2014. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

As part of this inspection we spoke with 12 people who used the service, four relatives, five healthcare professionals who had regular contact with the agency, the registered manager, the regional manager and seven members of care staff. We reviewed records relating to the management of the service which included six care plans, daily records, medication procedures, training and supervision records and quality assurance monitoring records.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at

Is the service caring?

People told us that they received consistent and respectful support from care staff and felt able to make choices and changes regarding their care and support when required. Care staff told us that they were well supported, trained and supervised by the agency so that they could provide safe care and support to people.

Is the service responsive?

We saw that people’s personal care and support needs were assessed and met. This also included people’s individual choices and preferences as to how they wanted their care to be provided. People we spoke with told us that they could make changes to their support and had been involved in reviews of their care. It was noted that changes to documentation were made to accurately reflect the support being provided by care staff.

Is the service safe?

Risk assessments regarding people’s individual needs were carried out and measures were in place to minimise these. Care staff understood their roles and responsibilities in making sure people were protected from the risk of abuse. The provider was taking appropriate action to ensure that all carers were kept up to date with safeguarding training.

Is the service effective?

We found that carers were knowledgeable about people’s individual care and support needs. People using the service that we spoke with, and their relatives, confirmed that care staff provided respectful care and support. The manager confirmed that measures were in place to ensure that reviews of care and support documentation were regularly monitored to meet people’s assessed needs.

Is the service well led?

Staff that we spoke with told us that they felt well managed and supported by the manager and staff based in the agency’s office and felt there was regular training so that they could safely provide care and support. People that we spoke with told us that they felt they were listened to and support was consistently and safely provided. Quality assurance systems were in place to regular audit the care and services it provided. Improvements had been made regarding some aspects of quality assurance since our last inspection in October 2013. Surveys were carried out to gather opinions from people using the service, relatives and staff to ensure that ongoing improvements could be made.

Plans of care detailed what the person's current needs were and their preferences and how staff were to provide appropriate care and support. People we spoke with told us they were happy with the service that they received.

Staff we spoke with demonstrated a good understanding of safeguarding processes and told us that they received regular training. Training records we reviewed confirmed this.

There were enough qualified, experienced and skilled staff to meet people's care and support needs. Staff training records showed that staff received appropriate and specialist training to provide care to people who used the service.

People were asked for their views about the service and their care and this was acted on. The provider also had systems in place to monitor the quality of the service provision; however this was not always effective.

Sagecare (Peterborough) is registered to provide personal care to people who live in their own homes. At the time of our inspection 258 people were receiving a personal care service.

We last inspected Sagecare (Peterborough) in August 2014. At that inspection we found the service was meeting all the essential standards that we assessed. This announced inspection took place on the 6 and 7 August 2015.

The service had a registered manager in post. They had been registered since 2013. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the scheme. 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 scheme is run.

The providers’ policy on administration and management of medicines had not been followed by staff which meant that people may not receive their prescribed medicines. Audits had not always identified issues with medicine management. Where issues had been identified the required action had not always been taken or recorded.

People’s needs were assessed and staff were able to support people and meet their needs. However some care plans contained limited information.

Risks to people’s safety had not always been assessed. Staff had no recorded information on how to deal with incidents should they occur.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) Deprivation of Liberty Safeguards (DoLS) and to report on what we find. We found that people who used the service had not had their capacity to make day-to-day decisions formally assessed.

The risk of harm for people was reduced because staff knew how to recognise and report abuse.

The recruitment process ensured that only suitable staff were employed to provide care to people using the service. There were sufficient staff to meet the needs of people receiving a service.

The provider had quality audits in place to monitor the safety and wellbeing of people using the service. However, issues had not always been identified. Where they had been identified, the action taken had not always been recorded.

People’s privacy and dignity was respected by all staff. People were aware that there was a complaints procedure in place and who they would contact. People found communication with staff in the office to be less than efficient.

Staff felt supported by the managers and they were able to raise any concerns or discuss any ideas they had.