The inspection took place on 2 October 2018. The inspection was announced which meant that we gave the provider 36 hours’ notice of our visit. This was because the location provides a domiciliary care service and we needed to be sure that the registered manager would be available.

Sally and Sarah is a domiciliary care agency. It provides personal care to people living in their own homes in the community. Not everyone using Sally and Sarah receives regulated activity the Care Quality Commission (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.

At the time of the inspection there were 31 people using the service.

The last inspection of the service was carried out in July 2017 and we rated them as required improvement. We found that the service was not meeting all the requirements of Health and Social Care Act 2008 and associated Regulations. We found concerns relating to the effectiveness of the providers governance systems. The provider did not have suitable systems in place to regularly assess and monitor the quality of the service to reduce any risks relating to the health, safety and welfare of people using services and others.

Following this inspection, we asked the provider to complete an action plan to show us what they would do and by when to improve the service to at least a rating of good.

At this inspection we found that the provider had undertaken consistent work to make improvements to the quality monitoring of the service. Regular audits were now taking place with a plan of any actions required and outcomes. This meant that any risks relating to people’s health, safety and welfare was being significantly reduced by the provider picking up on these through their quality monitoring audits.

The service had a manager who was currently in the process of applying to become the registered manager. A registered manager is a person who has registered with the 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 told us that they felt safe by the service provided. Staff had a good understanding of safeguarding, what their responsibilities were and could clearly tell us what action they would take if they had any concerns about the way people were supported. Staff received safeguarding training.

People's care needs were assessed and detailed plans were now in place to meet people’s individual needs. Since our last inspection of the service the provider had made changes to their care plans to make them more person centred and detailed the support people needed. People told us that they were cared for by staff who knew them very well, promoted their independence and understood how to support them.

Where risks of potential harm had been identified for people we found that there were risk assessments in place that recorded actions staff were able to take to reduce the potential for harm.

Medicines were being administered and managed safely by trained and competent staff.

People were supported to have maximum choice and control over their lives. Staff provided support in the least restrictive way and encouraged people’s independence. Staff understood their responsibilities in relation to respecting people’s privacy and dignity.

There were enough staff in place to provide people with safe care. We saw that the provider regularly reviewed the staffing levels to ensure that people had the maximum amount of time with staff.

Good recruitment systems were in place to ensure that the people employed were suitable to work with vulnerable people.

A training programme was in place that enabled staff to provide person-centred care.

Staff received regular s

This inspection took place on 14 July 2017. The inspection was announced which meant that we gave 48 hours’ notice of our visit. This was because the location provides a domiciliary care service and we needed to be sure that the registered manager would be available.

Sally and Sarah is a domiciliary care agency registered to provide personal care to people in their own home. At the time of our visit there were 16 people using the service.

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.

There was no formal system of audits in place. Because of the low number of people receiving support the provider felt that sufficient oversight was gained without these structured processes. However, we found some errors that would have been picked up if an audit process was in place.

People told us they were supported to take their medicines safely however we found some gaps and errors on medicine records. Following our feedback regarding this steps were taken to minimise the risk of this happening again in future.

Appropriate environmental checks had been carried out on people’s homes to ensure health and safety of staff and the people they cared for. Care records included risk assessments based on the individual’s care needs. These required more detail to inform staff how best to mitigate risk. We have made a recommendation about this.

People told us they felt safe using the service. The same staff regularly attended calls which meant that people knew who to expect.

The service had policies and procedures in place to safeguard people from abuse. Staff were able to tell us about different types of abuse and were aware of the action they should take if they suspected abuse was taking place. Staff were aware of whistle blowing procedures and all said they felt confident to report any concerns. We found that safe recruitment and selection procedures were in place and appropriate checks had been undertaken prior to staff starting work.

People told us staff had the skills and knowledge to provide support to them effectively. Some training was in need of updating and we saw that steps were being taken to address this.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. Staff had a working knowledge of the principles of consent and the Mental Capacity Act and understood how this applied to supporting people in their own homes.

Staff received regular informal support from management but a structured programme of supervision meetings was not in place. Following our visit supervision contracts have been introduced with the aim of meeting with staff every three months.

People were supported to access external health services and the service worked with health professionals to maintain and promote people’s health and wellbeing.

Some people were given support to prepare meals and where this was the case any dietary needs were recorded in care records.

People who used the service said that staff were caring and kind. People and their relatives spoke highly of the service and said that it provided high-quality care. Staff were knowledgeable about the people they provided care to and were respectful of people’s privacy and dignity.

Care plans detailed people’s individual needs and preferences which meant that they received support tailored to their personal needs. People and their relatives were involved in care planning.

The service had clear procedures for dealing with any complaints but a more structured approach to recording these was needed.

Staff described a p

Sally and Sarah are a domiciliary care service that provides personal care and domiciliary services to people living in their own homes. The service is named after the two directors, who are very hands on and involved directly in the running of the business. The service is provided from an office based at Innovation Court, Yarm Road, Stockton, and provides services to people living within an approximate 15 mile radius of the office, including rural areas. At the time of this inspection the service employed 11 staff and provided care to 34 people. The service focuses on providing private care and does not contract with local authorities. However, they do work with the local health commissioning group to provide some ‘end of life’ care services.

The service has a registered manager, who has been registered with us in respect of this service since 2013. 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 were protected by the service’s approach to safeguarding and whistle blowing, with people who used the service telling us that they were safe, could raise concerns if they needed to and were listened to by staff. Staff were aware of safeguarding procedures, could describe what they would do if they thought somebody was being mistreated and said that management listened and acted on staff feedback.

Safe arrangements were in place for staff recruitment and enough staff were available to provide people’s care. People who used the service and their relatives told us that staff were reliable, arrived when expected and stayed the correct amount of time. Staff confirmed that they were not rushed, had time to travel between calls and provide the care people expected.

The service had health and safety related procedures, including systems for reporting and recording accidents and incidents. The care records we looked at included risk assessments, which had been completed to identify any risks associated with delivering the person’s care. Safe systems were in place for assisting people with medicines, where this was part of their agreed care plan. However, some more detailed information about this would have been useful in some of the records we viewed. We discussed this with Sally and Sarah, and the registered manager who agreed to ensure additional detail was recorded in the relevant records.

People were cared for by staff who were appropriately supported and provided with training to help them carry out their role. People who used the service told us that their staff were competent and knew what was expected of them. Staff told us they were well supported by their management and could get help and support whenever they needed it. Management monitored staff performance during care visits, reviews and one to one discussions.

This service supports people in their own homes and only provides help with meal preparation and eating and drinking where this has been agreed as part of the person’s individual care plan. We saw that information about the help people needed with meal preparation, eating and drinking was included in people care plans where this was appropriate. Staff were able to describe people’s dietary needs and preferences to us.

We saw that people’s care records included information about people’s health and wellbeing, so that staff were aware of information that was relevant to people’s care. The staff we spoke with were aware of people’s health needs and could describe what they would do if someone was unwell or needed medical support during a care visit.

People who used the service told us that staff were caring, treated them well, respected their privacy and encouraged their independence. Staff were able to describe how they worked to maintained people’s independence, privacy and dignity.

People’s care records showed that their needs had been assessed and planned in a person centred way. People who used the service and their relatives told us that they were involved in planning and reviewing their care service. People also told us that their views were listened too and that any requested changes to their care had been made appropriately.

People who used the service had written information about the formal complaints process available in their care files. People also told us that they had been encouraged to get in touch with Sally and Sarah, or the manager, if they had any issues or concerns about their service. There had been no recent complaints about the service.

The service had an appropriate management structure and registered manager in place. People who used the service knew who Sally and Sarah and the manager were and told us that they were approachable and caring. People also confirmed that they had regular contact with Sally and Sarah or the manager, to check that they were happy with their service. Staff told us that the service was well managed and organised.

No one we spoke with during this inspection expressed any concerns about the quality of care people were receiving. However, at the time of our inspection the service did not have a regular programme of formal audits to help monitor service quality. The manager was able to describe lots of positive quality monitoring activities that were undertaken (which were confirmed by people using the service, relatives and staff), but many of these were informal and not recorded. We discuss the importance of formalising and recording these processes during our inspection.

The health and social care professionals we spoke with as part of the inspection told us that the service was reliable and professional, and that they had no concerns about the quality of people’s care.