This inspection took place on the 12 and 14 September 2018 and was announced.

Following the last inspection in November 2017, we asked the provider to complete an action plan to show what they would do and by when to improve all key question(s) to at least ‘Good.’ At the previous inspection we found four breaches of Regulation for 11 (consent), 12 (safe care and treatment), 17 (good governance) and 18 (staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we found that the provider had worked to address these breaches. We did not find any breaches of regulation at this inspection. However, the service was not always Well-led. People did not always receive a well-coordinated or reliable service. At times people’s care was late. Communication was not always proactive between the office and people who used the service. This was being addressed by the registered manager and new care manager at the time of this inspection. Policies and procedures required review to update in line with best practice and legislative changes. We recommend that the service updated their policies and procedures.

Not everyone using SCC Agency Ltd 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. At the time of this inspection the agency provided personal care to approximately 102 people living in their own homes in the West Sussex areas. The agency supported people living with a variety of identified needs, including those who may be living with dementia, mental health, older people, younger adults, people living with physical disability and sensory impairment.

There was a registered manager in post. 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’s needs were assessed with risks also being considered. When people required support with their medicines, this was managed safely. Risks associated with infection control were managed safely and care staff used protective equipment such as gloves and aprons.

Staff were supervised and received appropriate training, ‘spot checks’ and competency checks to make sure they were skilled in their roles.

Staff and the management team understood the basic principles of the Mental Capacity Act 2005 and people were asked for their consent before interventions and care was provided.

People told us that care staff were kind and compassionate and people valued the support provided to them by the agency. Care staff aimed to provide responsive, person-centred care to people.

Complaints were listened to and responded to appropriately.

People and those who were important to them, were involved in the review and planning of their care. People were involved in decisions about their care.

People did not receive end of life care at the time of this inspection.

This inspection took place on 7 November 2017 and was announced. The service is a domiciliary care agency which provides personal care to approximately 115 people living in their own homes in the West Sussex areas. The agency supports a range of people living with a variety of identified needs, including those who may be living with dementia, mental health, older people, younger adults, people living with physical disability and sensory impairment. People living with eating disorders or who may misuse drugs and alcohol may also be supported by this agency. The registered manager told us that the service was able to provide people with care at the end of their lives.

Not everyone using South Coast Care Limited receives personal care services. 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.

There is a registered manager at this service who has been registered with the CQC since April 2013. 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. The registered manager is also the registered provider for this agency.

The agency was previously inspected by us in October 2015 when they were rated as providing a good service to people. However, during this inspection on 7 November 2017, we found that the registered manager was unable to sustain this level of good practice. We previously had concerns about this provider’s ability to run a good service. In January 2015 we rated this provider as inadequate overall, with breaches of regulation in eight areas. Two of these breaches resulted in us taking enforcement action against the provider. We had significant concerns about the quality of service provision and the provider’s ability to have clear oversight and regular monitoring of the service. Other concerns related to poor medicines management, lack of detail in people’s care plans and risk assessments to mitigate risks to people. Staff were not completing mandatory training and there was a lack of staff supervision and poor management understanding of the Mental Capacity Act 2005 and how this affected their provision of care to people.

In May 2015 we completed a Focused inspection to review the provider’s progress against the previous concerns. We found that the provider was still providing an inadequate service in relation to the assessment of risks and completion of appropriate risk assessments for people. People’s medicines were still not being managed safely. There had been some improvements in the provider’s quality systems and it was noted that medicines audits were being completed by the registered manager. Despite the service being rated as good overall in October 2015, in November 2017 we found that this had not been sustained. The registered manager was not completing any audits to monitor the quality and safety of the service provided to people.

People’s safety was compromised in some areas. Risks to people weren’t always clearly identified, assessed or managed safely and actions were not always recorded for care staff to be able to reduce the risks. Accidents and incidents were not always recorded appropriately and risks identified were not always assessed with sufficient detail to mitigate identified risk as part of the person’s care plan. Records relating to medicines for people weren’t always completed accurately. However, people using the service told us that staff administered medicines appropriately to them and that they felt safe.

Care plans did not always reflect people’s individual needs clearly and the specific support that would be required to meet pe

The inspection took place on 20 August 2015 and was announced. The service provides personal care to over 100 people living in West Sussex. The service has a registered manager in post, who registered with CQC in April 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.

The last inspection took place on 28 May 2015. This was a focused inspection to follow up on two Warning Notices that had been issued in February 2015. We asked the provider to take action to address areas of concern relating to the drawing up of risk assessments for people and the monitoring of the quality of the service provided. The provider was required to take appropriate action by 31 March 2015. Although they had met the requirements regarding quality monitoring of the services, they had not met the Warning Notice in relation to Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which correlated to Regulation 12 of the Health and Social Care Act (Regulated Activities) Regulations 2014.

At this inspection, we followed up on outstanding areas of regulation breaches and found that the provider had now met the requirements.

Risks to people were identified, assessed and managed safely. Information contained within assessments provided information and guidance to staff. Accidents and incidents were reported promptly to the provider and appropriate action taken. New staff underwent all necessary recruitment checks to ensure they were safe to work with adults at risk. People’s medicines were managed safely and they were protected from the risk of abuse or harm. There were sufficient numbers of staff available to meet people’s needs safely.

Staff were trained in a range of areas and new staff were required to complete the Care Certificate, a nationally recognised qualification, which had been recently introduced. There were opportunities for staff to take additional qualifications and specific training was organised for staff to meet people’s particular care needs. Staff received regular supervisions and an annual appraisal and the provider organised staff meetings. Staff had a good understanding of the Mental Capacity Act 2005 and worked in line with the requirements of this legislation when gaining people’s consent. Staff supported people to eat well and to have sufficient to eat and drink to maintain good health. When people had become unwell, staff acted promptly in calling healthcare professionals.

Caring relationships were evident between people and staff and staff knew how to care for people in a personalised way. People were encouraged to express their views and to be involved in all aspects of their care. They were treated with dignity and respect and encouraged to be as independent as possible.

Care plans included detailed information about people, the care and support needed and also their preferences and personal histories. Care plans were reviewed by staff with people and their relatives on a monthly basis. Care staff read the care plan in people’s homes before they delivered care. People and their relatives knew how to make a complaint if they had any concerns and the provider had a complaints policy in place.

Care plans and staff files that were no longer in use were archived appropriately. People were involved in developing the service and were asked for their feedback about the care they received. Staff were also asked for their views. The service had quality assurance systems in place to measure and monitor the service delivered.

At our inspection on 8 and 12 January 2015, breaches of legal requirements were found in eight areas and we took enforcement action with regard to two of them. Warning notices were issued in respect of care and welfare of people and assessing and monitoring the quality of service provision, which were to be met by 31 March 2015.

We undertook this focused inspection to confirm that the service now met legal requirements as identified in the warning notices. 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 SCC Agency Limited on our website at www.cqc.org.uk.

The service provides personal care to approximately 120 people in their own homes living in the West Sussex area. The service has a registered manager in place, who registered with CQC in April 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. The registered manager is also the provider and nominated individual of the service.

We found that some improvements had been made and that one of the warning notices had been met. However, people were still at risk of receiving care that did not meet their needs safely because risk assessments did not provide sufficient information to staff to consistently mitigate the risks. Risk assessments in people’s care records had not always identified what the risk was, the action that staff should take nor had the level of risk been assessed.

Care staff knew people well and care was provided in line with the information provided in people’s care plans. People were happy with the care they received and thought that care staff were warm and friendly.

The registered manager had put in place a system of quality assurance measures. An electronic call monitoring system identified how long care staff spent when delivering care and support to people in their homes. Staff received supervisions and spot checks to ensure their practice was at an acceptable standard. People were asked for their views through an annual survey. Where actions had been identified, the management took steps to make the necessary improvements. Staff felt supported by the management team and communication between management and staff was clear and effective.

We found a continued breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which correspond to the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

This inspection took place on 8 and 12 January 2015 and was unannounced. The service provides personal care to approximately 120 people living in the West Sussex area. The service has a registered manager in place, who had registered with CQC in April 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.

At the last inspection on 5 August 2014, we issued two warning notices requiring the provider to make improvements to the care and welfare of people and to the assessing and monitoring of service provision by 31 October 2014. We also asked the provider to take action to improve the safeguarding of people who use the service and in supporting workers. The provider sent us an action plan on 18 October 2014 stating they were now meeting the requirements of the regulations. We found the provider had improved the safeguarding of people using the service. However, they had not made the

necessary improvements to the other areas of concern and were not meeting the requirements of the Regulations.

People’s safety was compromised in some areas. Some care plans had been rewritten and risk assessments updated but care plans still did not reflect people’s individual needs. Risks were not assessed accurately and action was not recorded for care staff to reduce the risk. Where challenging behaviour had been identified this had not been adequately assessed in order for staff to provide appropriate care that met people’s needs and protected their rights.

Medicines were not managed safely. Risk assessments failed to identify risks effectively and staff did not follow guidance relating to the safe use of medicines.

Recruitment processes were not followed as the provider had failed to ensure all necessary staff’s checks were carried out before staff commenced employment at the agency. There were sufficient staff to provide care to people who required it. However, some people said they received many different care staff and as a result did not receive continuity of care.

The management team and care staff were not aware of how the Mental Capacity Act 2005 affected their provision of care to people. This placed people who lacked capacity to make decisions at risk of not receiving the support they required in order for care to be provided in their best interests. Staff monitored people’s health and took action where appropriate, however, often people’s care plans failed to mention key health information relating to the person.

Staff did not receive regular and effective supervision. They had not completed training to equip them with the skills to meet people’s needs in the most effective way. People were not always involved in the planning of their care and their feedback was often not sought and acted on.

People said they knew how to make a complaint and records showed formal complaints had been responded to according to the agency’s policy. At other times the agency had failed to respond to people’s concerns, and people said they had found the management to be unresponsive.

Most people said their care needs were met and care staff demonstrated an understanding of people’s needs and how to meet them. Care staff showed a kind and patient manner and people said they felt safe with care staff. They were complimentary about the friendliness and helpfulness of care staff. Staff were aware of local safeguarding procedures and felt confident to use them. They demonstrated knowledge of what constituted abuse and their responsibilities in relation to reporting their concerns.

Staff said the management team was open and supportive. However, the management team were unfamiliar with the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Essential Standards of Quality and Safety. Quality monitoring processes in place had failed to identify when care staff did not stay for the scheduled amount of time to provide care. They had also had not highlighted the breaches of regulation found at this inspection. As a result action had not been taken to ensure the regulations were met.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we have taken at the back of the full version of the report.