This inspection took place on 18 and 19 October 2018 and was announced. Smithfield Health & Social Care Limited t/a Verilife, is a domiciliary care agency. It provides personal care to people living in their own houses and flats. At the time of the inspection 171 people were using the service, of which 151 people received 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.

The service had 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.

We inspected Smithfield Health & Social Care Limited t/a Verilife, in January 2017 and found significant shortfalls. We found two breaches of the fundamental standards and regulations. Staff were not always deployed in a way that met people’s needs. Effective systems were not in place to monitor and address late visits and the provider was not taking sufficient action to improve the service.

We took enforcement action and issued a warning notice relating to 'Good Governance' and told the provider to meet the fundamental standards by 12 April 2017. We followed up on the warning notice and we inspected the service on 15, 16 and 21 August 2017. We found that the provider had made improvements to the systems used to assess and monitor the quality of the service; however further improvement was required in specific areas of quality assurance and call monitoring. The service was rated overall requires improvement at June 2017 and in August 2017 inspections.

At this inspection we received a mixed response from people, their relatives and staff about the management of the service. We found the provider had not always monitored and analysed short, early or late calls, to identify patterns and improve on the service. The provider had not acted to make sure that risk assessments included appropriate guidance for staff on how identified risks should be managed. Care plans we reviewed did not always reflect people’s current needs and had not been updated when their needs had changed. The provider had identified communication needs for people but had no guidance in their care plan for staff about how to meet them.

You can see what action we told the provider to take at the back of the full version of the report.

People and their relatives told us they felt safe. The provider had clear procedures to recognise and respond to abuse. All staff had completed safeguarding training. The service had a system to manage accidents and incidents and to reduce recurrences. People were protected from the risk of infection.

The service had enough staff to support people’s needs and had carried out satisfactory background checks for staff before they started working at the service. The service had an on-call system to make sure staff had support outside of office working hours.

Staff supported people to take their medicines safely. The provider had a policy and procedure which gave guidance to staff on their role in supporting people to manage their medicines safely.

The service provided an induction and training, and supported staff through regular supervision and spot checks to help them undertake their role.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People consented to their care before it was delivered. The provider and staff understood their responsibilities within the Mental Capacity Act 2005. Some people lacked capacity to make important decisions about th

This announced inspection took place on 15, 16 and 21 August 2017. Smithfield Health & Social Care Limited t/a Verilife is a domiciliary care service providing personal care to people living in their homes. At the time of the inspection 170 people were using the service.

At our previous focussed inspection on 25 January 2017 we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found staff were not always deployed in a way that met people’s needs. Effective systems were not in place to monitor and address late visits and the provider was not taking sufficient action to improve the service.

Following that inspection we took enforcement action issued a warning notice to the provider in relation to the quality monitoring at the service and told them to meet the fundamental standards by 12 April 2017. The provider sent us a report of improvements they had made.

At this inspection we found that the provider had made improvements in the systems used by the service to assess and monitor the quality of the care people received. In March 2017 the provider had appointed one more care coordinator in addition to the existing three. As a result of these interventions the service had made improvements, which included updating staff rostering to allow them sufficient travel time between calls, informed people when staff were running late to attend their scheduled calls and maintained a record to show what action was taken in this matter. The provider carried out an analysis of late call alerts routinely and have also recorded what action was taken to address. Through our discussions with staff and people using the service, we confirmed there had been no missed calls to people.

Although the provider had made improvements since the January 2017 inspection, at this inspection we identified some further improvement was required in specific areas. Five members of staff calls were arranged back to back with no travel time allowed in between visits. Another four members of staff did not have sufficient travel time allocated between calls. We further found, that some people either received late calls or early calls instead as per their scheduled call time. A member of staff told us that sometime people requested them to come early or late on some occasions and so they accommodate their request. However, there was no record to show that people had requested them to come early or late. Also, on some occasions staff have not spent the full allocated time at people’s home but spent less time. A member of staff told us that when they finished their allocated tasks, people asked them to leave their home. However, there was no record to show people have asked them to leave earlier than their scheduled visit times.

The above issues were a continued breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

You can see what action we have asked the provider to take at the back of the full version of this report.

The registered manager held regular staff meetings, where staff shared learning and good practice so they understood what was expected of them at all levels.

The service worked effectively with health and social care professionals and commissioners. Feedback from a social care professional stated that the provider continued to make improvements and had been cooperative with safeguarding investigations.

People’s consent was sought before care was provided. However, we saw in people’s care records that five people were identified as not having capacity to make decisions in relation to their care. Although, the service had worked with their relatives, if appropriate, and the relevant health and social care professionals in making decisions for them in their best interests but had not maintained a record to reflect the same in line with the MCA, and this required improvement. There was no negative impact on people.

The service provided an ind

We carried out an announced inspection on 30 November 2016. At the last inspection on 19 September 2013 we found the standards inspected had been met.

Smithfield Health & Social Care Limited t/a Verilife is a domiciliary care agency which provides personal care for people in their own home. They may be older adults, people living with dementia, people with a learning disability or children needing support.

On the day of this inspection there were 148 people using the service who had personal care needs.

A registered manager was in place at the time of the 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.

Relevant checks had been carried out for recruiting staff, however, systems for checking staff members right to work in the UK did not identify an issue that we found. After the inspection we were informed that the relevant agencies had been informed of the issue and an audit undertaken on all staff files which found all checks had been completed and were up to date.

An electronic monitoring was system used to monitor times people had visits and how long staff stayed to support people. This confirmed staffing arrangements were adequate to meet people’s needs. Systems were also in place, following a recent satisfaction survey, to ensure the areas where staff worked was divided equally to ensure timekeeping was improved and people were supported by the same care workers as much as possible.

Staff could explain how they would recognise and report abuse and received the appropriate training in safeguarding adults. Policies and procedures were in place for safeguarding adults and children.

Person centred risk assessments had been undertaken. Plans were put in place to minimise any risks identified for people and staff to ensure they were safe from harm.

The service trained staff to support people appropriately. Areas covered included basic food hygiene, health and safety in people’s homes, moving and handling, administration of medicine, and the Mental Capacity Act 2005 which included training on the Deprivation of Liberty Safeguards.

Staff received regular one to one supervision and annual appraisals. The content of supervision sessions recorded what was relevant to individuals’ roles.

The service had systems to assess and record whether people had the capacity to consent to care. Staff understood the importance of asking for consent before they supported people.

Staff were clear that treating people with dignity and respect was a fundamental expectation of the service. They had a good understanding of equality and diversity and understood the need to treat people as individuals.

Care plans were detailed and personal and provided good information for staff to follow.

A complaints policy and procedure was in place and structures were in place to address complaints effectively.

We heard from staff that the registered manager was supportive and her approach was positive and open.

Regular auditing and monitoring of the quality of care was taking place. This included spot-checks and observations on the care provided by staff to people.

The service undertook an annual survey in June 2016 we saw there had been an overall improvement in satisfaction. However, the satisfaction rate for time keeping had decreased slightly and actions were in place to address this. We saw evidence of analysis and where there had been concerns raised, actions had been identified to support improvements.

We inspected the service on 19 September 2013 to monitor whether action had been taken to ensure effective recruitment procedures were in operation since our last inspection on 24 July 2013. On 19 September 2013 we found that the provider had carried out the required checks to ensure they employed suitable staff.

We inspected the service in June 2012 and found that staff competency was not monitored in accordance with the provider's own policy, and that records of care and staff supervision were not always up to date and there was a risk that people were not protected from the risks of unsafe or inappropriate care or treatment. We followed this up at a further inspection on 9 October 2012 and found that staff competency checks had been carried out in line with the induction policy and records had been updated.

We were able to contact four out of fourteen people who use the service, or their relatives.

A relative we spoke with said the staff are “very good and caring”.

A person told us “staff are so nice” and that the “whole company cares in every way”.

People said they were very satisfied with the service they received from staff and that they had no concerns or complaints.

People we spoke with were generally happy with the care they received from the agency. One person told us “They are fantastic and I have no complaints at all”. Another person described their carer as "brilliant and makes my wife laugh which I like". A person said "I get fairly regular staff who are good" and other people agreed that they had regular staff who met their needs. Most people told us the carers arrived on time and were reliable, but a small number of people had experienced late or missed calls, although they received a phone call from the office to inform them.

We found that people were asked for their consent before care was carried out and that care was planned and delivered in a way that met people's needs. People told us they felt safe with the care staff in their homes and we found staff were aware of how to manage an allegation of abuse. Not all the people we spoke with had received quality monitoring visits although we found the agency were taking steps to monitor the quality of the service.

Almost everyone we spoke with told us they found the care staff suitable, however we found that the agency had not carried out the appropriate pre-employment checks in every case, as they were required to do.