This announced inspection took place on 21 June 2018. Sonia Heway Care Agency is a domiciliary care agency. It provides personal care to people living in their own houses and flats. Not everyone using Sonia Heway Care Agency receives the 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 our inspection the service was providing personal care and support to 19 older adults.

At our previous inspection on 12 and 13 April 2017, we found breaches of legal requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because medicine administration records (MARs) were not completed correctly. There were gaps in the recording of the medicines administered to people although people were receiving their medicines as prescribed. The provider had not maintained a manual or electronic call monitoring (ECM) system record to show that they had monitored visits to people homes to ensure they received visits at the correct times, including when they were running late.

At this inspection we saw that the provider had made some improvements in the completion of MAR charts. However, we saw that people’s MAR charts were not always completed in full as they recorded that people had self-medicated when their care plans showed that medicines needed to be administered. Although the provider had introduced and operated an ECM system, they were not using it to monitor visits to people homes to ensure they received visits at the correct times, including when they were running late or arriving ahead of schedule and following this up effectively with clients and staff to address why calls were carried out later or earlier than scheduled. The provider did not use the ECM system to record notes to detail why staff were arriving late or early for calls.

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.

There were safeguarding procedures in place and staff knew how to safeguard people and how to raise any concerns. There were enough staff deployed to meet people's care and support needs. People were protected from the risk of infections. The provider carried out appropriate recruitment checks before staff started work. Records showed that the manager followed safeguarding protocols and submitted safeguarding notifications when required to the local authority as well as CQC.

Staff completed a programme of induction and mandatory training. Staff were supported through regular supervisions and appraisals. People's needs were assessed to ensure the service could meet their needs. 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. Staff asked for people for their consent before providing care and support. People were supported to have a balanced diet if required and had access to a range of healthcare professionals when required in order to maintain good health. Staff worked effectively with each other by ensuring that daily notes were completed in full to ensure there were effective handovers.

People said that staff were kind and caring. People said staff respected their privacy and treated them with dignity and they were encouraged to be independent whenever possible. People were provided with information about the service in the form of a ‘service user guide’ before they joined the service.

Care plans were regularly reviewed and people were involved in pl

This announced inspection took place on 12 and 13 April 2017. Sonia Heway Care Agency is a domiciliary care service providing personal care to people living in their own homes. At the time of the inspection 19 people were using the service.

At our previous comprehensive inspection on 24 and 26 August 2016 we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found the provider had not taken action to make sure medicines were managed safely and had not put in place risk management plans to mitigate the risk for people. People and their relatives where appropriate were not involved in the assessment and development of their care plan and the care plans were not person centred. Effective systems were not in place to monitor and improve the quality and safety of the service provided to people.

Following that inspection we imposed conditions on the provider’s registration at the location. We told the provider to carry out monthly audits of all care plans, risk assessments and management of medicine and send CQC a report of actions taken as a result of these audits. We also placed the service in special measures. For adult social care services, the maximum time for being in special measures will usually be no more than 12 months.

In line with the conditions we imposed, the provider had sent us reports from the results of the audits they carried out and the improvements they had made. As the provider had demonstrated improvements and the service is no longer rated as inadequate for any of the five key questions, it is no longer in special measures.

At this inspection we found people’s medicines were managed appropriately and they were receiving their medicines as prescribed by healthcare professionals. Senior staff completed risk assessments for people who used the service which provided sufficient guidance for staff to minimise identified risks. The provider involved people and their relatives, where appropriate, in the assessment, planning and review of their care. Staff supported people in a way that was caring, respectful and protected their privacy and dignity. Staff developed people’s care plans that were tailored to meet their individual needs. Care plans were reviewed regularly and were up to date. The service sought the views of people who used the services. Staff felt supported by the provider.

The service worked effectively with health and social care professionals and commissioners. Feedback from social care professionals also stated that the standards and quality of care delivered by the service to people was good and that they were happy with the management and staff at the service.

Since our inspection in August 2016, the provider had made improvements in the systems used to assess and monitor the quality of the care people received. The provider had taken action to make sure that most of the systems for monitoring and improving the quality and safety of the services provided to people were operating effectively.

However, at this inspection we identified some further improvements were required in specific areas. We found gaps in the recording of the medicines administered to people although people were receiving their medicines as prescribed. The provider had not maintained a manual or electronic call monitoring (ECM) system record to show that they had monitored visits to people homes to ensure they received visits at the correct times, including when they were running late had been followed up effectively and identify any patterns to address.

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

The service had a system to manage accidents and incidents to reduce reoccurrence.

The service provided an induction and training and supported staff through regular supervision and annual appraisal to help them undertake their role. The service had enough staff to sup

At our last comprehensive inspection on 30 & 31 March 2015, we found several breaches of legal requirements. People were not protected against the risk of safeguarding service users from abuse and improper treatment, risk of person-centred care, risk of need for consent, the risk of dignity and respect, and against the risk of regularly assessing and monitoring the quality of the service provided.

We took enforcement action following that inspection and served a warning notice on the provider in respect of the most serious breaches requiring them to become compliant with Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. We also asked the provider for an action plan to address the less significant breaches found.

We undertook an announced focussed inspection on 09 July 2015 to check that improvements required had been made following the enforcement action we had taken. We found that action had been taken to improve safety.

Additionally we carried out a comprehensive inspection on 22 and 23 October 2015, we found several breaches of legal requirements. The staff did not receive appropriate levels of supervision, people’s care plans were task oriented and not centred on each person’s individual needs, there were inadequate systems to assess, monitor and improve the quality and safety of the service provided, care and treatment was not provided in a safe way as risks were not identified or action taken to reduce risk, and arrangements to administer medicines were unsafe.

We took enforcement action following that inspection and served a warning notice on the provider in respect of the most serious breaches requiring them to become compliant with Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also asked the provider for an action plan to address the less significant breaches found.

We undertook an announced focused inspection on 05 April 2016 to check that improvements required had been made following the enforcement action we had taken. We found that action had been taken to improve safety, however we found that staff were prompting people to take medicines and applying creams to people when they were not suitably trained to do so and this required improvement.

This announced inspection took place on 24 and 26 August 2016. Sonia Heway Care Agency Ltd is a domiciliary care service providing support to people living in their homes. At the time of our inspection 19 people were using the service.

At this inspection we found that the arrangements for the safe management of medicines were not robust; staff were not assessed to be competent to administer medicine. Potential risks to people were identified but risk management plans to mitigate the risk for people were not put in place.

The provider did not carry out, collaboratively with the relevant person, an assessment of the needs and preferences for the care and treatment of people. People and their relatives where appropriate were not involved in the assessments and development of people’s care plans. The care plans were not person centred on each person’s individual needs and there was no guidance for staff about how to deliver specific aspects of care and meet the identified needs of people.

The provider did not establish systems or processes, to assess, monitor and mitigate the risks relating to the health, safety and welfare of people. The service did not have adequate systems to monitor the quality of the service and the issues identified from the audits were not actioned.

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 and has the legal responsibility for meeting the requirements of the law; as does the provider. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the se

We carried out an announced comprehensive inspection of this service on 22 and 23 October 2015 at which breaches of legal requirements were found. We found arrangements for the safe management of medicines were not robust. Potential risks to people were not always identified and risk management plans were not put in place to reduce the risk. Incidents that took place at people’s home were not followed up with GP or any other healthcare professional. Staff were not supported through supervision in line with the provider’s policy. The care plans were task oriented and not person centred on each person’s individual needs and there was no guidance for staff about how to deliver specific aspects of care. The service had inadequate systems to monitor the quality of the service.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Sonia Heway Care Agency Ltd’ on our website at www.cqc.org.uk’

We took enforcement action and served warning notices on the provider in respect of more serious breaches requiring them to become compliant with Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 by 11 December 2015.

We undertook this focused inspection on the 5 April 2016 to check that they had complied with this regulation.

This report only covers our findings in relation to the follow up on the breaches for the safe management of medicines and risk management. We have asked the provider to send us an action plan telling us how and when they will become compliant with the other breaches. These breaches will be followed up at our next comprehensive inspection of the service.

Sonia Heway Care Agency Ltd provides personal care for people in their homes. There were five people receiving personal care at the time of our inspection visit.

A registered manager was 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.

At our focused inspection on the 5 April 2016, we found that action had been taken to improve safety. The provider had arrangements in place to manage and report on the accidents and incidents. The provider had stopped the administration of medicines to the people who used the service in response to the warning notice. However, staff were involved in the prompting of medicines and application of creams to people when they were not suitably trained to do so. This required improvement.

We also found the provider completed risk assessments for every person who used the service. The risk management plans were up to date with brief guidance for staff to reduce risks. However, the guidance on the updated risk assessment was not detailed and a new member of staff would not benefit from the information about the correct equipment to use and a step by step process and this required improvement.

We carried out an announced comprehensive inspection of this service on 30 and 31 March 2015 at which breaches of legal requirements were found. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for ‘Sonia Heway Care Agency Ltd’ on our website at www.cqc.org.uk. At the inspection in March 2015 we had found that people were not protected against the risk of safeguarding them from abuse and improper treatment because when people presented behaviour that was challenging the agency had not put appropriate measures in place, including risks to people were not always identified, assessed and monitored. Guidance was not always provided to staff to help reduce risks. The provider had not responded appropriately to allegation of abuse in line with the provider’s policy. We took enforcement action and served a warning notice on the provider in respect of this more serious breach in relation to safeguarding people who use services from abuse.

We carried out this focused inspection on 9 July 2015 to check these more serious concerns identified at the last inspection had been addressed and that the service met current regulations. This report only covers our findings in relation to these concerns. We have asked the provider to send us an action plan telling us how and when they will address the other concerns we found at the inspection of 30 and 31 March 2015. We will follow up on the other concerns identified at a later date.

Sonia Heway Care Agency Ltd is registered to provide personal care for people in their homes. At the time of the inspection the agency was providing personal care services to five adults in their homes. 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 and has the legal responsibility for meeting the requirements of the law; as does the provider. 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 focussed inspection on the 09 July 2015, we found that concerns we had identified previously had been addressed and action had been taken by the provider to safeguard people using the service. People using the service were protected from abuse and improper treatment, because care workers did not use any restrictive practices and people’s care needs were reviewed and risks were identified and monitored. People and their relatives told us they were satisfied with the service provided. We found that the provider had met current legal requirements for safeguarding people from abuse.

On this occasion, we did not speak with people using the service, because the standard requirement relating to workers we inspected was not relevant to speak with people.

The provider had completed all appropriate staff recruitment checks including; satisfactory criminal records checks and written references before staff began work.

We carried out a themed inspection looking at domiciliary care services. We asked people to tell us what it was like to receive services from this home care agency as part of a targeted inspection programme of domiciliary care agencies with particular regard to how people's dignity was upheld and how they can make choices about their care. The inspection team was led by a CQC inspector joined by an Expert by Experience who has personal experience of using or caring for someone who uses this type of service.

We used telephone interviews and home visits to people who use the service and to their main carers (a relative or friend) to gain views about the service.

We spoke with senior staff at the time of our visit to the office and also spoke with five care workers over the telephone. We visited three people in their own home as part of this review and spoke with them and their relatives about their experiences of the support they had received. We also spoke with three people using the service, three relatives and one social worker over the telephone.

The majority of people spoke positively about their care workers. One person using the service said: “All the girls are lovely.” A relative told us that the: “[care workers] are very good and look after my wife well.”

People told us that they felt safe, and if they had concerns they were comfortable in raising these with a carer or someone from the agency’s office.

One relative expressed their concern about care workers being late for their visits and not always being informed of the delay. However, the three people we spoke with during our home visits said that staff were usually on time and when there were delays the agency or the care worker would let them know. One relative commented that they were “very impressed” with the information they received from the home.

All of the people we spoke with said that care workers treated them with respect. One person said that their preferred name was used by care workers.

People we spoke with told us that their care was personalised to their needs and that their care workers adapted very well when changes were made to care.

A few people could not recall the detail of their care plan or where it was located. However, two relatives told us over the phone that they were clear about the care plan and where it was located in the home. During our three home visits we also saw people’s care plan records that were kept in the home.

One relative felt that some care workers did not always know what they were doing and on occasions they had to be shown how to use the hoist equipment in the home. However, most of the people we spoke with said that staff were well trained and understood their needs.

At our inspection on 30 and 31 March 205, we found several breaches of legal requirements. The provider had not protected people against the risk of abuse and improper treatment, arrangements to obtain consent were not robust and people’s care was not always personalised. People were not always treated with respect and dignity, and there were inadequate systems to monitor the quality of the service.

We took enforcement action following this inspection and served a warning notice on the provider in respect of the most serious breach requiring them to become compliant with Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also asked the provider for an action plan to address the less significant breaches found. We undertook an announced focused inspection on 09 July 2015 to check that improvements required following our enforcement action had been made. We found that the provider had met current legal requirements for safeguarding people from abuse.

The current announced inspection took place on 22 and 23 October 2015

Sonia Heway Care Agency Ltd provides personal care for people in their homes. There were 6 people receiving personal care at the time of our inspection visit.

A registered manager was 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.

Arrangements for the safe management of medicines were not robust; care workers were not assessed to be competent to administer medicine. Potential risks to people were not always identified and risk management plans were not put in place to reduce the risk.

People and their relatives felt safe with the service. Recruitment checks were carried out to reduce the risks of employing unsuitable care workers. There were sufficient numbers of care workers to meet the needs of the people who used the service.

Care workers were not supported through regular supervision in line with the provider’s policy. Although, care workers had received training in the Mental Capacity Act (MCA) 2005 they did not have adequate awareness and understanding of MCA and this requires improvement. When people did not have capacity to consent; action had been taken to comply with the law about obtaining consent before people received care.

Care workers knew people’s preferences and treated people in a kind and dignified manner. People or their relatives where appropriate were involved in the assessment of their needs and told us they were happy with the care that was given. They felt confident they could share any concerns with the service and these would be acted upon as appropriate.

The care plans were task oriented and not person centred on each person’s individual needs and there was no guidance for care workers about how to deliver specific care. Care plans were not monitored and reviewed in line with the provider’s policy. Daily communication logs were maintained by care workers and people’s wellbeing and any change of needs were recorded.

Despite some improvement there were still insufficient systems to monitor the quality of the service. The provider took into account the views of people using the service and their relatives through questionnaires. The results were analysed and action was taken to make improvements. Care workers said they enjoyed working at the service and received good support from the manager. The office manager conducted spot checks and made phone calls to people’s homes to make sure people were receiving appropriate care and support.

We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014.You can see what action we took at the back of the full version of this report.