This inspection took place on 9 November 2017 and was unannounced.

At the previous inspection on 22 September 2016 we found SCA Care (Southampton) was not meeting the minimum standards required by the regulations. The provider had failed to make sure people received appropriate care and support which met their needs, and the provider had failed to follow legal guidance where people lacked capacity to make certain decisions. Following that inspection we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of effective and responsive to at least good. We received the provider’s action plan in the timescale requested.

At this inspection we found the necessary improvements had been made and sustained. There were no longer breaches of regulations.

SCA Care (Southampton) is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community and specialist housing. It provides a service to older people and younger adults who may have a range of needs arising from physical disability, a learning disability, dementia or mental health needs.

Not everyone using SCA Care (Southampton) received a regulated activity. The Care Quality Commission (CQC) only inspects the service being received by people provided with “personal care”, which is 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 provider did not have a registered manager in post. However steps had been taken to recruit a manager who was in the process of submitting their registration application. 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 provider had arrangements in place to protect people from risks to their safety and welfare, including the risks of avoidable harm and abuse. Staffing levels were sufficient to support people according to their agreed call schedules. Recruitment processes were in place to make sure only workers who were suitable to work in a care setting were employed. There were appropriate arrangements in place for infection control and the management of medicines.

Staff received appropriate training and supervision to maintain and develop their skills and knowledge to support people according to their needs. Staff were aware of the need to provide care and support only with the person’s consent and of legal requirements where a person was unable to consent. Where appropriate, people were supported to eat and drink enough to maintain their health and welfare. People were supported to access healthcare services, such as GPs and community nurses.

Care workers had developed caring relationships with people they supported. People were supported to take part in decisions about their care and support and their views were listened to. Staff respected people’s independence, privacy, and dignity.

Care and support were based on assessments and plans which took into account people’s abilities, needs and preferences. People were kept aware of the provider’s complaints procedure, and complaints were managed in a professional manner.

The service had an open, responsive ethos. Systems were in place to make sure the service was managed efficiently and to monitor and assess the quality of service provided.

This inspection took place on 22 and 27 September 2016 and was announced. The provider was given 24 hours because the location provides a domiciliary care service; we needed to be sure that someone would be available in the office.

SCA Care Southampton provides personal care and support to people in their own homes. At the time of this inspection the agency was providing a service to 168 people with a variety of care needs, including people living with physical frailty or memory loss.

A registered manager was not in post at the time of our 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. The service was currently in the process of registering the manager for the regulated activity of personal care.

Most people’s care plans provided comprehensive information and were reviewed regularly. However, these did not include information about people’s mental health needs and health conditions such as diabetes plans were not always adequate to support people appropriately.

We found staff were not following legislation designed to protect people’s rights. There were concerns about people's capacity to consent to decisions about their care; the provider did not make appropriate guidance when making decisions in people's best interest.

We found people’s safety was compromised in some areas. Some people had not received calls from the agency. The manager had completed an action plan on how to reduce the risk of missed calls to people receiving a service. We found also inconsistencies in the way medicines were managed. This meant that medicines were not always recorded correctly. Risks were managed appropriately, however we found some more information was required on some people’s records to support staff on action to take if they should have any concerns.

We received positive feedback from people about the service. All people who used the service expressed great satisfaction and spoke highly of the care staff.

People and their families told us they felt safe and secure when receiving care. Safe recruitment practices were followed and appropriate checks were undertaken, which helped make sure only suitable staff were employed to care for people in their own homes. Staff received training in safeguarding adults and child protection for when they came into contact with children. Staff told us they felt supported and received regular supervisions and support. There were sufficient numbers of staff to maintain the schedule of care visits. Staff meetings were held every three to six months.

People felt they were treated with kindness and said their privacy and dignity was respected. People were supported to eat and drink when needed. Staff had an understanding of the Mental Capacity Act (MCA) and understood that people had the right to make their own choices.

People felt listened to and a complaints procedure was in place. Staff felt supported by the management and felt they could visit the office and be listened to. There were systems in place to monitor the quality of the service provided.

We identified two breaches of regulations. You can see what action we have told the provider to take at the back of this report.

In our previous inspection we had found that people's care plans did not contain enough information about people's needs and how they should be met. People had not been protected against the risks associated with medicines as the provider's arrangements were not fully effective in ensuring people always received their prescribed medicines. The provider did not have robust quality monitoring systems to ensure people received a safe effective system.

We considered all the evidence we had gathered under the outcomes we inspected and we used the information to answer three of the five questions we always ask.

Is the service safe?

Is the service effective?

Is the service well led?

This is a summary of what we found:

Is the service safe?

People told us they felt safe receiving care from staff and were all aware that staff were following their care plans. Where people were administered medicines by staff they told us they felt staff were doing this safely and according to their doctor's instructions. The provider had reviewed their administration of medicine records and had implemented an auditing system to ensure all records were checked by senior staff. The records we saw showed all medicines had been appropriately given.

Staff received training in administering medicines and were assessed by senior staff on their competency to administer medicines. Managers audited medicine administration records every month.

Is the service effective?

During this inspection we found the provider and manager had reviewed the care planning system. People's needs were assessed before they began to use the domiciliary service. This identified the specific areas of care people required. The needs were risk assessed to look at measures staff could use to minimise the risk of harm occurring to people. The care plans were developed to give staff guidance on how to support each person in a personalised way and in accordance with the risk assessments.

People told us they had been involved in identifying their care needs and had been able to contribute to the assessment and care planning process. Staff told us they talked to people about their care plans and where people identified they wanted a change to their care plan, staff discussed this with their line manager.

Is the service well led?

At this inspection the manager and provider showed us the systems they had introduced to monitor and audit the quality of the service they provided. This included customer satisfaction surveys, minutes of quality audit meetings, and audits of medication, call logs and call times. People told us they were able to talk to the manager about concerns and felt confident they were listened to and changes to their care would be made. Staff told us they were responsible for bringing relevant medicine administration records and call logs to the office every month for senior staff to check them. They also told us manager's carried out observations of their practice quite regularly.

We checked our records and since our last inspection on 4 April 2013 the provider had changed its procedures and we (Care Quality Commission (CQC)) have received documentation and statutory notifications in relation to safeguarding incidents. We found the service was aware of the reasons to notify us of significant events at the service. This included notifying us of changes to the Nominated Individual and Registered Manager. Changes required were made following the last inspection in April 2013. This meant that we have been formally informed of persons responsible for the quality of the service to people in receipt of a personal care service.

We spoke with twenty nine people who used the service and relatives about day to day care delivery. We did this by carrying out five visits to people who use the service and a relative. The other people we spoke with on the telephone. We also spoke with members of the provider's management team and staff. We viewed records relating to care, staffing and the management of the service.

We considered five outcomes during this inspection. These being

Outcome 4 Care and welfare of people who use services

Outcome 9 Management of medicines

Outcome 11 Safety, availability and suitability of equipment

Outcome 13 Staffing

Outcome 16 Assessing and monitoring the quality of the service

We considered all the evidence we had gathered under the outcomes inspected. We used the information to answer the five questions we always ask.

This is a summary of what we found-

Is the service safe?

We found systems were in place to ensure that people who used the service were supported by staff trained to use equipment for moving and handling and assisting people with their mobility. Plans were in place to inform staff on how to use the equipment. We saw a system was in place for servicing the equipment and recording work completed. People were positive about the support they received.

We found the safety of the service was compromised as not all planned responses to people had been put in place. Staff were required to provide support to one person when a known health need arose. Their full needs had not been assessed and a plan had been used based on guidance from health professionals.

Staff were required by the service to be involved in the administration of medicines for some people. Most people told us they received the support they needed. However, the records of prescribed medicines and of their administration were not accurate and had not been rectified through the provider’s checks.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to medicines management.

Is the service effective?

People told us they had been asked about the care they wanted before it was provided and care-plans had been put in place. People gave us positive feedback about the service. We received comments such as: “I agreed my care plan, we work together the staff and I, as I want to keep as independent as I can for as long as I can”; “It’s a really good service, I would recommend them.”

However, from talking with people and viewing records, we found not all people’s needs were met. Examples related to assistance with mobility and continence. Care plans did not provide enough or up to date details to ensure staff had current information to provide consistent or effective care.

People told us there had been some changes in the staff who met their needs but their care needs were usually met. The management were taking action to improve the organisation and continuity of staff.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to care and welfare.

Is the service caring?

People told us they were provided with staff who had caring attitudes. We received comments such as “the carers are excellent, very friendly, I am happy with the care I get” and “they come twice a week and I have a shower, they always keep me warm and cover my ‘dignity.’ I can’t fault them at all”.

Is the service responsive?

Systems were in place to obtain feedback from people who use the service through individual reviews and surveys and the service could evidence they took action when issues were brought to their attention. A member of management staff had been recruited to respond to complaints monitor incidents and ensure that the service could evidence action taken to demonstrate the service was fully responsive.

Is the service well-led

Systems and procedures have been put in place or developed to monitor the service and develop quality assurance. However the processes in place had not ensured that all aspects of the service were well-led. For example issues with care planning had not been picked up in the service's quality monitoring and system in place had not ensured all staff had received regular supervision.

Plans to improve the service were not documented. Action planned to improve the service following complaints, accidents or missed calls were not clearly identified and monitored.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to assessing and monitoring the quality of service provision.