This announced inspection took place between the 5 and 14 December 2018. At our last inspection we rated the service good. However, at this inspection we found the service had deteriorated to Requires Improvement. This is the first time the service has been rated Requires Improvement.

Sunshine Wisbech is a domiciliary (home care) care agency. It provides personal care to people living in their own houses and flats. It provides a service to younger adults, older people, people living with dementia, people with a physical disability and people with sensory impairments. Not everyone using Sunshine Wisbech receives the regulated activity of personal care. 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 there were 52 people using the service.

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.

The service was not always safe. Not all risk assessments relating to the health, safety and welfare of people using the service had been completed. This meant reviews of risks to people were not always responded to in a way which promoted safety and this increased the risk of recurrence, putting people’s safety at risk.

We have made a recommendation about the identification and completion of risk assessments.

The service was not always well-led. The registered manager and provider had not always ensured we were notified about events that by law we must be notified about. The provider did not always follow their policies. Audits and quality assurance procedures were not always effective in identifying improvements that were needed.

Staff understood how to safeguard people. The providers recruitment process helped to ensure only people of good character were employed and there were sufficient staff employed to meet people’s needs. Skilled and competent staff administered people’s medicines safely. Staff helped people to keep a clean environment in their homes.

The service was effective. Staff with the necessary skills met people’s needs. Staff supported and encouraged people to eat a healthy and balanced diet with enough to drink. People were enabled to access health care services. People were given choice and control over their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice. The registered manager worked with other organisations such as the local authority who were involved in people’s care to help ensure that when people used, or moved to and from the service, they received consistent care.

The service was caring. Staff cared for and supported people in a sensitive, kind and compassionate way. Staff respected people’s privacy and dignity and promoted their wellbeing. The provider had procedures and policies in place to help people to access and use advocacy services. People had a say and were involved in how their care was provided. People were treated with fairness whatever their needs were.

The service was responsive. People received person-centred care that was based on their needs. Staff recorded their care visits to people and the provider monitored this situation to ensure that alternative staff resources could be deployed when needed. This helped improve the quality of people’s lives. Concerns were found and responded to effectively and this helped drive improvement. People, were supported with end of life care by staff who had the necessary knowledge and skills to do this with dignity. People’s end of life care wishes were respected an

Sunshine Wisbech is registered to provide personal care to people who live in their own homes. At the time of this inspection care was provided to 77 people who lived in the town of Wisbech and surrounding Cambridgeshire and West Norfolk villages.

This comprehensive inspection took place on 12 April 2016 and was announced.

A registered manager was in post at the time of the inspection and had been registered since 2010 under the current legislation. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the agency. 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 kept safe and staff were knowledgeable about reporting any incident of harm. People were looked after by enough staff to support them with their individual needs. Pre-employment checks were completed on staff before they were assessed to be suitable to look after people who used the service. People were supported to take their medicines as prescribed.

People were supported to eat and drink sufficient amounts of food and drink. They were also supported to access health care services and their individual health needs were met.

The CQC is required by law to monitor the Mental Capacity Act 2005 [MCA] and the Deprivation of Liberty Safeguards [DoLS] and to report on what we find. The provider was aware of what they were required to do should any person lack mental capacity. However, they were no arrangements in place to assess people’s mental capacity; people’s mental capacity was assessed by agencies who were responsible for funding their care. Some staff had an awareness of the application of the MCA.

People were looked after by staff who were trained and supported to do their job.

People were treated by kind and respectful staff who they liked. They and their relatives were given opportunities to be involved in the review of people’s individual care plans.

People were supported to reduce the risk of social isolation; they were helped to go shopping or take part in recreational activities that were important to them. Care was provided based on people’s individual needs. There was a process in place so that people’s concerns and complaints were listened to and these were acted upon.

The registered manager was supported by a team of management staff and care staff. Staff were supported and managed to look after people in a safe way. Staff, people and their relatives were able to make suggestions and actions were taken as a result. Quality monitoring procedures were in place and action was taken where improvements were identified.

We spoke with four people using the service (by telephone) and three relatives of people who used the service (two by telephone). All had positive comments about the standard of care and support they received from Sunshine Wisbech. One person told us that, “There is nothing they (Sunshine Wisbech) won’t do for you.” Another person told us that they, “Would not be with without them (Sunshine Wisbech).”

Staff had access to detailed plans of care which gave them guidance to ensure that they provided people with appropriate, individual, safe care and support. Risk assessments had been completed for people using the service to ensure that people were cared for appropriately and safely. However, some of the risk assessments we reviewed had not been updated since 2011.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to safely manage medicines.

The provider demonstrated to us that they had quality assurance procedures in place for reviewing the quality of the service delivered. These procedures were in place to ensure that people using the service consistently received appropriate, safe care and support on an on-going basis.

People were asked about their care needs and involved in determining how these would be met at a time the person wanted. Where a person lacked capacity to agree to their care the provider demonstrated to us how best interest decisions had been made in consultation with the person’s representative.

People's care plans contained detailed information which would allow any carer to care for that person in a way the person liked. Risk assessments had been completed for people who used the service and these had been reviewed on a regular basis to ensure people were cared for safely.

We reviewed staff training records and found that all of staff's files demonstrated to us that staff had recently completed safeguarding of vulnerable adults (SOVA) training. The manager also checked staffs’ knowledge about SOVA to ensure that they were competent and confident in reporting a SOVA concern were it to occur.

The records we reviewed demonstrated to us that staff were only employed with the service after appropriate identity, previous employment and Criminal Records Bureau checks had been completed.

The provider used a combination of methods to obtain people's views and experience of using the service. We saw that the majority of comments for the most recent service user survey were positive. Of the few negative comments that there were, we noted where the manager had responded to the matter to ensure that it was resolved to the person's satisfaction.