About the service: This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to children, younger and older adults. At the time of the inspection they were providing care to 169 people.

People’s experience of using this service:

People's risk assessments did not consistently cover all potential areas of risk, such as a risk of choking or falls. We looked at the systems in place for medicines management and found records did not support keeping people safe. People felt safe in the care of staff members and were happy with staffing levels. The provider had appropriate systems in place to support staff to raise any safeguarding concerns. Staff had access to appropriate personal protective equipment (PPE) to help prevent the spread of infection.

People told us they received effective support. Systems were in place to ensure that staff received

appropriate supervision to support them in their roles. Staff felt they were trained to the right level to effectively work with people.

Checks were made on the ongoing competency of staff and staff felt they could ask for extra training and support at any time. People told us that staff sought their consent prior to carrying out care and made people aware of the actions they were to take. People were supported to eat meals of their choosing and were assisted to access health professionals when necessary.

People told us care staff were very caring, kind and compassionate. Staff enabled people to be independent and to make choices where possible. People's privacy and dignity needs were maintained by staff members caring for them.

People told us they were provided with a responsive service. People received care and support to meet their individual needs. People and families spoke about being involved in the process of writing and reviewing their care plans. People knew how to make complaints and we saw evidence to show complaints had been fully investigated.

The provider’s systems and processes in place to monitor and audit the service required improvement. Records management needed improvements regarding medicines, risk assessments and quality monitoring of the service.

More information is in detailed findings below. We identified two breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 around safe care and treatment and governance. Details of action we have asked the provider to take can be found at the end of this report.

Rating at last inspection: Good (report published December 2016)

Why we inspected: This was a planned inspection based on the rating at the last inspection. The service now required improvement.

Follow up: We will speak with the provider following this report being published to discuss how they will make changes to ensure the provider improves the rating of the service to at least Good. We will revisit the service in the future to check if improvements have been made.

This inspection took place on 27 October 2016 and was announced. We gave the registered provider 24 hours notice of our inspection so that we would have staff available to show us records at the service’s offices when we visited.

At our last inspection of Supportive SRC Limited, published on 6 July 2016, we reported that the registered provider was in breach of Regulation 19; Fit and proper persons employed. This was because the registered provider did not operate recruitment procedures which were robust enough to protect people using the service from unsuitable staff.

The provider had not undertaken thorough background checks for staff before they started working with vulnerable people. We issued a requirement notice to the registered manager to send us a report (action plan), within 28 days, on how they intended to mitigate and address the breach of Regulation 19.

The registered manager sent this report to us promptly and we were satisfied with how they intended to address the issues we found. At this inspection we found improvements had been made to meet this regulation.

Supportive SRC Limited is registered with the Care Quality Commission to provide personal care to people who wish to remain independent in their own homes. The agency provides services throughout areas of County Durham and provides a range of home care and support. At the time of our visit there were approximately 300 people using this service who were supported by 151 staff.

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.

The registered manager showed us how the recruitment procedure had been changed since the last inspection. This included checks to ensure people could demonstrate their previous employment history including other previous posts involving children or vulnerable people. The registered manager and other senior staff responsible for overseeing the recruitment of staff at the service demonstrated that they knew the importance of ensuring that recruiting checks were robust. Systems in place at the service ensured staff could not work with vulnerable people until full background checks had been carried out. We saw that people using the service were protected from applicants who were unsuitable to work with vulnerable people.

This inspection took place on 1, 3 and 13 June 2016 and was announced. This meant we gave the provider two days’ notice of our visit because we wanted to make sure people who used the service in their own homes and staff who were office based were available to talk with us.

Supportive SRC Limited is registered with the Care Quality Commission to provide personal care to people who wish to remain independent in their own homes. The agency provides services throughout areas of County Durham and provides a range of home care and support.

At the time of our visit there were approximately 300 people using this service who were supported by 151 staff.

There was a manager in place who had recently been assessed by CQC as having the skills, qualifications and experience to be the registered manager. The registered manager had also worked in a key leadership role for the organisation for over ten years and was continuing in this role. A registered manager is a person who has registered with the Care Quality Commission (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. There was also a ‘homecare manager’ appointed by the provider to manage the day to day operation of the service.

Everyone who was using the service had a care plan which described how their individual care and support needs were to be met. This meant that everyone was clear about how people were to be supported. These were evaluated, reviewed and updated as required. People who used the service and those who were important to them were actively involved in deciding how they wanted their care, treatment and support to be delivered. The registered provider had detailed plans in place to improve how care plans were written and had started to make these changes.

The registered provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who used the service. We saw risk assessments were carried out and these were updated if new situations or needs arose.

We found the registered provider did not operate recruitment procedures which were robust enough to protect people using the service from unsuitable staff. The provider had not undertaken thorough background checks for staff before they started working with vulnerable people.

Feedback from people who used the service showed that staff and the registered manager were friendly, open, caring and diligent; people who used the service trusted them and valued the support they provided. People told us they were happy with the support from this agency and felt they were in control of the support they received.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA.

We found the registered manager had a good understanding about how the service was required to uphold the principles of the MCA, people’s capacity and ensure decisions about their best interests were robust and their legal rights protected.

The registered manager and staff that we spoke with promoted peoples’ wellbeing and it was evident that staff knew people who used the service well. This included their personal preferences, likes and dislikes. Staff had used this knowledge to form caring and therapeutic relationships. These relationships improved the agency’s effect

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, paying particular regard to how people’s dignity was upheld and how they could make choices about their care. The inspection team was led by a CQC (Care Quality Commission) inspector joined by an Expert by Experience- a person who has personal experience of using services or caring for someone who does

As part of this review, we visited four people in their own homes and spoke with them about their experiences of the support they had received from this service. Relatives were present during two of the visits. At the time of our visit to the office, we spoke with the manager and three care workers, two senior care workers, two home care managers and the out of hours on call member of staff. We spoke over the telephone with a further 19 people who used the service and a further five care staff during our visits to people.

People we spoke with were positive about the care and support they received. Comments included “They are all good carers”, “I’m 100 percent happy, we have got to know each other over time and have a good working relationship”, and “They are brilliant, like Angels”, “It’s a good care company. It’s excellent,” and “The lasses are just like friends.” Everyone without exception we spoke with told us staff treated them with respect. One person said “They respect me and I respect them. “ A relative who was present during one visit said “They wouldn’t be in if they did not treat (X) with dignity and respect.” Another relative said “They (the agency) have their good points, they just need the odd tweak here and there.”

When we visited we also had the opportunity of watching staff practices as they supported people. We heard staff address people respectfully and explain to people the support they were providing. Staff were friendly and very polite and understood the support and communication needs of people in their care. Staff waited for people to make decisions about how they wanted

their care to be provided.

People told us they never had a missed call and staff normally stayed for the length of time they had agreed to in their care plan. People told us they felt safe and would feel comfortable about contacting the manager if they were unhappy.

We spoke with a number of people who used the service and relatives. People spoke positively about the care they received. Comments included “I am quite happy with the service,” “The carers are all very nice girls,” “I am definitely really happy with them. They are all really really lovely” and “She (the carer) brings sunlight into my life.”

We saw people were fully involved in decisions about their care. One person said “A senior member of staff and a carer recently came out to visit me to discuss my care plan.”

People described how their care and welfare needs were met. Comments included “They make sure I have biscuits to hand when they leave and help me with my eye drops”. Another person described how, with the support of agency staff, they were able to enjoy shopping trips out in the community.

Relatives described how the agency had increased their family member’s number of calls in response to their changing needs.

We saw appropriate procedures were in place so staff were clear about the support each person needed with their medicines.

We found staff were recruited appropriately. This helped to make sure only people with the right skills and knowledge were employed to work for the agency.

We saw the provider had a system to regularly assess and monitor the quality of the service people received. We found there was also an effective complaints procedure.