This inspection took place on 6 March 2017 and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we needed to be sure that someone would be in. Supreme Care Services Limited is a domiciliary care agency which delivers care and support to older people and children in their own homes. The agency is based in Woolwich, South East London. At the time of this inspection 40 people were using the service.

At our last inspection on 14 and 16 March 2016 we found breaches of our legal requirements. We found that action had not always been taken to manage risks to people using the service safely. We found that the provider had not notified the CQC when the previous registered manager stopped running the service. The provider had also failed to notify the Care Quality Commission about three allegations of abuse in relation to people using the service.

At this inspection we found the provider had made the required improvements and that appropriate procedures were in place to support people where risks to their health and welfare had been identified and notifications, including safeguarding concerns were being submitted to the CQC as required by law.

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 and associated Regulations about how the service is run.

People said they felt safe and staff treated them well. The service had appropriate safeguarding adults procedures in place and staff had a clear understanding of these procedures. There was a whistle-blowing procedure available and staff said they would use it if they needed to. Appropriate recruitment checks took place before staff started work. People’s medicines were managed appropriately and people received their medicines as prescribed by healthcare professionals.

The registered manager and staff had a good understanding of the Mental Capacity Act 2005 and acted according to this legislation. Staff had completed an induction when they started work and they had received training relevant to the needs of people using the service. People’s care files included assessments relating to their dietary support needs. People had access to health care professionals when they needed them.

People and their relatives said staff were kind and caring and their privacy and dignity was respected. People had been consulted about their care and support needs and care plans were in place that provided information for staff on how to support people to meet their needs. People and their relatives were provided with appropriate information about the service. They were aware of the complaints procedure and said they were confident their complaints would be listened to, investigated and action taken if necessary.

The provider recognised the importance of monitoring the quality of the service provided to people. They took into account the views of people using the service through satisfaction surveys and telephone monitoring calls. The provider carried out unannounced spot checks to make sure people were supported in line with their plans of care. Staff said they enjoyed working at the service and they received good support from the registered manager and office staff. There was an out of hours on call system in operation that ensured management support and advice was always available for staff when they needed it.

This inspection took place on 14 and 16 March 2016 and was announced. At our last inspection on 14 May 2014, we found the provider was meeting the regulations in relation to outcomes we inspected.

Supreme Care Services Limited is a domiciliary care agency which delivers care and support to older people and children in their own homes. The agency is based in Woolwich, South East London. At the time of this inspection 80 older people and 12 children were using the service.

The service did not have 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 previous registered manager left the service in June 2015. The current manager had been working at the service since September 2015. They had begun the process of applying to the CQC to become the registered manager.

At this inspection we found breaches of the Care Quality Commission (Registration) Regulations 2009. These related to information the provider is required by law to notify the CQC about. The provider had failed to notify the CQC when the previous registered manager stopped running the service. The provider had also failed to notify the Care Quality Commission about three allegations of abuse in relation to people using the service.

We also found a breach of the Health and Social Care Act 2008 Regulated Activities) Regulations 2014. We found that action had not always been taken to manage risks safely. We saw information was recorded in peoples care plans on how they should be supported with their care needs however there were not always risk management plans or guidance in place advising staff how to support people where risks to their health and safety had been identified. You can see the action we have told the provider to take at the back of this report.

We found the service had safeguarding adults and children’s procedures in place and that staff had a clear understanding of these procedures. There was a whistle-blowing procedure available and staff said they would use it if they needed to. Appropriate recruitment checks took place before staff started work. People had access to health care professionals when they needed them and were supported, where required, to take their medicines as prescribed by health care professionals.

The manager had a good understanding of the Mental Capacity Act 2005 and acted according to this legislation. Staff had completed an induction when they started work and they were up to date with their training. People had been consulted about their care and support needs. Care plans provided information for staff on how to support people to meet their needs. People’s care files included assessments relating to their dietary support needs. People were aware of the complaints procedure and said they were confident their complaints would be listened to, investigated and action taken if necessary.

The provider was introducing a call monitoring system at the service. We were not able to assess the impact of the system on people's care as the system was not fully in place at the time of inspection. We will assess this at our next inspection of the service.

The provider recognised the importance of monitoring the quality of the service provided to people. They took into account the views of people using the service through telephone monitoring calls and satisfaction surveys. The provider carried out unannounced spot checks to make sure people were supported in line with their care plans. Staff said they enjoyed working at the service and they received good support from the manager. They said there was an out of hours on call system in operation that ensured management support and advice was always available when they need

We gathered evidence against the outcomes we inspected to help answer our five key questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? We also gathered information from people using the service by telephoning them.

Below is a summary of what we found. If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

People told us they felt safe with care staff coming into their homes. The provider had safeguarding vulnerable adult’s policies and procedures in place and staff we spoke with were aware of their responsibility to safeguard the people they supported.

There were systems in place which ensured that managers and staff learnt from events such as accidents and incidents, complaints, concerns and investigations. This reduced the risks to people and helped the service to continually improve.

The registered manager informed us that they took peoples care needs into account when setting the rota and matched staff skills and experiences to ensure that people’s needs were met.

Is the service effective?

People’s health and care needs were assessed with them, and they were involved in writing their plans of care. Where people needed two staff to support them, this had been identified and the appropriate support was provided. People said that their care plans were up to date and reflected their current needs.

People told us that their family members had been involved in the care and support they received.

Is the service caring?

We spoke with about 20% of people who used the service and their relatives and they told us that they were satisfied with the care that they were receiving. For example, people told us that “the staff are always on time”, “I have a regular carer”, “they do what I ask them to do”, “My carer has time to do everything she has to do…I don’t feel rushed”. Staff we spoke with knew about the care needs of people and it was clear they genuinely cared for the people they supported.

People using the service, their relatives and / or friends had completed an annual satisfaction survey. Where shortfalls or concerns were raised these were taken on board and were being dealt with at the time of our inspection.

Is the service responsive?

People knew how to make a complaint if they were unhappy. Most people we spoke with told us that they were satisfied with the service they received and therefore had nothing to complain about. The provider’s complaints log showed that people had made complaints in the past and the provider had responded to their complaints in line with their policy. However, one person told us that they had made a complaint in the past and although this was dealt with they felt that more could have been done.

The service worked well with other agencies and services to ensure people received care and support that was safe and met their individual needs.

Is the service well-led?

The service had a quality assurance system in place including an annual customer satisfaction survey, telephone monitoring and spot checks. We saw that where issues were identified, the provider took action to address these promptly. As a result the quality of the service was continuously improving.

Care staff we spoke with informed us that they felt supported by office staff. They told us that they felt comfortable to discuss any concerns they had with their line manager and knew their concerns would be looked into. Staff told us they were clear about their responsibilities and the provider’s policies and procedures. This helped to ensure that people received a good quality service at all times.

People who used the service and their families told us that overall they were happy with the service provided by Supreme Care Services Limited. One person's family told us they were '"quite happy" and people who used the service said the service was "reasonable", "alright" and "mostly good". People told us they were offered choices and their privacy and dignity was maintained. They said care staff were generally good. People told us the care they received generally matched their care plan. People told us they knew how to complain and the agency occasionally carried out spot checks on its staff, however one person told us they would prefer it if the provider let them know before turning up at their home.

We found that people were involved in their care and their privacy and dignity was maintained. People's care needs were assessed and care was planned and delivered to meet their needs. The provider had safeguarding procedures in place which staff were aware of and people who used the service knew how to complain. The provider did not follow effective recruitment procedures to ensure its staff were checked before delivering care to people. Staff felt supported and were adequately inducted and trained. The provider carried out some quality checks and sought people's feedback on the service, but it did not always ensure learning from incidents took place or changes were implemented when issues had been identified.

We spoke to around 20% of the people who received a service or their relatives over the telephone to ask about the service they were provided with. The majority of people we spoke with were happy with the home care they received. One person's relative told us their family member "seemed to be satisfied". One person told us they felt the service was "working quite well" but another said the service "sometimes could be better". People told us they were happy with the care staff they received. One person described staff as "pleasant ladies" and another person said their carers were "quite good". People told us staff were usually consistent but when cover for carers was needed they were usually notified in advance. People told us care staff supported them in accordance with their care plan and sometimes with medication. Most people we spoke with were aware that the provider carried out reviews of their care and quality checks on care staff.

We found that care staff sough consent before delivering care to people. People's needs were assessed and care was planned, however sometimes care plans did not reflect the care provided. People's medication arrangements did not always match their care plan and we found staff sometimes administered medicines they were not sufficiently trained to. The provider had made improvements to recruitment checks to ensure staff were appropriately vetted before working with people, and it had carried out and followed up on quality assurance.