Supreme Care Services Limited, Morden branch is a domiciliary care agency. This service provides personal care to people living in their own houses and flats. It provides a service to people over 65 years old, some of whom have learning and physical disabilities, ill-health or may be living with dementia. At the time of inspection 126 adults were receiving support from this service.

This inspection was carried out on 5 June 2018 and was announced. 48 hours before the inspection we contacted the service to let them know that we will be coming to inspect them. We wanted to make sure that the registered manager would be available on the day of inspection.

At the last inspection, the service was rated Good. At this inspection we found the service remained Good.

At the time of the inspection the service had a registered manager. 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.

People had support to meet their needs safely. The service followed good practice to assess and monitor potential risks to people. Staff were thoroughly checked before they were employed by the service. Staff followed the service's processes to provide immediate support to people when incidents or accidents took place. Some people told us that staff were regularly late for their shifts but the management team had an action plan in place to address this issue.

Staff were supported to meet their role expectations as necessary. Where people required support to prepare their meals or attend to their health needs, staff had provided them with the assistance as required. Staff recently completed all the mandatory courses provided by the service and had their skills checked which ensured they were suitable for their role. However, we found that staff’s knowledge in relation to the Mental Capacity Act (2005) was limited and after discussing this with the management team we were told this would be addressed as necessary. Staff told us they reported any concerns to the management team, including if they noticed people not being able to make decisions for themselves.

People felt confident they received good quality services and that the staff team were caring and attentive to their well-being. Staff supported people to meet their individual needs and had information on what was important to people so they could meet people’s preferences. Staff had time to talk to people and put effort to have conversations with people. People felt dignified and respected which helped them to feel valued.

People’s care plans were easy to read and held all the necessary information for staff to adhere to ensure effective care for people. Robust assessments were carried out to provide staff with information on the support people required to stay safe always. Processes were in place for people to raise their concerns should they have any and actions were taken to resolve issues to people’s satisfaction.

People told us the management team responded to their needs quickly and appropriately when they approached them. A lot of effort was recently put to change the service’s culture to increase the staff team’s performance. Staff had support and motivation to perform their duties to a high standard. Systems were in place to monitor the quality of the service delivery and the registered manager followed processes to check on staff’s performance regularly. There were well established links with the local community which showed the service’s open mindedness and good practice.

We carried out this announced inspection on 25 May 2016. We last inspected this service in October 2014. At that inspection we found the service was meeting all of the regulations we assessed.

Supreme Care Services is a domiciliary care provider which provides support and care to 265 people living in their own homes in the London Boroughs of Kingston and Wandsworth. People who use the service are mainly older adults living within the local community, some of whom have dementia. The service also supports some younger adults.

There was a registered manager employed at the service. 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 provider had arrangements to help protect people from the risk of abuse. People told us they felt safe because of the way staff cared for them. Plans to manage people's individual risks were in place, and staff took action to care for people in ways which promoted their safety. There were enough staff employed to care of people and speak with them so they did not become isolated. Staff reminded people to take their medicines appropriately.

All staff received induction training and subsequent refresher training. Staff told us access to training was good. They said they found training very helpful in doing their jobs effectively.

Our inspection of staff records indicated that staff received monthly supervisions and annual appraisals to make sure they were appropriately supported in their roles.

We found that people who used the service were supported to have a nutritious and balanced diet. Where necessary the provider ensured people were appropriately supported with their healthcare needs.

People gave us positive feedback about their regular care workers. People said they were treated with caring and kindness by them. They told us that where in the past they had experienced frequent changes in the staff who supported them, this had improved recently. In turn this had helped people develop much better relationships with staff who they said understood them better. People told us staff respected their privacy and dignity and encouraged them to express their views and be actively involved in their care and support.

People received care that was appropriate to meet their assessed needs. Their support plans were updated on a regular basis or when there was a change to their care needs.

The service had a complaints procedure. This enabled people to raise a complaint if the need arose. People were confident their complaints would be responded to appropriately.

We found there was a positive culture in the agency and good leadership. There were effective systems in place to continually monitor the quality of the service. People were asked for their opinions via feedback surveys. Action plans were developed where required to address any areas that needed attention. Records management was found to be good.

At this inspection we spoke with the director who was also the registered manager; the two care co-ordinators, who we were told covered the services provided in Kingston and Wandsworth; the training and development officer; five relatives and ten people who use the service. We inspected six people’s care files and eight care workers staff files.

We considered our inspection findings to answer questions we always ask; is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Was the service caring?

People who use the services were supported by kind and attentive care workers. Those people who we talked with said the care workers treated them well and respected their privacy. People said that they were very pleased with the care they received. One person said about their care worker, "She’s a lovely girl, very caring and very dependable”. Another person told us, "I am very happy indeed, no complaints at all with the service they provide for me”. The relatives of people who we also spoke with said the care workers were caring, punctual and reliable. One person who we spoke with said, “Overall it’s a good service. It depends on the carers; the ones we have at the moment are good. They are kind and caring too”.

People who use the services told us they had discussed their care plans and that they were able to discuss relevant issues and make decisions about what they wanted to do.

Was the service responsive?

People who use the services were able to ask for changes in their care and support as their needs changed. Care plans were reviewed regularly and people told us that they felt well supported.

All the people who use the services we spoke with knew how to make a complaint. There was an appropriate complaints procedure in place. Those complaints that had been made since the last inspection had been resolved satisfactorily and the director indicated that they would be supportive of anyone who needed to complain.

Was the service safe?

People who use the services were treated with respect and dignity by the care workers. People told us they felt safe with the service they received. Safeguarding procedures were robust and care workers understood how to safeguard people being supported.

Recruitment practice was safe and thorough. The registered manager ensured that care workers were appropriately qualified to meet the care needs of people who used the services. This helped to ensure that people’s needs were met.

Was the service effective?

People who use the services health and care needs were assessed together with them, and they were involved in their care and support planning. People told us that they had been involved in their care and support plans and that the plans reflected their needs. We inspected six people’s care files. They included essential information about the person, needs and risk assessment information and service delivery or care plans.

Care workers received regular and appropriate training and supervision to ensure they were able to meet the specific needs of people using the service.

Is the service well-led?

The manager and the care co-ordinators carried out regular checks to assess and monitor the quality of services provided and took appropriate action to address any issues or concerns raised about service quality.

The views of people who use the services, their representatives and care workers were listened to by the managers. Care workers told us they were clear about their roles and responsibilities. They had a good understanding of the ethos of the agency. This helped to ensure that people received a good quality service.

At our previous inspection of Supreme Care Services in November 2013 we identified that action needed to be taken by the service provider to improve care planning and support provided to people who used the service. We also found that improvements were required to do with the supervision, support and development of it's staff. During our follow up visit we found that appropriate action had been taken by the provider to address concerns to do with staff supervision and that planned improvements to do with needs assessment and care planning were in the process of being implemented.

The manager told us that home’s policy to do with staff supervision had been revised since the last inspection and new practice implemented. We were told by the manager that staff now received regular supervision quarterly. A care co-ordinator told us that staff received improved supervision and that people who used the service have remarked on the improvements. We saw evidence that demonstrated that staff had been on appropriate and relevant training since the last inspection.

We spoke with the manager about the agency’s complaints process and we saw that there was an effective complaints system available. Complaints had been analysed to identify any emerging trends so that appropriate action could be taken and comments and complaints that people had made were responded to appropriately.

Some people who used the services or their relatives told us they were happy with the care and support they received and other people who said that they were not so happy with their service were referring to their evening or weekend calls and told us that calls were often late and sometimes missed. They said they did not get a call from the office to let them know that their care worker was going to be late.

The manager and the care co-ordinators we spoke with told us that each service user had a copy of their care plan in their home. All the people we spoke with said that they had a care plan and that they were able to express their wishes and preferences to do with the care and support they received. One person said, “I have a care plan and they asked me how I wanted the support right at the beginning of the care”.

People told us that they felt safe with their care workers and that they wore their staff identity badges and a uniform. This has helped protect people from potential abuse as they know that the people who visit them are Supreme Care staff.

Staff supervision and performance appraisal had not been carried out according to the agencies policy and procedures.

People knew how to make a complaint. Where they had to complain, improvements had been made. One person who we spoke with said, “I had to complain because things were not being done and we didn’t have a care plan. Supreme dealt with the complaint well and things have improved a lot since then”.

We spoke with five people who use the services and / or their relatives and they told us that they were happy with the care and support they received. Most of the people said that they had a care plan that they had helped draw up and that met their needs.

All of the people said that they felt safe with their care workers. However some people said that their care workers did not always wear their uniforms or identity badges.

People said that their care workers were kind and courteous and always respectful. However most people said that they were often late and that they did not get a call from the office to let them know that their care worker was going to be late.

All the people we spoke to knew how to make a complaint but they said that at the time they did not need to do so.

We made an unannounced visit to the agency with two officers from the host Local Authority. We did not speak to people who use the service on this occasion as the main purpose of the inspection was to look at the recruitment procedures and training arrangements in operation at the agency.

This section was not completed for this inspection. More information about what we found during the inspection is available in the report below.