About the service: Surbiton 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 older adults. At the time of the inspection the service was providing personal care to 19 people.

People’s experience of using this service:

¿ There were systematic and widespread failings in the oversight and management of the service. Records were not always easily accessible and issues identified during the inspection had not always been picked up during audits.

¿ The service did not have a registered manager that was an active presence within the service on a day-to-day basis.

¿ Care and treatment was not always delivered in line with people’s preferences. End of life care and support was not always in line with people’s wishes.

¿ People were protected against abuse as staff knew how to identify, respond to and escalate suspected abuse. Risk management plans that were in the new format were detailed and robust.

¿ There were sufficient numbers of staff deployed to keep people safe. Improvements in the rota system meant almost all staff were given adequate travel time between visits.

¿ People received their medicines as prescribed, however medicines audits did not always identify issues found during the inspection.

¿ People received care and support from staff that underwent training, however during the inspection we identified that not all staff had completed training and the training matrix was not up to date.

¿ Staff were knowledgeable about and adhered to the principles of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. People’s consent to care and treatment was sought and respected.

¿ Staff supported people to access food and drink that met their dietary needs and preferences, where agreed in their care plans. Staff also supported people to make and attend healthcare appointments to monitor and maintain their health.

¿ People and their relatives confirmed they were supported by staff that were caring, compassionate and treated them with respect. Staff had up to date information on people’s dependency levels and encouraged people to remain independent where safe to do so.

¿ There had been an improvement in the personalisation of people’s care plans, which detailed people’s preferences, life history, wishes and needs. Care plans were regularly reviewed to reflect people’s changing needs.

¿ People and their relatives were aware of how to raise a concern or complaint.

¿ People spoke positively about the management of the service, stating they felt their views were taken on board and could access the provider when needed.

¿ The provider encouraged working in partnership with other healthcare professionals and stakeholders to drive improvements.

Rating at last inspection: The service was previously inspection on 19 and 24 September 2018 and was given an overall rating of Requires Improvement. This was because we rated the key question, ‘is the service safe’, as Requires Improvement and is the ‘service well-led’ as Inadequate. The service was rated Good in the key questions effective, caring and responsive. We also identified breaches in the Health and Social Care Act (Regulated Activities) Regulations 2014 around staffing and good governance.

Why we inspected: Prior to this inspection we were made aware of an on-going safeguarding concern that had placed people at risk.

Enforcement: At this inspection we identified two breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 around care and treatment received in line with people’s wishes and oversight and management of the service.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This comprehensive inspection took place on 19 and 24 September 2018 and was announced.

Surbiton was registered with the Commission on 3 August 2017 and has not previously been inspected.

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 older adults. At the time of the inspection there were 19 people using the service.

The service had a registered manager in place. 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.

At this inspection we identified breaches of the regulations in relation to safe care and treatment and good governance.

People did not always receive care and support that was safe as the provider failed to deploy staff in a timely manner and staff were not given sufficient travelling time to arrive at their allocated visits at the agreed time. This meant that people had to wait for their allocated visits and impacted negatively on them.

There were systematic failings in the overall oversight and management of the service. Auditing processes were not in place which meant issues were not identified in a timely manner and action to address the issues was delayed or did not take place.

People were not always protected against the risk of identified harm as risk management plans did not clearly identify the control measures to mitigate the risks. We raised our concerns with the provider who sent us an updated risk assessment and confirmed all risk management plans would be updated shortly.

People did not always receive their medicines in line with good practice. Medicine administration records were unclear, did not use key codes to identify when and why medicines were not administered as prescribed and were not audited. We raised our concerns with the provider who sent us an updated medicine administration record. The provider confirmed this is being rolled out throughout the service and would be in place by 28 September 2018.

People received care and support from staff that had undergone pre-employment checks to ensure their suitability for the role.

People were protected against the risk of cross contamination as the provider had systems and processes in place to safely manage infection control.

People received care and support from staff that reflected on their working practises and received training to enhance their skills and knowledge. Although training and supervisions had taken place, the provider had failed to adequately document these. After the inspection the provider sent us an updated training plan and staff supervision record. However, this was still not completed sufficiently.

Staff were aware of their roles and responsibilities in line with the Mental Capacity Act 2005. People confirmed their consent to care and treatment was sought prior to care being delivered.

People were supported to access sufficient amounts of food and drink that met their dietary needs and preferences in line with their care package. Where required people were supported to make appointments with healthcare professionals.

People received support from staff that demonstrated kindness and compassion. People confirmed where required they were provided with emotional support and guidance.

People were encouraged to participate in the development of their care plans. Although care plans were in place and reviewed to reflect people’s changing needs, they were not as person centred as they could be.

People were aware of how to raise a concern or complaint. Complaints were managed in such a way to reach a positive resolution in a timely manner.

People spoke positively about the provider and told us they found her approachabl