This inspection took place on 30 and 31 October 2018. The registered manager was given 48 hours' notice because the location provides a domiciliary care service and we needed to ensure that the registered manager would be present.

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, some of whom may be living with dementia and have complex physical health needs. The Care Quality Commission (CQC) only inspects the service being received by people provided with personal care, which is help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the start of our inspection there were 83 people using the service in this respect.

The service had a registered manager. 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.

When we last inspected this service in August 2017, we identified breaches of legal requirements. These breaches of regulations related to risk assessments, staff training and good governance.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions for Safe, Effective and Well-led to at least good.

At this inspection, we found that the service had addressed the concerns around people receiving safe care. Staff had been appropriately trained to meet people’s assessed needs. Care records detailed the risks associated with people’s health and care, and guidance was available for staff on how to keep people safe.

Although there were systems in place to ensure staff were safely recruited, we found that there were shortfalls in the service’s oversight of staff who required permission to work in the UK.

Improvements had been made to managerial oversight of people’s care packages. There were comprehensive systems in place to monitor the care people received. However, we identified a gap in the service’s ability to actively and accurately monitor the total number of people receiving care. We have made a recommendation about this.

We received positive feedback from people and relatives regarding the timeliness of care visits, the competence and caring nature of staff and the overall management of the service.

Medicines were managed safely. Staff had received training in medicines administration and had had their competencies assessed.

Care plans were completed with the consent of people and their relatives. These were reviewed on a regular basis to ensure the people received the care that they needed.

Staff received regular documented supervisions and an annual appraisal. Staff told us they felt supported.

People were supported to maintain good health and had access to healthcare services where necessary.

The service regularly requested feedback from people who used the service, to improve on the services provided.

This inspection took place on 4, 8 and 10 August 2017. The provider was given 48 hours' notice because the location provides a domiciliary care service and we needed to ensure that the registered manager would be present. When we last inspected this service on 19 and 20 July 2016, we identified breaches of regulations 11 and 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches of regulations related to risk assessments, medicines management and compliance with the Mental Capacity Act (2005). We also identified concerns related to staff training.

Surecare Enfield is a domiciliary care agency based in North London which provides home based care for adults primarily living in the London Boroughs of Enfield and Haringey. At the time of the inspection, there were 83 people using the service.

The service has a registered manager. 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 found that improvement had been made to how the service assessed and mitigated individual risks associated with people’s care and treatment. However, some risks to people had not been identified and risk assessments had not been updated as and when people’s care needs changed.

The provider had a quality monitoring system to ensure standards of service were maintained and improved. However, we found that there was a lack of management oversight of one complex care package.

We saw evidence of a comprehensive staff induction and on-going training programme. However, some staff had not been appropriately trained to undertake certain complex care tasks.

Medicines were now managed safely and effectively and there were regular medicines audits in place. Staff had completed medication training and regular competency assessments.

All staff had received training on the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS) and staff understood what to do if they had concerns with regards to people's mental capacity. Where decisions were made in a person’s best interests, this was documented in the person’s care assessment.

People and relatives told us they felt safe. Procedures and policies relating to safeguarding people from harm were in place and accessible to staff. All staff had completed training in safeguarding adults and demonstrated an understanding of types of abuse to look out for and how to raise safeguarding concerns.

Staff received regular documented supervisions and an annual appraisal. Staff were safely recruited with necessary pre-employment checks carried out.

We received positive feedback from people and relatives regarding the caring and supportive nature of staff.

People were supported to maintain good health and had access to healthcare services, where necessary.

The service regularly requested feedback from people who used the service.

We received positive feedback from people and relatives regarding the overall service provision received. Staff spoke positively of the support they received from management.

We identified three breaches of regulations relating to risk assessments, staff training and good governance. You can see what action we told the provider to take at the back of the full version of the report.

This inspection took place on 19 and 20 July 2016. This was an announced inspection and the provider was given 48 hours' notice. This was to ensure that someone would be available at the office to provide us with the necessary information. When we last inspected this service on 19 December 2013 we found the service met all the regulations we looked at.

SureCare Enfield is a domiciliary care agency based in North London which provides home based care for adults primarily living in the London Boroughs of Enfield and Haringey. At the time of the inspection, there were 139 people using the service. The service provides approximately 4000 hours of care per week and many people who use the service require palliative care. The service employs 115 staff.

The service has a registered manager. 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.

Risks were not always adequately assessed for people using the service. During the inspection we identified particular risks to people, for example epilepsy and choking which had not been identified by the provider. General risk assessments were in place and were reviewed regularly.

Medicines were not always safely managed. There were inconsistencies between what care plans and medicines risk assessments stated as to what medicines support people received. Daily records completed by staff in relation to medicines support people received differed from what instructions were given as part of the care plan.

The provider did not always adhere to the Mental Capacity Act 2005 (MCA 2005). Some consent forms were signed by relatives with no documented authority. There were no best interest decisions or mental capacity assessments highlighting that people did not have capacity to sign their care plan consent forms. Staff had not received training in the MCA 2005.

People and relatives told us they felt safe. Procedures and policies relating to safeguarding people from harm were in place and accessible to staff. Staff demonstrated an understanding of the types of abuse to look out for and how to raise safeguarding concerns.

The service maintained sufficient staffing levels and people told us that carers generally arrived on time and they were contacted if there were any changes to their care routine.

We saw evidence of a comprehensive staff induction and on-going training programme. However, not all staff training had been updated recently. Staff were safely recruited with necessary pre-employment checks carried out. Staff received regular supervisions and annual appraisals.

We received positive feedback from people and relatives who told us staff were caring, consistent and responsive to their needs.

People were confident about how to complain and complaints were logged. However, complaints were not analysed for trends or learning points identified.

The registered manager had recently implemented a number of changes to improve the care people received and ensure quality was monitored effectively.