Archived: SureCare (Bolton)

Updated 19 February 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.’

This inspection took place on 04, 05 and 06 November 2015 and was announced. The provider was given 48 hours’ notice of the inspection to ensure management were available at their office to facilitate our inspection. The inspection team consisted of one adult social care inspector from the Care Quality Commission.

Before the inspection visit we reviewed the information we held about the service, including the Provider Information Return (PIR), which the provider completed before the inspection. The PIR is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.

We reviewed information we had received since the last inspection including notifications of incidents that the provider had sent us. We also liaised with external agencies including the contract monitoring team from the local authority.

During our inspection we went to the provider’s head office and spoke with the operations director, the business development manager, the care manager, the administrator, four care staff members and the care coordinator.

At the time of our inspection there were 64 people who were using the service, which employed 31 members of care staff. At the time of the inspection two new staff members were being recruited but had not yet started employment.

We reviewed the care records of six people that used the service and records relating to the management of the service. We looked at documentation such as care plans, staff personnel files, policies and procedures and quality assurance systems. We visited four people who used the service in their own home and we spoke with two other people who used the service and to the relatives of two people who used the service over the telephone as part of the inspection. This was in order to seek feedback about the quality of service being provided.

Updated 19 February 2016

The announced inspection took place on 04, 05 and 06 November 2015. At our last inspection on 24 June 2013 the service was found to be meeting all regulatory requirements.

The provider was given 48 hours’ notice of the inspection to ensure management were available at their office to facilitate our inspection. At the previous inspection on 24 June 2013 the service was found to be meeting all regulatory requirements.

Surecare (Bolton) is a domiciliary agency which provides personal care for adults in their own homes. Clients can self-refer or care is commissioned by the local authority. The office is based on one of the main roads in Farnworth, Bolton. At the time of the inspection, 64 people were using the service.

At the time of the inspection there was no registered manager in post but a member of staff was going through the process of registering with the Care Quality Commission. 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.’

People we spoke with told us they felt safe using the service During the inspection we checked to see how the service protected vulnerable people against abuse. There was an up to date safeguarding vulnerable adults policy in place. We found that the staff we spoke with had a good knowledge of the principles of safeguarding.

The provider had a whistleblowing policy in place and this included contact details for the Care Quality Commission but details for the local safeguarding authority were missing.

Each care file contained a variety of risk assessments. There was a ‘generic risk assessment’, an ‘individual risk management’ document a ‘manual handling’ risk assessment. There were risk assessments for falls, bathing, showering and medication. We found these risk assessments were reviewed as required in response to changing needs of the person who used the service.

We looked at how the service managed people’s medicines and found that suitable arrangements were in place to ensure that people who used the service were safe. All staff administering medication had received training, which we verified by looking at training records. An up to date ‘medication management policy’ was available for staff and a ‘policy for medication to be taken as required’ was also in place which instructed staff how to accurately administer and record these medicines.

We found people were receiving care from care staff who were deployed consistently in a way that met people’s needs. Some people who used the service lived alone and staff required the use of a key to access their house. We saw the keys were appropriately stored in a ‘key safe’ outside each house we visited.

We found there were suitable recruitment procedures in place and required checks were undertaken before staff began to work for the service. Each staff file contained a contract and job description which had been signed and dated.

We saw evidence of a comprehensive induction pack, with appropriate training provided for roles and responsibilities, along with competency testing. Staff also signed to confirm they had read policies and procedures and that they were aware of the provider's requirements in respect of data protection and confidentiality.

There was an appropriate up to date accident/incident policy and procedure in place. Records of accidents and incidents were recorded appropriately within people’s care files.

There was an up to date ‘business continuity plan’ in place which covered areas such as loss of utility supplies, loss of staff, office damage, loss of IT systems and adverse weather.

People who used the service told us they felt that staff had the right skills and training to do their job.

At the time of the inspection the service was in the process of introducing ‘StaffPlan’ which is a computer software programme specifically produced for the care and support sector to assist them in organising the deployment of staff.

We found there was a staff induction programme in place, which staff were expected to complete when they first began working for the service. Staff told us they felt they had received sufficient training to undertake their role competently. We reviewed the service’s training matrix, and staff training certificates, which showed staff had completed training in a range of areas, including training in dementia, moving and handling, behaviours that challenge services, safeguarding, first aid, medicines, infection control and health and safety.

All care staff were given a staff handbook that included policies and procedures, which was discussed with the staff member as part of the induction process.

Staff received supervision and appraisal from their manager. These processes gave staff an opportunity to discuss their performance and identify any further training they required.

Before any care and support was provided, the service obtained consent from the person who used the service or their representative. We were able to verify this by speaking with people who used the service, checking people’s files and speaking to staff.

Care files contained a ‘data protection service user consent’ form, a ‘medication administration authorisation’ form, a ‘consent to care and treatment’ form and details of whether the person could sign documentation themselves or if a family member was required.

We found from looking at people’s care records that the service liaised with health and social care professionals involved in people’s care if their health or support needs changed and the service worked alongside other professionals and agencies in order to meet people’s care requirements where required.

We saw that people’s nutrition and hydration status was recorded in a ‘full care needs assessment’ document which identified if the person required assistance with eating, drinking and shopping.

We spoke with staff to ascertain their understanding of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS).Two staff told us they had previously completed training in MCA and DoLS. We checked staff training records to see which staff had completed MCA and DoLS training and saw that 75% of staff had completed this training.

People who used the service and their relatives told us that staff were kind and treated them with dignity and respect and that they and their relatives were involved in developing their care and support plan where they wished. Whilst visiting people in their own homes we observed warm interactions between people and staff.

The service had a Service User Guide and this was given to each person who used the service in addition to the Statement of Purpose, which is a document that includes a standard required set of information about a service. There was also a ‘SureCare Guide to your Support Service’ document which included a ‘customer charter’, ‘principles of care’, ‘independence’, ‘choice’, ‘emotional needs and fulfilment’. These documents included details of how to make a complaint and referenced the local authority, the Care Quality Commission and the Local Government Ombudsman.

We saw there was a ‘customer care’ policy, which was up to date and recently reviewed. Other supporting policies included ‘confidentiality, ‘nutrition and diet’, ‘bathing and showering’, ‘bed bathing’, ‘handling service user's money’, ‘no response,' 'dealing with emergencies’, ‘key holding’ , ‘use of personal protective equipment’ and ‘challenging behaviour’ policies. There was also a resident's ‘charter of rights’ and a policy on ‘autonomy and choice’, which helped staff to understand how to respond to people’s different needs. Staff were aware of these policies and how to follow them.

We saw that prior to any new admission a pre-assessment was carried out with the person and their relative(s). We verified this by looking at care records.

People told us that should there be a need to complain they felt confident in talking to the manager directly and had regular discussions with management. The service had a complaints policy and procedure and we saw that they followed this consistently. Complaints and concerns investigations had been carried out following issues raised regarding quality of service provision and missed visits and the service had taken remedial action to reduce the potential for a reoccurrence.

The service sought the views of people using the service and their relatives. We saw that a quality assurance survey/service user’s views questionnaire had been undertaken and completed in January 2015. Another survey was due to be undertaken in November 2015 after the date of the inspection. We saw that remedial action had been taken to resolve the issues identified in the survey.

People who used the service had a care plan that was personal to them with copies held at both the person’s own home and in the office. This provided staff with guidance around how to meet their needs, and what kinds of tasks they needed to perform when providing care. Regular reviews of care needs were undertaken by the service. The manager told us that all care files had recently been reviewed and that a rolling programme of reviews was followed every three months. We looked at records and saw that there was an up to date log of care file reviews for 2014 and 2015.

People told us that they were listened to by the service.

The manager told us that if the service received a new referral it would not be accepted until it was certain that there were enough staff available to meet the person’s care needs. This may have included whether there was a need to recruit additional staff.

There were systems in place to record what care had been provided during each call or visit. Care plans contained a document, which was completed by staff at each visit.

There was no registered manager at the service. At the time of the inspection one member of staff was in the process of registering with the Care Quality Commission to become the registered manager.

Staff told us they felt they were able to put their views across to the management, and felt they were listened to. The staff we spoke with told us they enjoyed working at the service and said they felt valued.

The service undertook audits to monitor the quality of service delivery. We saw a number of audits in place such as care file and medication audits, and spot checks on care staff to verify their competence in providing safe and good quality care.

We found the service had up to date policies and procedures in place, which covered all aspects of service delivery including safeguarding, medication, whistleblowing, recruitment, complaints, equality and diversity, moving and handling and infection control.

Audits of medication administration had been completed which the service shared with the local authority contracts monitoring team as requested. Staff we spoke with confirmed they had been subject to audits of their practice through direct observation and questioning.

The service had a business continuity plan in place which covered areas such as loss of access to the office, loss of staff, loss of utilities and the action to be taken in each event. The plan also included the prioritising of people who used the service with regards to their individual needs.

The service had recently produced five ‘service development’ files that were being used to help identify if the service was meeting all the regulatory requirements. To support these files, an action plan had been developed in 2015 and was due for review in January 2016.

The service had recently set up a new ‘on-call’ rota for out of office hours telephone contacts, which was supported by an on-call file that recorded all calls received.

The manager said they endeavoured to explain any instructions or changes in practice to the staff group so that they understood why the request or instruction was being made.