This inspection took place on 23 August 2018 and was announced. We gave the provider 24 hours’ notice to ensure they were available to facilitate our inspection. We last inspected the service on 9 February 2016 we found the service was meeting the fundamental standards and we rated the service Good.

A24 Group - Sutton is a domiciliary care agency that provides personal care and nursing care to adults and children living in their own homes across the UK. The agency has been in operation for around 22 years and provided personal and nursing care to people in healthcare settings as well as in people’s own homes. We only regulate personal care and nursing people receive in their own homes so did not look at the other part of the business. The agency provides domiciliary care as several distinct brands: Ambition 24 Nurses, British Nursing Association, Grosvenor Nursing and Mayfair Nurses. People had a wide range of complex nursing needs. The registered manager told us there were five people receiving care at the time of our inspection . However, our inspection findings showed this number was inaccurate. We again asked the registered manager to clarify the number of people and they gave us a list of seven people using the service. This list did not include everyone staff told us they provided personal care to. This meant the registered manager lacked robust oversight of the service.

There was 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 found standards had deteriorated and the service was rated requires improvement overall. The registered manager and provider lacked good oversight of the service which meant they had not identified and resolved the issues we found. For example, the provider had not established systems to regularly and consistently audit medicines records to check people received medicines safely. The provider’s record keeping could also be improved, such as records of the care people received.

The provider did not always assess risks relating to people’s care and did not always ensure comprehensive, reliable care plans were in place for staff to follow. Instead for some people the provider relied on documentation from other services which was several years out of date.

The provider did not always supervise staff in a way which supported them to do their jobs and some staff had not had any supervision for several years. The provider had not established systems to assess the competency of staff to check they provided care in the best ways.

People may not have received care in line with the Mental Capacity Act 2005 (MCA) as the provider had not established systems to assess people’s capacity in relation to their care when they suspected people lacked this.

People were safeguarded from abuse by the provider as staff understood their responsibilities in relation to this. Staff received training in safeguarding adults to help keep their knowledge current.

People were supported by sufficient numbers of staff to meet their needs. The provider followed suitable recruitment processes so that only suitable staff worked with people.

Staff received a programme of training to help them understand their roles, including clinical training for nurses which helped them maintain their registration with their regulatory body.

People received the support they needed in relation to eating and drinking. People also received support in relation to their day to day health.

People and relatives were positive about the staff who supported them and developed good relationships. Staff treated people with kindness, dignity and respect. Staff understood the people they were working with and the

This inspection took place on 9 February 2016 and was announced. The provider was given 48 hours’ notice because the location provides domiciliary nursing care and we needed to be sure that someone would be available in the office. The last Care Quality Commission (CQC) inspection of the agency was carried out on 3 December 2013, where we found the service was meeting all the regulations we looked at.

A24 Group Ltd - Sutton is a domiciliary care agency that provides nursing and personal care to people in their own homes. Some people are privately funded, although the vast majority are funded by their local Clinical Commissioning Group (CCG). The service specialises in providing nursing and/or personal care to children, younger adults and older people with complex health care needs. The support people receive varies greatly and the time staff can spend providing nursing and/or personal care in a person’s home ranges from four to 24 hours a day. There were 6 children and 14 adults living in various parts of the country receiving nursing and/or personal care and support from the service when we inspected A24 Group in Sutton.

The service had a registered manager in post. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

The relatives of people using the service told us they were happy with the standard of the nursing and/or personal care their family members received from staff working for A24. They said the nurses and/or care workers always turned up on time and delivered the care package they had planned and agreed with the agency. People also said staff looked after them in a way which was kind and caring. If people were nearing the end of their life they received compassionate and supportive care.

People and their relatives told us they felt safe when staff from the agency visited them in their home. The manager knew how and when to report abuse or neglect if they suspected people were at risk. Risks to people’s health, safety and wellbeing had been assessed and staff had been provided with guidance about how to manage these in order to keep people safe. The agency also ensured each person’s home environment was risk assessed to identify any potential hazards people living there might face.

People were supported to keep healthy and well. Staff ensured people were able to access community health and social care services whenever they needed them. People were encouraged to drink and eat sufficient amounts to reduce the risk to them of malnutrition and dehydration. People received their medicines as prescribed and staff knew how to manage medicines safely.

People and their relatives (where appropriate) were involved in making decisions about their care and had care plans that focused on their needs and preferences. People and their relatives had agreed to the level of support they needed and how they wished to be supported. Care plans provided staff with guidance about how people’s needs and preferences should be met. When people's needs changed, senior nurse coordinators responded by immediately reviewing the person’s care plan.

The registered manager and staff demonstrated a good understanding of the Mental Capacity Act 2005 and acted according to this legislation.

There were enough suitably competent staff to care for people using the agency. The registered manager matched people with nurses and care workers who had the right mix of knowledge, skills and experience to meet their specific nursing and/or care needs. Staff were suitably trained and knowledgeable about the individual needs of the people they cared for. They were also well supported by the registered manager and the nurse coordinators. The provider carried out appropriate checks to ensure sta

At the time of this inspection there were seven people receiving care and support in their own homes, funded personally or through their local Clinical Commissioning Group (CCG).The relative of another person explained that they had recently stopped receiving care from the agency. They assured us that this decision was not made because of any concerns about the care that that been provided.

We were able to speak with the representatives of four people who received a service and a nurse who was supporting one other person. All of the feedback we received was positive, with people telling us that “staff are wonderful”, “really caring”, and “very efficient”.

People told us that the agency contacted them regularly to make sure the package of care they were receiving still suited their needs. They said if anything was not quite right it was addressed quickly.

We looked at the recruitment processes used by the agency and saw that all of the necessary checks had been undertaken. We also looked to make sure that staff supporting people had the skills and training to help them in their role. The information that we received showed us that there was an ongoing staff training programme in place.

This service is managed centrally in South Africa. However it retains a registered location in Sutton.

The A24 group employed over 30.000 staff who worked in hospitals care homes and other registered services. A small number of staff also provided care and support to people in their own homes. This inspection was to look at the outcomes for those people.

We were able to speak with nine people who have arranged support packages for a client or relative. All of them were happy with the care that was being delivered and we received positive feedback from them. Comments we received included, “my ladies are fab, they allow us to have a proper life” and “the ladies that come are wonderful”. One person told us “they’re 110 percent, I trust them completely, they’re a really good team. They work with me completely to provide the best possible care for my relative”. Another person told us “they’re absolutely wonderful, my relative is very happy”.

We were told that the agency kept in constant contact with people to ensure that the care package remained suited to the persons needs. Any problems were addressed promptly. The only concern that was raised by one person was related to the lack of continuity of the package coordinators. They had found that key people changed frequently and it had meant explaining everything to them all over again.

The agency currently provides care at home for four clients. We were able to speak with representatives of three of them.

All of the feedback we had was very positive. Two of them told us that initially there had been some problems setting up the care plans but that had now been sorted out.

Comments we received included “they run rings round agency’s we have used in the past”, “they are the best we have ever had” “always helpful” “very reliable” and “I can’t say enough good about them”.

We were told that feedback to senior managers is encouraged and this is always taken seriously. People considered that the agency worked in partnership with them to ensure everything was done as they liked it.

Several staff have been working with their clients for some time, in one case more than eight years and people said they were “competent and capable”. They also praised the coordinators of the service saying “they are always so helpful” “we are encouraged to say if anything isn’t right”.