Agincare UK Surrey is a domiciliary care agency which is registered to provide personal care to people in their own homes. At the time of our inspection the service was providing personal care to 85 people.

This inspection took place on the 18 December 2017 and was announced. We gave 72 hours’ notice of the inspection to ensure that staff would be available in the office. This was also to allow the manager time to arrange some home visits for us as part of this inspection.

There was no registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (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. There was a manager in post who started in February 2017 was in the process of registering with CQC. The manager assisted us with our inspection.

We last carried out a comprehensive inspection of this service in January 2017 when we rated the service as Inadequate overall. We took some enforcement action against the provider at that time as we found that the service was not being managed adequately. Following that we carried out a focused inspection in June 2017 to look at Safe and Well-Led to check the registered provider had taken action in response to the concerns we had identified in January 2017. We found they had and the service had improved, however we stated at the time that we would wish to see this improvement embedded before we could change the rating we had awarded. This comprehensive inspection was conducted to look at the service as a whole and to see if all five areas that we inspect on had sustained those improvements. We identified no concerns at this inspection.

People told us they were cared for by staff who were kind and caring. And people were supported by staff to remain as independent as they were able. They said staff arrived on time and carried out care for them in the way they wished it. People said they had not had a missed call and if staff were going to be late they were informed. Risks to people were identified and actions taken to help people stay safe. In the event of an accident the agency followed this up.

People and their relatives told us they felt safe with staff from Agincare. Staff had a clear understanding of the different types of abuse and the procedures to be followed if they had witnessed or suspected abuse had taken place. The registered provider had followed safe recruitment processes to ensure they only employed suitable staff. Staff were aware of their duties in relation to infection control when working in people’s homes.

If an emergency occurred at the office or there were adverse weather conditions, people’s care would not be interrupted as there were contingency procedures in place. There was an on-call system for assistance outside of normal working hours.

Staff had received training and supervisions that helped them to perform their duties. They also received spot checks from senior staff whilst they were working with people. Staff understood the Mental Capacity Act 2005 (MCA) and we found that people’s consent was sought before the agency provided care to them.

There were enough staff to ensure that people’s assessed needs could be met and all visits could be undertaken in a timely manner. Management of medicines was undertaken in a safe way and recording of such was completed to show people had received the medicines they required. Regular auditing of medicines charts took place to help ensure staff consistently followed best practice.

Care plans included background histories for people and information about how people preferred their care to be provided. Guidance for staff was detailed and there was evidence people were involved in their care planning.

People’s nutritional needs were met by staff who would cook

This inspection took place on 20 June 2017 and was announced.

We carried out an announced comprehensive inspection of this service on 20 January 2017. At that inspection we found breaches of legal requirements. We undertook this focused inspection to check that the provider now met legal requirements in relation to safe care, staffing and governance. This report only covers our findings in relation to those requirements.

The provider had taken appropriate action and addressed these breaches. We could not rate the key questions safe and well led as being good because to do so requires consistent good practice over time. We will check that the improvements have been embedded into practice and sustained at our next planned comprehensive inspection

Agincare UK Surrey is a domiciliary care agency providing personal care for people in their own homes. There were 83 people receiving the service at the time of the inspection.

There was not a registered manager in post. 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. Since the last inspection the registered manager had left the service. A new manager was in post and had applied to become the registered manager.

People received the medicines they required. This was confirmed by care records and Medication Administration records (MAR). However, staff were not always signing the MAR following administration. This had been addressed with the staff responsible for the errors.

People and their relatives told us they felt safe. Risk assessments were completed and staff followed these to minimise the risks and try to keep people safe. These included risk assessments for mental health, diabetes, infection, falls, medication, choking, skin integrity, the environment and moving and handling. Staff were regularly reminded to keep people safe.

There were sufficient staff to meet people’s needs. The agency had enough staff to cover all scheduled visits each day, and the agency had enough staff to ensure people received their care when their regular care workers were delayed.

People were protected against the risks of potential abuse as staff knew how to report safeguarding concerns and safe recruitment practices were followed.

The provider had effective systems in place to monitor the quality of the service they provided. Since our least inspection the manager had carried out two telephone surveys, the provider had completed a quality audit and staff had been regularly spot checked.

The records had improved and were now accurate and up to date. New care plans had been completed to allow staff to see what care they needed to give people and staff were following this guidance. People and their relatives had been involved in developing them.

Staff told us the manager was supportive. Two staff meetings had been held since our last inspection. Minutes of these meetings showed that the manager had clarified the changes made to improve the service and had thanked care staff for their efforts in improving the care people received.

This inspection took place on 12 and 20 January 2017 and was announced.

At the last inspection in April 2014 we found breaches of Regulations 9 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to the planning and delivery of care to people and respecting and involving people. We found at this inspection these Regulations continue to be breached. We also identified some new concerns.

Agincare UK Surrey is a domiciliary care agency providing personal care for people in their own homes. There were 173 people using the service at the time of the inspection.

There was a registered manager in post. 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. We have been informed since the inspection the registered manager had left the service. They are no longer registered with us.

People were not being protected against potential risks because risk assessments and guidelines for staff were not in place.

There were not sufficient staff to meet people’s needs.

Medicines were not managed safely. People did not always receive the medicines they required and staff had not had their competency checked.

Staff did not always receive refresher training to help ensure they remained up to date with best practice. We have made a recommendation about staff having access to up to date training.

Staff did not receive appropriate support to enable them to carry out their duties.

People's rights were not protected because the staff did not act in accordance with the Mental Capacity Act 2005. People were not consenting to their care and not all staff had knowledge of the Mental Capacity Act 2005.

People were not treated as though they mattered or made to feel at the centre of the service as they were not always receiving person-centred care. People did not always know which care worker would be visiting them or receive the care they expected because staff did not stay for the allocated time.

Peoples care plans were not person centred and lacked the detail required for staff to help ensure they provided care that met people’s needs, and care was not always planned and delivered to meet the nutrition and hydration needs of people..

The provider did not have effective systems in place to monitor the quality of the service they provided and the registered manager did not have good management oversight of the agency.

Staff had mixed views on whether the registered manager was supportive and complained about a lack of support from head office.

People were protected against the risks of potential abuse because staff knew how to identify potential abuse and report safeguarding concerns. The provider followed safe recruitment practices and had developed plans to help ensure that people’s care would not be interrupted in the event of an emergency, such as loss of utilities or severe weather.

People were supported by staff who had received induction training which included shadowing more experienced staff.

People had access to health care professionals and people and their relatives were involved in developing and reviewing their care plans. People told us their privacy and dignity was respected by staff.

People knew how to complain and the provider had a written complaints procedure. We have recommended that the way complaints are handled is improved.

During the inspection we found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also made two recommendations to the registered provider. You can see what action we told the provider to take at the back of the full version of the report.

The overall rating for this service is ‘Inadequate’ and the service has therefore be

We visited the offices of Agincare UK (Surrey) and spoke with the registered manager and three members of staff. Following the inspection we spoke by telephone with five staff members and with twelve people who used the service and two relatives.

Staff told us that they used different ways to gain people’s consent. Most people we spoke with told us that staff asked for consent before providing any care.

People told us that staff were “Very caring and polite”. Most people told us they were happy with the care they received. However, seven people told us that staff often arrived late and two people told us that they did not have access to care plans in their homes.

We spoke to staff who told us that they had received training in how to safeguard people they supported. People told us that they felt safe when staff were in their homes.

We looked at staff recruitment files and saw that, in most cases, appropriate checks had been made before staff were allowed to start work.

We saw that the provider had systems in place to monitor the quality of the service, such as quality surveys. However some people we spoke with did not remember being asked for their views. In addition some people told us that they would be reluctant to complain if they needed to.

Agincare UK (Surrey) is a domiciliary care agency providing personal care for people in their own homes. At the time of our visit the service supported 168 people. We spoke with 17 people who used the service and nine family members.

The service has a registered manager in place and they provided good leadership and support to the staff.  A registered manager is a person who has registered with CQC to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider. They were also involved in day to day monitoring of the standards of care and support that were provided to people that used the service. This ensured that people received care and support that met their needs, and enabled them to keep living in their own homes.

The people that we spoke with said they always got their visit from staff, but we did get varying feedback from people about staff not arriving when they were meant to. People also told us that staff could sometimes be late and they were not always contacted by the staff member or the office when this happened. This meant that people did not have their preferences and choices for support met by the service as not all staff arrived at the times they were needed. You can see what action we have asked the provider to take at the back of the full report.  

People told us that they were very happy with the care and the staff that supported them. However they did not always get the information they needed at the time it was needed. For example, a number of people told us they did not know who was coming to support them, as they did not always get their rota. This meant that people did not receive appropriate information in relation to their care. You can see what action we have asked the provider to take at the back of the full report.

The service had good systems in place to keep people safe. Assessments of the risk to people from a number of foreseeable hazards had been developed and reviewed. One person told us, “Yes I feel safe as staff wear a recognisable uniform, carry ID and are always polite. They make you feel comfortable and you feel they know what they are doing.”

People’s needs and choices had been clearly documented in their care plans. Where people’s needs changed the service acted quickly to ensure the person received the care and treatment they required. One person told us, “They notice if I am not well without me having to tell them and always ask if they can do anything to help, get the GP or whatever. Some even offer to pop back later to see if I am okay.”

People who used the service and their family members that we spoke with all agreed that the people were supported by kind and caring staff. Staff were able to tell us about the people they supported, for example their personal histories and their interests. A person told us, “They come in, chatter away to me which I love and they treat me as an individual and have a joke. They take an interest in me and my family but are respectful and professional.”

People told us they were involved in the planning and review of their care. Where people were unable to do this the service considered the person’s capacity under the Mental Capacity Act 2005. We saw records that showed where a person’s capacity to understand a decision may have changed the service had contacted the local authority to discuss having an assessment of that person. This was done to see if a best interest decision needed to be made for that person to keep them safe.