Care4U - Surrey is domiciliary care agency supporting older adults and people living with dementia. Not everyone using Care4U - Surrey receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the point of our inspection there were 13 people supported by the service who were receiving a regulated activity.

The service had 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.

The inspection took place on 7 November 2018 and was announced.

Risks to people were not identified and recorded. There was no monitoring or analysis of accidents and incidents that had taken place to identify trends and reduce further risk. Although staff felt they knew people’s needs, care plans were not person-centred and did not include any detail around people’s end of life wishes. People were not always referred to healthcare professionals when needed.

People and their possessions were not always treated with kindness, respect or dignity. We received varied feedback from people and relatives about staff. We were told a person and two relatives that staff had been verbally abusive towards them. The registered manager had not informed us and the local authority of this. We have now informed the local authority.

Appropriate checks were not in place to ensure that staff were suitable to work at the service. Following the inspection, we asked the registered manager for additional information so we could check that staff had satisfactory Disclosure Barring Service (DBS) checks completed. We have still not received this information.

Rotas were not available for staff to view and there was no call monitoring system in place. This left people at risk of missing care calls. Following the inspection, the registered manager sent us a rota for five days worth of calls that showed not all staff had travelling time in between calls. This meant that staff would be late arriving to care calls.

Staff members were not up to date with mandatory training. They had also not completed training around preventing pressure ulcers even though they cared for people with pressure wounds. Staff received regular supervision.

Communication between staff was not always effective. Staff members could not identify who had management oversight of the service due the registered manager’s absence. People told us that there was not always a care file in their home for the staff to be able to communicate with each other, and they were not always informed if staff were running late.

The service had not notified the Commission of all reportable incidents. This included people missing care calls and staff being verbally abusive towards people. Safeguarding procedures were not followed and appropriate referrals were not made to local authority.

Although people, some relatives and staff felt the registered manager was approachable, there was a lack of management oversight. The service did not have quality assurance systems in place. Only one audit had been completed since the service had started operating. The issues found in this audit had not been resolved.

There was a lack of evidence that pre-assessments had been completed. The registered manager told us they had thrown them out as he thought they were no longer needed. People gave varied feedback on whether they were involved in their care planning or not.

There were gaps in Medicine Administration Records (MARs) and additional handwritten entries on to MARs had not been double signed by staff to ensure their accuracy. There was no