About the service: Caterham Domiciliary Care Agency provides personal care and support to people living in their own homes and to 15 people living in four properties owned by the provider. Services are provided to older people, people with mental health issues, physical and learning disabilities and sensory impairment. At the time of the inspection 61 people were receiving care in their own homes.

People’s experience of using this service:

Staff were not always ensuring that the risks to people were assessed. Care plans did not always have guidance on how to reduce the risks to people. The management of medicines was not always undertaken in a safe way and there was no evidence that staff were competently assessed in relation to medicines administration. There was no formal recording of accidents and incidents and no evidence that they were being analysed for trends.

People’s rights were not always being protected as staff were not working within the principles of MCA. Staff required more detailed training and supervisions to ensure that they were providing the most appropriate care.

People and their representatives were not always informed of the choices around the care delivery. There was not always detailed guidance for staff around the specific needs of people. Daily notes were task focused and did not provide detail on the person’s care. Quality assurance systems were not robust and the provider and registered manager lacked understanding of the requirements of the regulations.

People and their relatives were complimentary about the caring nature of staff. People were supported to access health care when they needed. Staff always turned up to the call and stayed for the duration of the call. People said that staff treated them with dignity and respect. Staff said they felt supported and valued by the management team. People fed back positively about the leadership of the service.

Rating at last inspection: Good. The last report was published on the 12 August 2016.

Why we inspected: This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Enforcement: Action we told provider to take (refer to end of full report)

Follow up: We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned for future dates.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Caterham Domiciliary Care Agency provides personal care and support to 28 people living in their own homes and up to 24 people living in six properties owned by the provider, only two of these people received the regulated activity of personal care. Services are provided to older people, people with mental health issues, physical and learning disabilities and sensory impairment.

The inspection took place on 29 and 30 June 2016. The provider was given twenty-four hours’ notice of the first inspection day.

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.

Staff had a positive and caring attitude about their jobs. People told us that they were happy with the care and support they received. When asked about the service one person said it was, “First class, I am well looked after.” Another person said, “The service is everything I expected it to be, everything I need they do.” All the staff we spoke with were extremely happy in their work and proud of the job they do.

People received a safe service from the Caterham Domiciliary Care Agency. There were sufficient numbers of staff who were appropriately trained to meet the needs of the people who used the service. Risks of harm to people had been identified and clear plans and guidelines were in place to minimise these risks, without restricting people’s freedom. Staff understood their duty should they suspect abuse was taking place, including the agencies that needed to be notified, such as the local authority safeguarding board or the police.

People received their medicines when they needed them. Staff managed the medicines in a safe way and were trained in the safe administration of medicines.

Staff recruitment procedures were robust to ensure staff were suitable to support people. The provider had carried out appropriate recruitment checks before staff commenced employment. Staff received regular support in the form of annual appraisals and formal supervision to ensure they gave a good standard of safe care and support. Staff received a comprehensive induction and ongoing training, tailored to the needs of the people they supported.

Where people did not have the capacity to understand or consent to a decision the provider had followed the requirements of the Mental Capacity Act (2005). An appropriate assessment of people’s ability to make decisions for themselves had been completed. Staff were heard to ask people for their permission before they provided care.

People were supported to have enough to eat and drink. They received support from staff where a need had been identified. People’s dietary support needs were recorded and met by the staff.

People were supported to maintain good health. When people’s health deteriorated staff responded quickly and made sure they received appropriate treatment.

The staff were kind and caring and treated people with dignity and respect. Good interactions were seen throughout our inspection. When people visited the office staff talked with them and showing interest in what they were doing. When we visited a supported living home, the same positive interactions were seen. The staff knew the people they cared for as individuals, and had a good rapport with relatives, giving a family feel to the service.

People received the care and support as detailed in their care plans. Care plans were based around the individual preferences of people as well as their medical, psychological and emotional needs. They gave a good level of detail for staff to reference if they needed to know what support was required.

People knew how to make a complaint. When complaints had been received these had been dealt with quickly a

We carried out this inspection to check whether the provider had taken action to address the concerns we identified at our last inspection of the service in November 2013.

At our last inspection we found that people who used the service had not been involved in the development of their care plans and that the provider had not assessed whether people had the mental capacity to make decisions for themselves. There was no evidence that the provider had not developed contingency plans to ensure that people would continue to receive care in the event of an emergency. We found that the provider not obtained appropriate references for all staff employed. We also found that, although the provider had distributed satisfaction surveys to people, there was no system in place to collate the results of the surveys, record the action taken as a result and to feed back to people who used the service.

At this inspection we found that the provider had increased the involvement of people in the development of their care plans and had introduced mental capacity assessments. The provider was able to demonstrate that appropriate references had been obtained for all staff and that contingency plans for use in an emergency had been developed.

Almost all the people who used the homecare service and their relatives provided positive feedback about the service they received from the agency. They said that they received their care from regular care workers, which was important to them, and that their care workers almost always arrived on time. People gave positive feedback about the care workers who provided their support. One person said of their care worker, “She looks after me very well. I’m very lucky to have her.” Relatives also spoke highly of the homecare service. One relative told us, “The care has been fantastic. I’d recommend them to anyone” and another said, “I’m confident in the staff. They’re very proficient in what they do and they listen to the client, which is the most important thing.” One relative told us that they had raised a concern with the provider about their family member’s care. The relative said that they were dissatisfied with the provider’s initial response but that the service was now “improving.”

People who lived in properties owned by the provider told us that they felt safe and secure where they lived. They said that they knew and liked the care workers who supported them. One person told us, “I feel settled here” and another said, “I’m happy, I’ve got nothing to complain about.”

We checked a sample of care records in each of the properties owned by the provider and found that each person had an individual care plan. However we found that some people’s care records did not contain all the information required to ensure that people received safe and appropriate care. We also found that some care staff were not aware of the content of people’s care plans, which meant that people were potentially at risk of receiving inappropriate care because staff were unaware of how people needed and preferred their care to be provided.

We found that there were systems in place to obtain the views of people who used the service. However we found that the provider had not developed a system to assess and monitor the quality of service that people received. This meant that the provider could not assure themselves that key aspects of the service were functioning effectively and that people who used the service were receiving the care and support they required.

At the time of this inspection Caterham Domiciliary Care Agency was providing an active service to 41 people.

We spoke with the provider, registered manager, assistant manager, administrative staff , five care staff, three relatives of people who used the service and seven people who received care from the service.

People we spoke with all made very positive comments about the staff and care they provided and said the staff were caring and treated them well. People also said that they were usually supported on time and by staff familiar to them. They had no complaints but knew how to make one if they needed to.

One relative of a person who used the service told us they had tried other agencies before and they had cut time short, but this one never does. They said the staff never made their relative feel rushed and would even stay longer if there is a need.

All of the relatives and people receiving a service we spoke to told us they had received quality questionnaires but had not yet seen any feedback from the agency as to what quality issues had arisen from the questionnaires and what the organisation was going to do about them to improve quality.

Staff told us that travelling time between visits, being able to stay longer if needed, reliable company cars being provided for staff, as well as the way staff felt highly supported, all contributed to timekeeping, meeting call times and general reliability of visits.

We found that before people received any care or treatment they were asked for their consent but where people did not have capacity the provider did not act in accordance within legal requirements.

We saw people experienced care, treatment and support that met their needs and protected their rights but there were no written procedures in place to plan for any foreseeable emergencies. This meant that if an emergency situation did occur there would be no procedures known to staff to mitigate the risks that may arise and facilitate continuation of safe appropriate care.

We noted that people who used the service were not cared for and supported by staff who had appropriate checks undertaken before they began work, to ensure they were suitable to work with the people the service supports.

We found that although the health and safety of people was reviewed and audited, there was no quality assurance system in place to record the findings of quality questionnaires, analyse the results, identify and record action to improve quality and feed back to the people who use the service, and the provider did not always protect people as they did not complete follow up action required following disciplinary hearings.

We found that people had their rights to make decisions about their care and treatment upheld, even when these were unwise decisions. Where people lacked capacity to make decisions their legal rights were protected.

The people we spoke with said they received the care and support they needed in a timely way. One person said, “I get the care and support I need when I need it." They said they were supported with their health care needs (where appropriate) by staff.

The people we spoke with had some support to make sure they took their medication on time and as their doctor prescribed. They were happy with this arrangement and said their medicines were given out safely. One person said, “I have tablets which the staff look after for me. They bring them to me when I need them and a glass of water. The staff make sure I have taken them.”

We found staff were recruited safely and people were protected against staff who were not suitable to work with them.

Complaints were recorded and thoroughly investigated to make sure people were safe and protected. People had confidence concerns would be responded to. One relative said, “The staff are all very nice, I have never been worried. They care for (my relative) so well. If I complained I know they would sort it out, but I don’t need to (my relative) is looked after so well.”

People who use the service and their families were full of praise for the agency. They said they were supported to be as independent as was practicable. Some said they were supported to do things, such as attending sporting events that they would not have been able to do had they continued to live with their families. This was particularly so, where the individual had parents who were elderly.

A number of people, including some care managers commented that the Registered Manager and the Registered Provider, a husband and wife team were very ‘homely people’ and ‘were like parents’.

Care managers commented the agency provides ‘more support than others’ and that staff ‘keep trying to encourage… (individuals in supported living) … even when some of them are difficult to motivate’.