This inspection took place on 31 May and 1 June, 2018 and was announced.

Surecare Cheshire East is a large domiciliary care agency. It provides care to people living in their own houses and flats in the community. It provides a service to older adults. At the time of the inspection the registered provider was providing support to 117 people.

Not everyone being supported by Surecare Cheshire East received personal care. The Care Quality Commission (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.

There was a registered manager in post at the time of the inspection. A ‘registered manager’ is a person who has registered with 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.

At the last inspection which took place in January, 2017 we identified a breach of Regulations 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Regulation 18 Care Quality Commission (Registration) Regulation 2009. The registered provider was awarded an overall rating of ‘Requires Improvement’. Following the inspection we asked the registered provider to complete an action plan to tell us what changes they would make and by when. An action plan was submitted and during this inspection, we looked to see if the registered provider had made the necessary improvements.

At the last inspection we found that local governance systems were ineffective. The systems which were in place did not effectively monitor and assess the quality and standard of care people received. During this inspection we looked at the governance systems, audits and checks which were in place and found that improvements had been made. The registered provider was no longer in breach of regulation in relation to ‘Good Governance’ although further developments could be made to the area of quality assurance.

We have recommended that the registered provider reviews some of the quality assurance systems to further to improve the quality and standard of care being provided.

At the last inspection we found that the registered provider had not notified CQC of incidents that had happened in accordance with their regulatory responsibilities. During this inspection, the registered provider demonstrated their knowledge and understanding of the notification process and the different notifications they should be submitting. The registered provider was no longer in breach of this regulation regarding ‘notification of other incidents’.

People and relatives told us that the standard and quality of care provided was safe. Risk assessments contained the most relevant and up to date information and staff were knowledgeable in the area of safeguarding and whistleblowing procedures; they knew how to report any concerns and who to report their concerns to.

We found that there was sufficient numbers of staff on duty to meet the needs of people who were receiving personal care. We received positive feedback from people, relatives and staff about the staffing levels, how staffing levels were managed and how people generally received care from consistent and regular carers.

The registered provider’s recruitment processes were reviewed. Staff records were organised and contained the necessary information required. The records we looked at had suitable references, previous employment history and disclosure and barring system checks (DBS) in place. DBS checks ensure that staff who are employed are suitable to work within a health and social care setting. This enables the registered manager to make informed decisions about the suitability of applicants with regards to working with vulnerable adults.

Medication ma

We completed an announced inspection Surecare Cheshire East on 25 January 2017 and 30 January 2017. This was the first ratings inspection carried out at the service.

Surecare Cheshire East are registered to provide personal care. People are supported with their personal care needs to enable them to live in their own homes and promote their independence. At the time of the inspection the service supported 165 people in their own homes.

There was a registered manager at the service. 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 identified two Regulatory Breaches. You can see what action we told the provider to take at the back of the full version of the report.

The provider did not have effective systems in place to consistently assess, monitor and improve the quality of care provided to people. Care records did not always contain an accurate account of people’s individual needs and preferences.

The registered manager was not fully aware of their responsibilities to inform us (CQC) of any notifiable incidents that had occurred at the service.

We found that improvements were needed to ensure that topical medicines were managed safely.

The provider had not completed mental capacity assessments to ensure that where people were unable to give their consent, decisions were made in line with the Mental Capacity Act 2005 (MCA). Staff did not fully understand the requirements of the MCA. This meant that the provider had not considered if decisions were made in people's best interests if they were unable to do this for themselves.

Improvements were needed to ensure that staff had understood training provided to enable them to carry out their role effectively.

People felt safe when they were supported and staff had a good understanding of people’s risks, although records we viewed did not always provide details of people’s risks

There were enough suitably qualified staff available to keep people safe and the provider had effective recruitment procedures in place.

People were supported to eat and drink sufficient amounts in line with their assessed needs.

People were supported to access other health professionals to maintain their health and wellbeing.

People were supported in a caring and compassionate way that protected their privacy and dignity. Choices in care were promoted by staff and people’s choices were listened to and acted on.

People and relatives were involved in the planning of their care. Staff knew people well and people told us they received care that met their preferences.

The provider had a complaints policy available and people knew how to complain and who they needed to complain to.

People and staff the registered manager was approachable. Staff were supported to carry out their role and the registered manager carried out checks on staff performance.

We spoke with a range of people about the agency. They included the owner, manager, staff, relatives and people who received a service. We also had responses from external agencies including social services. This helped us to gain a balanced overview of what people experienced using the agency.

During the inspection we looked at care planning, staff training and supervision records.

People who used the agency told us they provided a good service. Comments included, “This is the best agency we have had.”

People told us they had received a visit from the manager of the agency before the service commenced. This was to introduce themselves and carry out an initial assessment. They told us their needs had been discussed and they had agreed with the support to be provided. One relative spoken with said, “They continually provide a high level of service for my husband.”

We found that there were enough skilled and experienced staff so that people had their care delivered at the right time, usually by the same people and in ways they wanted. One person who used the service said, “They do try and keep to the same carers which is good.” Also, “The staff are so professional and competent.”

We spoke with Cheshire East council's contracts monitoring team, they confirmed there were no concerns with the service being provided by the agency.

There were a range of audits and systems in place to monitor the quality of the service being provided

We completed an unannounced inspection on 09 July 2012 at Cheshire East Homecare Limited, which is part of the Surecare Cheshire East provider group.

We met with three people who used the service in their own homes. We also spoke with four family members of people who used the service. As part of our inspection, we reviewed the records held in the branch office in Macclesfield and in people's homes.

People who used the service and their family members all told us that they were happy with the care and support provided by the staff.

There had been no complaints received by the service and people who used the service told us that they were confident the manager would appropriately address any issues they had.

Comments from people who used the service included: "The staff are genuinely lovely people, all of them act in a professional way."

"The staff are very kind and do all they can in the short time they are here to make me comfortable. They are respectful and friendly and I am treated with dignity."

"I've not needed to comment on anything really, but if I did I'd tell the carer directly and let them tell the manager, or I would ring to speak to the manager at the office." They also told us: "I have my regular carer's who know me very well. I'd like continuity of staff, except in an emergency, you'd expect there to be a hiccup then."

We spoke with four family members of people who used the service. One told us: "The staff discussed the care they could provide with my relative and how often, and my relative made her own decision about how much support she needed to have and it seems to work very well."

Other comments from family members included:

"The staff are kind and caring, I have no concerns about the staff they are respectful of my relatives’ privacy and dignity."

"We have used other home care services and find this service to be five star."