Greenway Homecare (Surrey) Limited is a domiciliary care agency which provides personal care and support to people in their own homes. At the time of our visit the service supported 32 people with personal care in the Surrey areas including Redhill, Horley, Caterham, Oxted and Godstone.

The inspection took place on 18 July 2018 and was announced.

There was a registered manager in post at the time of our inspection. 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 last inspected this service in November 2016 when we rated the service as Requires Improvement. There were two breaches of Regulations - Regulation 12 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were due to risk assessments not being updated to meet the changing needs of people using the service and no staff supervisions being completed. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions to at least good. We used this inspection to check whether or not the provider had made the necessary improvements. At this inspection we found the service still had further work to do in order to meet a rating of Good.

The service did not record and monitor any accidents or incidents for patterns or trends. There was no business continuity plan in place for people in case of an emergency or disaster. Shortfalls were identified in the management of medicines as best practice guidance was not always followed. We also found there was no call monitoring system in place.

Staff and management had received training on Mental Capacity Act 2005 (MCA) but were found to have limited understanding of the principles of the MCA. Consent to care and treatment was always sought by staff.

There was a lack of robust quality assurance. Although the provider had auditing systems in place to monitor the quality and safety of the service, these were not always used effectively to scrutinise records or identify where improvements were needed.

Staff managed risks to people’s safely. Where incidents had occurred, the staff took appropriate action to keep people safe. Staff understood how to identify and respond to suspected abuse. Staff took appropriate measures to stop the spread of infection during their care. Robust checks and references were completed before any staff were employed by the service.

Staff treated people in a caring, considerate and respectful way. People told us that they felt staff were kind towards them. People's choices were considered in the delivery of care.

People were supported to prepare and eat food that they liked in line with their dietary requirements. Staff had sufficient training and supervision to carry out their roles. People's needs and choices were assessed and people were involved in important decisions and choices. Staff worked alongside healthcare professionals and other organisations to meet people's needs.

People's histories and care needs were included in their care plans which helped staff provide responsive care. There were sufficient numbers of staff to support people. People received personalised care that reflected their needs, interests and preferences. People had access to activities that reflected what was important to them. Regular reviews were undertaken and any changes to people's needs were actioned by staff. Staff communicated any changes in care with each other. The provider had a clear and accessible complaints procedure.

The registered manager worked alongside staff and was actively involved in people's care. No one was receiving end of life care at the time of our inspection. Systems were in place to invo

This inspection took place on 8 November and 10 November 2016 and was announced. The provider was given 24 hours’ notice because we wanted to be sure there would be someone at the office when we called. We told the registered manager we would return on the second day. This was their first inspection since the provider registered with the Care Quality Commission in January 2014.

Greenway Homecare (Surrey) Limited is a domiciliary care agency which provides personal care and support to people in their own homes. At the time of our visit the service supported 32 people with personal care in the Surrey areas including Redhill, Horley, Caterham, Oxted and Godstone.

There was a registered manager in post at the time of our inspection. 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 no effective system in place for staff to receive a comprehensive induction and training programme to support them in their role. There were acknowledged gaps in supervision and no end of year appraisal in place for staff.

Risk assessments were in place to identify the areas of risk and to reduce the likelihood of people coming to harm, with guidance for care workers on how to carry out care tasks. However they were not always updated.

Robust staff recruitment procedures were not always followed to minimise the risk of unsuitable staff being employed.

People were supported with their medicines and staff knew what to do if they had any concerns. However people’s medicines were not always recorded appropriately and training was not reviewed on a regular basis to ensure that staff remained competent to carry out this task.

Staff had a good understanding of how to recognise and report any signs of abuse and protect people from harm however safeguarding training was not refreshed on a regular basis to ensure that their knowledge was up to date.

Staff understood the principles of the Mental Capacity Act 2005 (MCA). Care workers respected people’s decisions and gained people’s consent before they provided any care and support. However, the provider did not have any specific training on the MCA for staff to keep their knowledge up to date.

There were sufficient staff to meet people’s needs and packages of care were declined if needs could not be met. The management team also carried out personal care visits to people and were available to cover shifts in an emergency or if care workers needed more support.

Care workers were aware of people’s dietary needs and food preferences. Care workers told us they notified the registered manager or the management team if they had any concerns about people’s health. We also saw people were supported to maintain their health and well-being through access to health and social care professionals, such as GPs, district nurses and social services.

People and their relatives told us care workers were kind and caring and knew how to provide the care and support they required. Care workers understood the importance of getting to know the people they supported and showed concerns for people’s health and welfare.

Staff respected people’s privacy and dignity, respected their wishes and promoted their independence. People and their relatives were actively encouraged to express their views during assessments and reviews and were involved in making decisions about their care and whether any changes could be made to it.

People and their relatives knew how to make a complaint and were able to share their views and opinions about the service they received. There was an annual questionnaire in place to allow people and their relatives the opportunity to feedback about the care and treatment they received.

The service was fa