About the service:

S & M Healthcare is a domiciliary care agency which provides personal care and support to people in their own homes. At the time of our inspection the service was providing personal care to 28 people.

People’s experience of using this service:

At our last inspection we identified a breach of regulation relating to recruitment practices which were not robust and placed people at risk. At this inspection we found improvements in recruitment practices but identified other areas of the service which required some improvement.

Systems did not alert the registered manager quickly when calls were missed. This meant some people had gone without their care visits. Although people told us that there had been missed calls, it was acknowledged that things had improved in recent weeks. People's experience was mixed. One person who used the service commented, "They get somebody in an emergency. Not always the best somebody, but somebody...I think if I were to rate them I don't think they'd be outstanding but they're pretty good."

The registered manager carried out person centred assessments of people’s needs and preferences. However, sometimes the information from these assessments was not placed promptly in people’s homes so that staff could refer to it. Some aspects of the care plans for people with complex health conditions needed more detail to help staff provide safe care. The registered manager regularly reviewed care plans but did not always update care plans with people’s changing needs promptly. Staff were not always clear about people’s needs as a result.

Staff were trained to give people their medicines but we found some errors with the medication administration records. Staff received a structured induction and other training to help them carry out their roles. Some important training had not been given to staff which could have placed people at risk.

Informal support from the manager was very good, although structured, regular support was not in place for all staff. The registered manager was addressing this by developing the role of one member of staff to help carry out spot checks and supervisions to monitor the quality of the service.

People were very positive about the kindness and caring nature of the staff, with some being singled out for particular praise.

The provider regularly asked for feedback from the people who used the service and addressed people’s informal concerns well. Formal complaints were responded to in a timely manner and to people’s satisfaction.

Staff understood their responsibilities with regard to keeping people safe from abuse and knew how to raise concerns if they needed to.

People, or their relatives consented to their care and were able to express their preferences with regard to how their care was delivered. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice

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

Rating at last inspection:

At the last comprehensive inspection the service was rated Good (report published 21 April 2016). This inspection was followed by a focused inspection which rated the key question of Safe as Requires Improvement and the key question of Well-Led as Good. This report was published on 5 October 2017 but did not change the overall rating of Good. At this inspection we found the overall rating to change to Requires Improvement overall and now the four key questions of Safe, Effective, Responsive and Well-Led have all been individually rated as Requires Improvement.

Why we inspected:

This inspection was carried out as part of our regulatory schedule. The inspection was brought forward due to an increase in the number of concerns about missed calls and staffing levels.

Please see the action we have told the provider to take section towards the end

We carried out an announced comprehensive inspection of this service in March 2016. After that inspection we received concerns in relation to the provider’s recruitment and induction practices of staff. As a result, we undertook a focused inspection on 1 August 2017 to look into those concerns. We visited the provider’s office on this date.

During our conversations with staff after this initial visit, some raised concerns about staffing levels. Therefore we decided to gain feedback from people and relatives via the telephone on 7 August 2017 about staffing levels at the service.

This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for S&M Healthcare Ltd on our website at www.cqc.org.uk.

S & M Healthcare Ltd is a service that provides care to people in their own homes. At the time of the inspection, 26 people were receiving care that is regulated by the Care Quality Commission.

There was a registered manager working 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.

We found one breach of legal requirements during this inspection. This was due to the provider not having robust systems and processes in place to ensure that staff were of good character and competent before allowing them to provide support to people in their own homes. You can see what action we told the provider to take at the back of the full version of the report.

We have also judged that improvements were required in relation to staffing levels to ensure there are consistently enough staff to cover all of the required care visits and to meet people’s needs.

The inspection took place on 11 and 14 March 2016 and was announced.

S & M Healthcare provides care and support to people living in their own homes. At the time of our inspection, 14 people were receiving the service.

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.

People experienced a service that was safe. There were rare staff related emergencies leading to occasional missed calls but priority was given to those people who were most in need of support. Staff and the management team understood their obligations to report any concerns where someone may be at risk of abuse or harm. Staff also understood the risks to which people were exposed and how they needed to support them safely.

Where staff were involved in assisting to manage people's medicines, they did so safely.

The service people received was effective. Although most staff had not been trained in the Mental Capacity Act 2005, to understand how to support people who could not make decisions for themselves, they understood their responsibilities in this area. They ensured they sought consent and took into account people's best interests.

Staff had a clear understanding of their roles and people’s needs. They had access to support from the management team when they needed it. They were alert to changes in people's well-being or health and worked with relatives to ensure people's health and welfare was promoted. This included supporting people to eat and drink enough to maintain good health, if this was required.

People experienced a service that was caring. Although there were sometimes unavoidable changes, meaning that staffing could not always be consistent, people received support from staff who were respectful of their privacy and dignity.

Staff understood people's needs and preferences. Where people's needs changed, staff recognised the importance of informing the manager so that care plans could be reviewed if necessary. However, people and their representatives were not all confident that the agency would act robustly in response to their concerns.

Systems for monitoring the quality and safety of the service took into account the views of people using the agency. The manager was aware of their legal obligations for running the agency and took into account developments in the care sector which could help to improve the service.

S & M Healthcare was registered in March 2013 and is therefore a newly established organisation. We saw that full consultation and assessment had been completed prior to any support being provided to the one client currently on their register. The person receiving support had been fully consulted and their choices had been recorded. Choices had been monitored to recognise that the person may change these choices once support was being delivered. This was confirmed during our discussions with other professionals who provided support.

We looked at the one care plan that had been developed by the provider. This evidenced a thorough assessment of needs and detailed how to provide the chosen support. The choices of the person receiving support were continuously monitored to ensure the appropriate member of staff was allocated. This showed us that the provider had put the needs of the individual at the centre of the care plan and supported dignity and independence. This was confirmed through our discussions with the person receiving support who told us that they felt there was nothing more the provider could be doing to meet their needs. Care was planned and delivered in a way that was intended to ensure people's safety and welfare.

There were policies and procedures in place to ensure staff knew how to recognise and report any safeguarding issues. We saw evidence of appropriate actions that had been taken when unacceptable behaviour by another agency had been reported. Policies and procedures were in place to support all areas of care that was delivered and to ensure the actions of all staff protected the safety and wellbeing of people.

We saw records that showed us that appropriate recruitment practices were in place with regard to the employment of any new members of staff. The provider had an effective staff recruitment process in place to be certain that people received support and safe care from suitable, skilled, and knowledgeable staff.