We carried out this inspection on 21 and 22 June 2018. This inspection was announced, which meant the registered manager was given 48 hours’ notice of our inspection visit. This was because the location provides a small domiciliary care service and we needed to be sure that someone would be available to meet with us.

We checked progress the registered provider had made following our inspection on 17, 18 and 19 October 2017 when we found they were in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Regulation 13, Safeguarding service users from abuse and improper treatment; Regulation 12, Safe care and treatment; Regulation 18, Staffing; Regulation 11, Need for consent; Regulation 9, Person-centred care; Regulation 17, Good governance; Regulation 16, Receiving and acting on complaints; Regulation 20A, Requirement as to display of performance assessments. We also found omissions in the reporting of incidents to CQC as required by regulations which was a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009. The overall rating for the service was ‘Inadequate’ and the service was placed in Special Measures.

Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that significant improvements had been made and it is no longer in breach of the regulations, rated as inadequate overall or in any of the five key questions. Therefore, this service is now out of Special Measures.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. At the time of this inspection Samfos Health was supporting eight people.

Not everyone using Samfos Health necessarily receives support with the 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.

There was a registered manager employed 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.

Staff understood what it meant to protect people from abuse. They told us they were confident any concerns they raised would be taken seriously by the registered manager.

Safe procedures were in place to make sure people received their medicines as prescribed.

There were enough staff available to ensure people’s care and support needs were met. The registered provider had effective recruitment procedures in place to make sure staff had the required skills and were of suitable character and background.

Staff were provided with an effective induction and relevant training to make sure they had the right skills and knowledge for their role. Staff were supported in their jobs through regular supervisions and an annual appraisal.

Staff understood the requirements of the Mental Capacity Act 2005. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The registered provider’s policies and systems supported this practice.

People were supported to access relevant health and social care professionals to ensure they were getting the care and support they needed to best meet their needs.

Positive and supportive relationships had been developed between people, their relatives, and staff. People told us they were treated with dignity and respect.

People’s care and support was planned and delivered in a way that ensured it met their needs and reflected th

We carried out this inspection on 17, 18 and 19 October 2017. This inspection was announced, which meant the provider was given 48 hours’ notice of our inspection visit. This was because the location provides a domiciliary care service and we needed to be sure that someone would be available to meet with us.

Samfos Health is a domiciliary care agency registered to provide personal care to people in their own homes. At the time of this inspection Samfos Health was supporting 46 people.

There was a registered manager employed 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.

Not all care staff we spoke with could remember receiving training in protecting vulnerable adults or children from abuse. There was no record of any member of staff undertaking this training. However, care staff were aware of what actions to take if they suspected someone was being abused.

Effective systems were not in place to ensure that people were supported to take their medicines safely.

Care records did not fully reflect whether a person had capacity to make decisions about their care and treatment. Care staff were not aware of the principles of the Mental Capacity Act 2005 (MCA). However, they were able to tell us about the importance of involving people in decision making.

People were supported to have maximum choice and control of their lives and staff did support them in the least restrictive way possible. However, the policies and systems in the service did not support this practice.

Staff did not receive regular supervision, annual appraisals, or appropriate training to support them to carry out their jobs effectively.

People’s care records were not person-centred and were not regularly reviewed. This meant the information as how to best support people to meet their needs was incomplete. There was no evidence that people’s personal preferences were taken into account when care records were reviewed.

Some of the care records we looked at included risk assessments, which identified any risks to the person’s health and wellbeing. However, there was no evidence of any of the risk assessments being updated following a review or change in the person’s needs. This meant the information regarding each risk may no longer be relevant to the person.

The service had an up to date complaints and compliments policy and procedure. However, some people told us they weren’t satisfied with the responses they had received when they had complained. Complaints were not investigated in a timely way. No records were kept of complaints.

The views of people and their relatives were not regularly obtained, and were not recorded.

The service had up to date policies and procedures which reflected current legislation and good practice guidance. However, some of these needed further development to include local guidance specific to the service. Care staff did not have access to the latest versions of the policies to keep their knowledge up to date.

There was no evidence of regular quality audits being undertaken to ensure safe practice and identify any improvements required.

Safe staff recruitment procedures were adhered to.

People were supported to eat and drink to maintain a balanced diet.

People were treated with dignity and respect and their privacy was protected. All the people and relatives we spoke with made positive comments about the care provided by staff.

During this inspection we found the service was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Regulation 13, Safeguarding service users from abuse and improper treatment; Regulation 12, Safe care and treatment; Regulation 18, Staffing; Regulation 11, Ne

Samfos Health is a domiciliary care agency registered to provide personal care for people living in their own homes. The also provide a staff agency service.

At the time of the inspection the service was supporting 8 people. Two people had just started using the service. We telephoned five of those people and were able to speak with four people to obtain their views of the support provided and one relative about their experience of the support their relative received from the agency.

At the time of this inspection the service employed staff who worked for the staff agency and/or the domiciliary care agency. We telephoned eight care workers and were able to speak with six of them to obtain their views and experience of working for this service. We also spoke with three members of staff on the office visit.

The provider was given short notice before our inspection that we would be visiting the service. We did this because the registered manager is sometimes out of the office and we needed to be sure that they would be available.

There was a manager at the service who was registered with CQC. 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 and associated Regulations about how the service is run.

The service was last inspected on 20 December 2013 and was meeting the requirements of the regulations we checked at that time. This was the first rated inspection of the service.

People received care from the same group of care workers and were introduced to any new staff who would be supporting them. People felt comfortable with their care workers and it was evident that a trusting relationship had developed. People and a person’s relative told us care workers turned up on time and stayed the full amount of time.

We saw there were sufficient staff to provide regular care workers to people using the service.

People had risk assessments in place, which were designed to ensure that potential risks to people were managed and minimised whilst still promoting independence. We saw the process in place to ensure that some people’s risk assessments were reviewed at regular intervals could be improved.

Systems were in place to manage people’s medicines.

Recruitment procedures were in place but we saw the organisation of staff files would benefit from being improved.

We found the service had relied on training that some staff had completed prior to working for the service. The registered manager told us staff were assessed whilst they were observing and shadowing staff but this was not documented. It is important that providers provide training for staff to ensure they have the right knowledge and skills needed to carry out their role, so that people receive effective care. The registered manager provided us with a copy of the services new training matrix which included a schedule of training to be delivered at the service.

Although staff told us they felt supported by the registered manager and care co-ordinator, we saw staff did not receive regular supervisions or an annual appraisal.

Staff told us they enjoyed caring for people using the service. Staff were able to describe people’s individual needs, likes and dislikes.

The provider had a complaint’s process in place. We found the service had a robust process in place to enable them to respond to people and/or their representative’s concerns, investigate them and take action to address their concerns.

People were supported with their health and dietary needs, where this was part of their plan of care.

There were quality assurance systems in place to monitor the quality of the service provided but we saw these systems could be operated more effectively.

People and relatives spoken with knew who the registered manag

This is a small agency. People who used the service understood the care and treatment choices available to them. This was because the provider involved people in the decisions about their care and support.

People’s needs were assessed. Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. People’s care needs were followed up by risk assessments to make sure the plan of care minimised the risk to people.

The care co-ordinator said they had plans in place to cope with severe weather so that people would continue to receive service.

People who received care were very positive about the way care workers maintained cleanliness and controlled the spread of infection. They said the care workers always look clean and washed their hands before and after helping them.

People who spoke with us said they found the staff who worked for the agency, respectful, reliable and knowledgeable.

The agency recruitment and selection processes were followed by the provider when recruiting staff. We found appropriate checks were undertaken before employing staff to work for the agency.

The manager said they had not received any complaints. However in the event of receiving complaints the manager said they would fully investigated and resolved, where possible, to the complainant’s satisfaction.