About the service:

Sarah Care Limited 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 the service was supporting approximately 125 people with personal care.

People’s experience of using this service:

• People told us they felt safe receiving care from Sarah Care Limited. People were supported to raise any concerns and they told us the service responded promptly to resolve any issues. Staff were trained in their responsibilities for safeguarding adults from abuse. This supported people to stay safe.

• Staff were trained in safe medicines administration. They administered people’s medicines in a safe way. However, we identified that improvements were required to the records maintained by the service in respect of medicines management, particularly when staff were prompting people with their medicines. Staff did not always record prompts given with individual medicines and the service did not always gather information about the medicines people were taking when staff prompted with medicines. This was a breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014; good governance.

• Risks to people receiving care where assessed, however some improvements were needed in this area to ensure all risks were adequately assessed and all necessary risk reduction measures were recorded.

• People told us they usually received care from a small number of regular care workers who knew them well. They told us staff usually turned up on time, stayed for the correct length of time and provided them with all the support they needed in accordance with their preferences.

• Staff were kind and caring and were keen to deliver a person-centred service. People told us they felt well-treated and staff were respectful towards them.

• 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. People's consent was obtained before care was delivered. Where people were unable to consent to their care due to a lack of capacity, relevant people were consulted about their care in accordance with the Mental Capacity Act 2005. We have made a recommendation about the service obtaining copies of Lasting Powers of Attorney granted by people using the service.

• People were supported to make decisions about their care and were involved in regular reviews to make sure it continued to meet their needs.

• Feedback was regularly obtained from people using the service, their relatives and staff via various methods. It was used to improve the service and to improve people’s experience of receiving care.

• Staff received a wide range of training which supported them to undertake their roles effectively. Staff told us they were very well supported by the registered managers and they felt the service was well-managed.

• We found there was an open, welcoming, positive culture within the service. Staff all enjoyed their jobs and the staff team communicated well and worked effectively together. People using the service told us the communication they had with the service was very good and the service was efficiently run.

• The service worked well with other organisations and this supported them to deliver effective care to people. We received positive feedback about the service from one of their commissioners prior to this inspection.

• Senior staff and the registered managers completed a range of checks on the service to monitor the quality and safety of the care provided. We found some improvements were needed to the quality assurance system to ensure it adequately identified the issues we found in the assessment of risk and recording of medicines support.

• More information is in the full report.

Rating at last inspection:

At the last inspection the service was rated good (pu

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.

Our inspection was discussed and arranged with the registered manager two days in advance. This was to ensure we had time to visit and contact people who used the service and speak with the registered manager and staff.

People who used the service, their relatives, staff and other interested parties spoke positively about Sarah Care. Their comments included, “Everything’s good, no problems,” “We couldn’t ask for better” and “So pleased we have this service.”

People who used the service said they felt safe whilst receiving support and care from their care workers. People looked forward to when their care worker was visiting and told us, “They are like my own family.”

Where people needed help and assistance to administer their medicines this was provided in a safe way. All staff were trained in how to administer medicines safely and people told us they always received their medicines at the appropriate times.

The service followed the requirements of the Mental Capacity Act 2005 (MCA) Code of practice and the principles of the Deprivation of Liberty Safeguards (DoLS). This helped to protect the rights of people who may not be able to make important decisions themselves.

There were enough staff employed to make sure all visits were carried out at the agreed time. The registered manager made sure full employment checks were completed for all staff before they were offered a position at the service.

Staff felt well supported by the registered manager and senior staff. They said they had regular meetings with their line manager’s where they were given the opportunity to discuss their work and talk about how they could improve the quality of the service.

People said they had their own regular care worker’s who knew them well and cared for them as agreed in their care plans. Each person’s care plan was updated regularly and changes made where necessary.

People told us they could talk to any of the staff at Sarah Care. They said if they had any concerns or worries they were confident staff would listen to them and look at ways of resolving their issues.

There were effective systems in place to audit, monitor and improve the quality of the service provided. Regular checks were undertaken to make sure safe procedures were adhered to. People who used the service, their relatives, staff and other interested parties had been asked their opinion via surveys. The results of these surveys identified any areas for improvement and feedback was given about any actions taken as a result of listening to people.

Our inspection was discussed and arranged two days in advance. This was to ensure we had time to speak with staff and contact people who used the service.

There were approximately 157 people who used the service at the time of the inspection. We spoke over the telephone with 20 people who used the service and with five relatives of people who used the service. We also spoke with five staff and the registered provider/manager in person.

We saw information to demonstrate how arrangements to seek people’s consent to care or treatment had been agreed. People had care records which included up to date information about how they wanted their care and support provided, and they understood the care and treatment choices available to them. One person said, “They [staff] are friendly and professional. They make sure things are right for me.”

People received safe and appropriate care because their needs were assessed before care was delivered. This ensured the provider could meet people's individual needs.

We saw records to confirm medicines were managed safely and effectively.

We found there was an effective recruitment procedure in place and relevant checks were carried out when staff were employed.

We saw that the service had provided people with information about how to complain. People who used the service told us their comments and complaints were listened to and acted upon.

We carried out a routine/scheduled inspection of this service. We visited the office and spoke to the registered manager and other senior staff. Care workers also came to the office to meet with us. From the office we contacted people that received a service from this agency and also spoke to some relatives of people that received a service. We asked people about their experiences of the support they receive from the service.

We spoke with five people who received a service from this agency over the telephone. Everyone spoke positively about their care workers and felt that they fully supported their care needs. Without exception, people said that all their care workers spoke with them in a in a calm and respectful way.

All five people we spoke with told us that their care was personalised to their needs. In all cases, people were happy with their care workers and said that the care workers adapted very well when changes were made to the care they required.

We spoke with two relatives of people that received care. They confirmed they had been involved in discussing and reviewing the care of their loved one with a supervisor from the agency. People receiving care said they were also involved in making decisions about their support needs. One person said, "I have a care plan that states exactly what my wishes and needs are and it's regularly updated every six months"

People and their relatives felt that staff were well trained and understood their needs. One person told us "My care workers does everything just as I like it, she even folds my towels the way I like them folding."

People told us that they felt safe, and if they had concerns they would speak with a family member, friend or somebody from the office.