This inspection took place on 6 April 2018 and was announced. We gave the service 48 hours’ notice of the inspection visit because it is a small service and the registered manager is often out of the office supporting staff or providing care. We needed to be sure that they would be in.

At our last announced comprehensive inspection of this service in November 2016, we found improvements were required to meet the legal requirements. At a follow-up inspection in April 2017, we found that the provider had made the required improvements. However, we did not revise the overall rating of the service from "Requires Improvement" to ‘Good’ because to do so would require a longer term track record of consistent good practice.

Following the latest inspection, the overall rating for the service remains "Requires Improvement".

Savannah Care is a domiciliary care agency which provides personal care and support to people living in their own homes, many of whom were older people. There were thirteen people receiving services from Savannah Care at the time of our inspection. Most people using the service lived in Surrey.

The service had a registered manager in post. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

We found that people were not adequately protected from avoidable harm. The provider did not always assess the risks people faced such as those relating to their health needs. This meant that there were not always management plans in place to help staff minimise these risks. The provider did not have adequate systems in place to ensure that people's support needs were assessed and their care plans devised in a timely manner. There was not always evidence that people had been involved in their care planning although people told us they received personalised care which met their needs. This was largely because people were usually supported by the same staff who had come to know them, their routines and preferences well.

The provider had an effective recruitment procedure which helped to ensure that only applicants suitable for the role of care workers were employed. The registered manager consistently followed the provider's recruitment procedure.There was a sufficient number of staff to support people safely.

Staff were appropriately supported by the provider through an induction, relevant training, supervision and appraisal. Staff knew how to protect people from abuse. They understood how to recognise the signs of abuse and how to report suspected abuse. The provider had systems in place to report incidents and accidents and staff were aware of these systems. The registered manager reviewed incidents and took action to prevent them from happening again.

Staff understood their responsibility to protect people from the risk and spread of infection and followed the provider's procedures in relation to infection control. Staff knew how to prepare people's meals safely and in accordance with current health and safety and food hygiene practices. Staff supported people to meet their nutritional needs. People were supported to access the health care services they needed to maintain their health.

People were supported to have maximum choice and control of their lives. Staff and the registered manager understood their roles and responsibilities in relation to the Mental Capacity Act (MCA) 2005. Staff involved people in their care delivery and ensured people consented before care was provided.

Staff were caring. They treated people with kindness and respected their dignity and privacy. Staff encouraged and supported people to maintain their independence as far as possible.

People knew how to report their concerns or complaints about the servi

We carried out an unannounced comprehensive inspection of this service on 18 November 2016. At which breaches of legal requirements were found in regards to person-centred care, safe care and treatment, staffing and good governance. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements. They stated they would take the necessary action to address the breaches by 14 February 2017.

We undertook this focused inspection on 25 April 2017 to check they had followed their plan and to confirm they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Savannah Care Limited on our website at www.cqc.org.uk

Savannah Care Limited provides a domiciliary care service, supporting people with their personal care in their own homes. At our inspection 23 people were receiving a service.

A registered manager was 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.

At this inspection we found the provider had made many improvements and were now meeting the breaches of regulations previously identified.

Staffing levels had improved to ensure there were sufficient staff to meet people’s needs. We saw people were receiving their care at the scheduled time and staff were able to stay the full allocated time to meet people’s needs. The registered manager had identified training opportunities and staff had undertaken the provider’s mandatory training. Supervision sessions were also being held in line with the provider’s policy.

People’s care records had been reviewed and updated. They provided clear and detailed information about the person using the service and the level of support to be provided at each visit, this included in relation to medicines administration. The registered manager had assessed the individual risks to people’s safety and management plans were in place to minimise those risks.

The registered manager had improved processes to review the quality of service delivery. Spot checks were now being undertaken regularly, at which people were asked for their feedback about the quality of support provided. There were systems in place to learn from complaints received and any incidents that occurred. The registered manager was also making further improvements to systems to review the quality of care records and track staff’s adherence to visit times. Where concerns were raised or improvements were required, these were addressed.

We undertook an announced inspection of the service on 18 November 2016. This was the first inspection of this location since it was registered on 29 June 2016.

Savannah Care Limited provides a domiciliary care service, supporting people with their personal care in their own homes. At the time of our inspection 21 people were receiving a service..

The service had 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.

There were not sufficient numbers of suitable staff available to provide care in line with people’s preferences and at the agreed times. The staff rota system showed that sufficient time was not allocated to enable care workers to provide care at people’s preferred times and for the required length of time. Communication logs also showed that staff did not consistently attend visits at the scheduled times. People and their relatives confirmed that staff arrived at different times.

Staff had not completed the provider’s mandatory training and did not attend regular refresher training courses. Staff had also not received regular supervision. There was a risk that staff did not have up to date knowledge and skills to provide people with care in line with good practice guidance.

The registered manager had not appropriately assessed the risks to people’s health and safety. The registered manager had not identified the risks of people falling or those associated with moving and handling needs, dietary requirements or in relation to sensory impairments. The registered manager has also not developed adequate management plans to mitigate these risks.

The registered manager had not ensured the principles of safe medicines management were followed in regards to the administration and recording of topical creams. People’s care records did not provide clear instructions about what creams people needed applying and to what areas of their body. Care records were not updated in line with changes in people’s prescriptions.

Due to a shortage of staff, there was at times a lack of consistency in the staff supporting people. This was impacting on the relationship and rapport between people and their care workers. This also meant that some of the newer care workers did not know people’s routines and preferences in regards to how support was delivered.

Care plans were not reviewed and updated in line with changes in people’s needs. The care plans did not provide sufficient information and detail about a person’s support needs to inform staff what action to take to meet the identified needs. The registered manager did not have an appropriate process in place to audit the quality of care records.

There were not sufficient systems in place to review the quality of service delivery. Spot checks had not been completed and there were no systems in place to manage this process and ensure regular checks on the quality of care delivery. There were no systems in place to review key performance data and learn from complaints, incidents and accidents.

The system to review staff’s compliance with people’s visit times could not be relied upon and was seen to record inaccurate data, meaning the registered manager could not be assured that staff attended people’s visits on time and stayed the required length of time.

The provider was in breach of the legal requirements relating to person-centred care, safe care and treatment, staffing and good governance. You can see what action we have asked the provider to take at the back of this report.

Staff were aware of their responsibilities to provide care in line with the Mental Capacity Act 2005 code of practice. They were also knowledgeable in recognising signs of abuse and were