The inspection was carried out on 9 November 2016. The inspection was announced.

Scott Care office is based in Sittingbourne and is easily accessible for staff, visitors, including people who may have mobility difficulties. At the time of the inspection the service was providing support to 120 people. Most people were funded by the local authority or through NHS continuing care services with a smaller proportion of people paying privately for their support.

We last inspected the service on the 1 July 2015, when we made three recommendations to assist the provider with improvements. The recommendations were in relation to the administration of medicines, people being provided with a copy of the complaints procedure and the formal system for monitoring quality and safety across the service. At this inspection we found that the registered manager had taken action and improvements had been made.

There was a registered manager for 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 and associated Regulations about how the service is run.

The feedback we received from people was positive. Those people who used the service expressed satisfaction and spoke highly of the staff. For example, one person said, “I am very happy with the service”.

The agency had suitable processes in place to safeguard people from different forms of abuse. Staff had been trained in safeguarding people and in the whistleblowing policy. Staff were trained in how to respond in an emergency (such as not being able to gain access to a person’s premises or finding a person collapsed) to protect people from harm.

The service had robust recruitment practices in place. Applicants were assessed as suitable for their job roles. Refresher training was provided at regular intervals. All staff received induction training and they worked alongside experienced staff and had their competency assessed before they were allowed to work on their own.

The provider carried out risk assessments when they visited people for the first time which included an environmental assessment.

Incidents and accidents were recorded and checked by the provider to see what steps could be taken to prevent these happening again. The registered manager ensured that they had planned for foreseeable emergencies, so that should they happen, people’s care needs would continue to be met.

The registered manager involved people in planning their care by assessing their needs on the first visit to the person, and then by asking people if they were happy with the care they received.

People were supported to choose a healthy and balanced diet. Where staff had identified concerns in people’s wellbeing there were systems in place to contact health and social care professionals to make sure they received appropriate care and treatment.

Most people either managed their own medicines or members of their family helped them. Some people required staff assistance with medicines. Staff who administered medicines had received training and management checked that staff were safe to administer people’s medicines by carrying out regular competency assessments. The registered manager ensured that staff had a full understanding of people’s care needs and had the skills and knowledge to meet people’s needs. People received consistent support from staff who knew them well. People felt safe and secure when receiving care.

Staff presented a caring approach as did the staff working in the office who supported the delivery of care. People were happy with the staff and made many positive comments about the staff who supported them. The provider made sure people had information about the service before the commencement of care and support being provided.

The service had processes in pl

The inspection was carried out on 1July 2015. The inspection was unannounced. Normally we give 48hrs notice of an inspection to a domiciliary care agency. However this inspection was planned as an unannounced due to the concerns we had received from the public and social services.

Scott Care office is based in Sittingbourne and is easily accessible for staff, visitors, including people who may have a mobility disability. At the time of the inspection the service was providing support to 105 people who use the agency services regularly. Most people were funded by the local authority or through NHS continuing care services with a smaller proportion of privately funded people. The service is one of two domiciliary agencies run by the provider at this location. . The service is in the process of change with Scott Care (Medway) office joining them in the Sittingbourne office. This has entailed a lot of upheaval and resulted in a loss of some co-ordinating and care staff.

The agency has a new manager who had recently applied to become the manager. A 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 Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services.

The agency was not accepting new referrals, due to the concerns that had been raised and the need for more staff. The agency was recruiting care staff to make sure there will be sufficient numbers of staff to meet people’s needs and provided a flexible service. We have made a recommendation about this.

Concerns had been raised about individuals not receiving their medicines as prescribed. There had been incidents where medicines had not been given, or had been given late. The agencies system for recording medicines administered was not robust and did not show the actual medicines administered. Staff were being retrained and had to show competency before they could administer medicines again. We have made a recommendation about this.

People said that they knew they could contact the office at any time, but they felt that communication between the office and staff was not always effective. A complaints procedure was in place to ensure people’s concerns and complaints were listened to, and addressed in a timely manner and used to improve the service. However, although people told us that they would be happy to make a complaint, half the people we spoke with said they did not have a copy of the complaint procedure. We have made a recommendation about this.

The agency had suitable processes in place to safeguard people from different forms of abuse. Staff had been trained in safeguarding people and in the agency’s whistleblowing policy. Staff were trained in how to respond in an emergency (such as not being able to gain access to a person’s premises or finding a person collapsed) to protect people from harm.

The agency had robust recruitment practices in place. Applicants were assessed as suitable for their job roles. Refresher training was provided at regular intervals.

All staff received induction training and they worked alongside experienced staff and had their competency assessed before they were allowed to work on their own.

The provider carried out risk assessments when they visited people for the first time which included an environmental assessment.

Incidents and accidents were recorded and checked by the provider to see what steps could be taken to prevent these happening again.

The provider involved people in planning their care by assessing their needs on the first visit to the person, and then by asking people if they were happy with the care they received.

People were supported to choose a healthy and balanced diet. Where care workers had identified concerns in people’s wellbeing there were systems in place to contact health and social care professionals to make sure they received appropriate care and treatment.

Formal systems for monitoring quality and safety across the service had not been properly implemented at the time of the inspection. This meant that some opportunities to identify potential improvements had been missed, although the manager was able to demonstrate that she encouraged and acted upon feedback from people who used the service.

Whilst we found a number of areas which required improvement, the manager was able to provide evidence that she had also recognised them, and in most cases was also able to provide evidence that she had started to take action to address them.

The inspection was carried out by two inspectors. They spent six hours in the office of the service looking at records and speaking with staff. Following on from the visit to the agency office we spoke with relatives, people who used the service and further staff members by telephone to gain their views and experience of the service.

During this inspection we set out to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? and is the service well led?

Below is a summary of what we found. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

We found that the service provided by the agency was safe. People we spoke with said that they were happy with the service provided and they felt safe in the hands of the staff. We looked at how staff had been recruited and saw they were now undertaking all the required checks to ensure staff were suitable to work with vulnerable people.

Is the service caring?

People were supported by staff who were kind and attentive. All of the people we spoke with told us that the staff were polite and friendly. We saw there were cards and letters received by the service from people expressing their thanks for the care they had received. For example one person had written in to thank the service for “All the care your staff gave my mother”.

Is the service effective?

We found that most people who used the service felt that it met their needs. People told us that the care was good and one person commented on the willingness of their staff as “many of the carers stay a bit longer than they should to make everything is done”. Relatives we spoke with told us that care was provided in line with assessed care and support needs.

Is the service responsive?

People’s needs had been assessed before they started using the service. When their needs changed, care plans were updated to reflect what support was required. We saw that systems were in place for reviewing care plans. Assessments were detailed and reflected a range of care needs such as personal care, preparing food and drinks and prompting medication.

Is the service well-led?

People told us they were able to raise concerns with the manager. We saw that suitable systems were in place to assess and monitor the quality of the service. This included spot checks, telephone surveys and questionnaires for people who used the service and their relatives.

Our aim is to speak with a representative proportion of people who use the service. We spoke to 10 people who used the service or their relatives. Most people that we spoke to said that they would recommend the agency. Comments included, “They can’t do too much for me”; “'My regular carer, she's a diamond”; and “'The girls are good but the office is not so good”

People said that they were involved in their care and treatment. They said that staff respected their privacy and dignity. However, one person had woken up one morning to find a member of staff standing in front of them who they had never met before.

People had individual plans of care and most people told us that they had a regular team of staff to support them. However, one person told us that they no longer had a regular team this lack of consistency was impacting on their experience of the service.

Selection and recruitment procedures did not ensure that people who used the service were safeguarded.

People said that they felt safe when being supported by staff. Staff knew how to raise concerns with the agency and to external agencies.

Staff had regular training and support to help them carry out their roles, including how to administer medicines.

People were regularly contacted to provide feedback on the level of the service that they received.

During this inspection, we looked at records at the providers offices. We spoke to staff and people who use the service to gather their feedback and views.

People consented to the care and treatment they received and were able to make changes to their care packages when they needed to. Records were accurate and up to date and reflected peoples’ care needs.

Staff were recruited fairly and the service undertook the necessary checks to ensure that staff were fit to work for the service. Staff received support and training that enabled them to deliver care safely and meet peoples’ needs.

The provider responded appropriately to complaints and investigated them where necessary. People told us “If I have any concerns or want to change anything I can just phone the office and they sort it all out for me”.

People told us they were involved in the development of their care plan and spoke very highly about the competence of staff and the quality of care given.