What life is like for people using this service:

People who received care from SD Agency told us they felt safe and supported by staff who visited them. Staff were punctual and consistent at carrying out visits with people in a person-centred manner. One person told us, “I like the agency. They are very attentive. They haven’t missed any visits in four years with me.” People were supported to continue living at home in a way that enabled them to be as independent as possible.

Staff were trained and supported to be effective carers in a collaborative team. Where needed, staff were quick to support people to have access to health care professionals such as occupational therapists or, when necessary, emergency services. On relative told us, “We would recommend SD Care Agency to anyone requiring an efficient and competent care agency.”

People and relatives described staff as caring and kind towards them. Staff were approachable and friendly with people they cared for and knew them well.

Care plans were created with people and relatives to ensure they were person centred and tailored to peoples’ needs and routines.

The service was well managed by a supportive and progressive management team. People, staff and relatives were involved in helping the service improve.

More information can be seen in the main body of the report for each Key Question below.

Rating at last inspection:

Requires Improvement (February 2018).

About the service:

SD Care Agency is a domiciliary care agency that was providing personal care to 30 people aged 65 and over at the time of the inspection.

Why we inspected:

This was a scheduled inspection based on the previous rating. We inspect all services rated as 'Requires improvement' every 12 months to ensure that we regularly monitor and review the quality and safety of the service people receive. At the last inspection we found that safeguarding incidents had not always been referred to the local authority or CQC. We also found that some visits had been missed and quality assurance checks were not effective or robust. We saw that improvements had been made to the service people received since our last inspection. At this inspection we found safeguarding or accidents and incidents were being escalated and sent as notifications to CQC and the local authority. Visits were not being missed by staff and quality assurance checks were effective at driving improvement and ensuring high standards.

This inspection took place over three days. We carried out our inspection to the offices of the service on 16 November 2017 which was announced. We gave 48 hours’ notice of the inspection to ensure that staff would be available in the office. This is our methodology for inspecting domiciliary care agencies. Following that we carried out telephone interviews with staff on 20 and 22 November 2017.

SD Care Agency is registered to provide personal care needs of older people who may have dementia, physical disabilities and sensory impairments. At the time of our inspection the service was providing personal care to 44 people.

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.

Systems and procedures to safeguard people from abuse were not being followed by the registered manager. They had failed to notify the local authority and the Care Quality Commission (CQC) about four safeguarding concerns that had been reported to them.

People were not receiving the care in the way they preferred it. Staff had not visited at the times specified which caused concern to people. When staff were on annual leave, new staff allocated were not introduced which caused anxiety to people.

Contemporaneous records were not always maintained for each person and actions identified when carrying out performance reviews on staff were not recorded.

Quality assurance systems were in place but not all were robust. The issues we had identified during the inspection had not been noted through the quality assurance systems. People, relatives and associated professionals were able to provide regular feedback through completing questionnaires. Comments were positive about the care provided to people.

People and their relatives told us that they felt safe with staff who attended to their needs. Staff who visited people had a good understanding of the different types of abuse and the procedures to be followed if they had witnessed or suspected abuse had taken place. Robust recruitment processes were followed to help ensure that only suitable people were employed at the agency. People received the medicines they required. Infection control procedures were in place that helped staff to protect people against the risk of cross infection.

People were supported by staff to ensure their needs were met when they arrived. There was a system in place to protect people from potential risks and staff had a good understanding of how to manage identified risks. Care plans were in place for people and included information about how people preferred to be supported.

Accidents and incidents were recorded and monitored by the registered manager. These were discussed with staff to help minimise the risk of a repeated event. If an emergency occurred at the office or there were adverse weather conditions, people’s care would not be interrupted as there were procedures in place which were known by staff. Emergency out of hour’s contact details were provided to people in the Service User Guide and in their care records.

People were supported by staff who received training, supervisions and annual appraisals that helped them to meet people’s needs. They also received spot checks to ensure they supported people effectively. New staff commencing their duties undertook induction training to help prepare them for their role.

Staff were up to date with current guidance to enable people to make decisions. Staff had a clear understanding of Deprivation of Liberty Safeguards (DoLS) and the Mental Capacity Act (MCA) as well as their responsibilities in respect of this.

People prepared and cooked their own meals for staff to heat in the microwave. Meals taken by peo