Sentinel homecare is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to mainly older adults but also some younger disabled adults. At the time of the inspection, care and support was being delivered to 146 people.

The inspection took place between the 20 and 28 June 2018 and was announced.

At the last inspection in June 2017 we rated the provider as requires improvement. We had concluded that improvements had been made since the previous inspection in 2016 but some issues remained with the accuracy and completeness of documentation. We found one breach of regulation relating to good governance.

At this inspection we found further improvements had been made and the service was no longer in breach of any regulations. Feedback from people about the quality of the service was good. The service was committed to continuous improvement of the service and took feedback and complaints seriously. Because of this we rated the service good across all domains.

A registered manager was in place. 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.

People told us they felt safe and secure using the service. Safeguarding issues were taken seriously by the service and appropriately reported and acted on. Risks to people’s health and safety were assessed and mitigated.

There were enough staff deployed to ensure people received a timely and consistent service. People said staff usually arrived on time and did not miss calls. Staff were recruited safely to help ensure they were suitable to work with vulnerable people.

Overall medicines were managed safely. Clear records were maintained of the support people were provided with. Some medicine care plans needed updating to ensure they reflected people’s current support needs.

Staff received a range of appropriate training relevant to their role. Support mechanisms were in place which included regular supervision and appraisal. Improvements had been made to staff rotas to ensure people received a higher level of continuity with regards to care workers.

People’s nutritional needs were assessed and plans of care put in place to meet those needs.

The service was compliant with the requirements of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). People’s consent was sought before care and support was delivered.

People’s care needs were assessed and plans of care put in place for staff to follow. The service worked with external health professionals to help meet people’s needs.

People said staff treated them with kindness and compassion. People said they usually received care from the same care workers who they had become familiar with.

The service planned care and support around maintaining and promoting people’s independence.

People’s views and opinions were regularly sought by the service and used to make improvements to the service. These included taking complaints and comments seriously and using them to improve working practices.

The service had a comprehensive governance framework in place which included regular auditing and checking of how the service was operating. Findings from audits and checks were used to make further improvements to the service.

The service accessed best practice guidance to inform policies and procedures and help ensure a consistent and high standard quality of care.

Sentinel Home Care provides a range of domiciliary care services to people throughout the Bradford area from an office close to the city centre. The agency provides care and support to a wide range of people including older people, people with a dementia related condition, and people with learning or physical disabilities.

The inspection took place between the 2 and 8 June 2017 and was announced. This meant we gave the provider a short amount of notice that we would be visiting the office in order to ensure a manager was present.

A registered manager was in place. 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 the last inspection in November 2016 we identified significant concerns. Staff were cutting visits short and care and support tasks were not getting completed. We found there were insufficient staff deployed to ensure a high quality and reliable service. We identified five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We rated the service ‘inadequate' overall.

At this inspection we found improvements had been made. The service had reduced the number of care packages provided, reorganised rotas and included travel time. Electronic call monitoring had been introduced as well as more rigorous checks on staff practice. This had the effect of improving the quality, consistency and reliability of the service provided.

Feedback from people who used the service was improved with people saying care needs were met by the service. Some people still raised some concerns about the timeliness of staff, but overall we found this was a much improved picture.

People told us they felt safe using the service. Safeguarding procedures were in place and had been used to help keep people safe. Staff had received training in safeguarding vulnerable adults.

Whilst some improvements had been made to medicines systems, medicines were not consistently managed in a safe way. There was not always a clear record of the medicine support provided to each individual person.

Risks to people’s health and safety were assessed and clear and detailed risk assessments put in place. However some of these required updating when people’s care plans changed.

There were sufficient staff to provide a reliable and consistent service. Safe recruitment procedures were in place to help ensure staff were of suitable character to work with vulnerable people.

People spoke positively about staff and said overall they had the skills and knowledge to support people effectively. Staff received a range of training and support.

Some people said they received consistent care workers, others said this was not the case. We saw work was being undertaken to further improve the consistency of care workers.

The service was acting within the legal framework of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). People’s consent to care and support was sought.

People said staff were kind and treated them with dignity and respect. Staff we spoke with demonstrated good, caring values.

People’s care needs were assessed and detailed and person centred plans of care put in place to help keep people safe. These provided step by step instruction to assist staff in providing appropriate care.

People said they received appropriate care from the service. Most care visits took place at a consistent time with staff staying for the required amount of time. However some people still complained about the timeliness of the service. We concluded this was an improving picture due to changes made to rotas and the introduction of the electronic care system.

Complaints were logged and action taken to try to address them. Th

Sentinel Homecare provides a range of domiciliary care services to people throughout the Bradford area from an office close to the city centre. The agency provides care and support to a wide range of people including older people, people with a dementia related condition, and people with learning or physical disabilities. At the time of the inspection the service was providing care packages to approximately 230 people.

The inspection took place between 28 November and 2 December 2016 and was announced. At the previous inspection in May 2015 we identified two breaches of regulation and rated the provider as ‘requires improvement.’ At this inspection we found improvements had not been made and the service continued to be in breach of these two regulations, as well as an additional three.

A registered manager was in place. ‘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.

Feedback about the service was mixed and had deteriorated since our previous inspection in 2015 with over half the people we spoke with raising significant concerns about late calls, calls cut short and a lack competency of some staff who delivered care and support. Although some people said staff were nice and friendly, other people said this was not consistently the case and they were not always treated with dignity and respect.

Most people said they received appropriate support with their medicines. However medicines were not managed in a safe or proper way as a complete record of the support provided to people was not kept.

People said they felt safe and comfortable around staff. We saw safeguarding procedures were in place and we saw evidence they had been followed and actions put in place to try and prevent incidents of this nature reoccurring.

Risks to people’s health and safety were assessed and clear and person centred risk assessments put in place for staff to follow. Some people said that staff did not always follow or were unfamiliar with risk assessments.

There were not sufficient quantities of staff deployed to ensure a consistent and reliable service. Although we saw most people got calls at an appropriate time, this was not consistently the case and some visits were cut short. Safe recruitment procedures were in place, although some people complained about the quality of new staff.

Staff received regular training, support and supervision. Despite this being the case, a number of people raised concerns about the lack of skill and competency of new care workers and lack of continuity of care workers.

The service was complaint with the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). People’s consent to care and treatment was sought and people told us they were given choices.

Overall, people received appropriate support to maintain good nutrition and hydration.

People’s healthcare needs were assessed and plans of care put in place for staff to follow. However late and short visit times had the potential to impact on people’s health.

We received mixed feedback about the attitude and behaviour of staff. Some people told us care workers were kind and considerate whereas others gave examples of staff not treating them appropriately. People said they were not always introduced to new care workers or informed if they were going to be late.

Information on people’s likes and dislikes and preferences had been sought as part of a person centred approach to care planning.

The service had taken the time to listen to people and record their comments or concerns. We found whilst effort was taken to resolve complaints, complaints surrounding areas such call time and length and reliability had not been fully addressed due to

The inspection started on 28 May 2015 with an announced visit to the provider’s offices. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we needed to be sure that someone would be in.

The provider changed their registration with CQC in June 2013 following a move to new offices. This was the first inspection at the new location. The agency provides support, including personal care, to adults living in their own homes. At the time of the inspection there were 170 people who used the service. The agency did not provide services to children.

The service had a registered manager. 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 procedures in place to protect people from harm and staff were aware of how to report any concerns about people’s safety and well-being. People felt safe when they were supported by a regular staff team. Some people expressed concerns about the number of different carer workers who were supporting them. The lack of continuity somewhat undermined their confidence in the service. The staff recruitment and selection procedure was robust and newly appointed staff were not allowed to work until all relevant checks had been completed and references received.

All staff completed induction training and shadowed more experienced care workers when they started work. Most staff felt their initial training was sufficient because they had previous experience of working in a care setting. However, some said they thought care workers who were new to care should have more support before being allowed to work on their own. There was a planned programme of staff supervision and appraisals. However, many of staff we spoke with felt the management team did not use supervisions in a positive way to support them with their professional and personal development. They felt one to one supervision meetings where only held when they had done something wrong. The majority of people who used the service said staff delivered their care and support competently. However, some people who used the service felt staff lacked the knowledge, skills and experience to meet more complex needs. For example, when supporting people living with dementia.

People who used the service were asked for their consent before care and support was delivered. There were processes in place to make sure care and support was planned and delivered in people’s best interests when they were unable to give their consent. Where appropriate people were supported to have adequate amounts to eat and drink.

People told us the staff were caring and respectful. They told us staff supported them to maintain their independence. Most people said staff arrived on time or let them know if they had been delayed. Staff told us they believed the service was caring and said they would recommend it to family and friends.

The provider carried out a full assessment of people’s needs at the time of referral to make sure they would be able to deliver the care and support people needed. People’s care and support needs were detailed in support plans. The support plans were person centred and easy to follow which helped to make sure people received appropriate care and support. Staff confirmed care and support was delivered according to the plans, for example, they said the provider was very strict about making sure there were always two care workers when this was specified in the plan.

There was a complaints procedure and complaints and concerns were recorded. People who used the service told us they know what to do if they had any complaints or concerns. The registered manager told us feedback was always given to people who raised a concern. However, we found this was not always recorded.

There was a quality assurance and monitoring system in place. However, this needed to be improved. In the course of the inspection we found some shortfalls which the provider’s quality checks had not identified. People who used the service told us they thought communication from the office could be improved and more attention should be given to planning to reduce travel time and late calls. Staff also expressed the view that communication could be improved and felt they did not always get enough support from the management team.

We found the provider was in breach of two regulations. You can see what action we told the provider to take at the back of the full version of the report.