This inspection took place on 25 and 26 October 2017. The service was given 48 hours' notice because the location provides a domiciliary care service and we wanted to visit the office, talk to staff and visit people who used the service in their own homes.

SOS Homecare Limited - Statham House is a domiciliary care agency located in the borough of Trafford, Greater Manchester and provides personal care to adults within their own home. At the time of our inspection visit, 110 people used the service.

During 2016 the Care Quality Commission (CQC) inspected SOS Homecare Limited - Statham House on two occasions. In March 2016 we found the service was not compliant in ensuring people using the service received safe and appropriate care that met their needs. The service was rated ‘Inadequate’, placed into special measures and we told the provider to take appropriate action. In November 2016 we returned to the service and found steady progress had been made. This resulted in an overall rating of ‘requires improvement.’

During this inspection, we found sustained improvement in four out the five key questions. This meant the service achieved an overall rating of ‘Good.’

There was 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.

We saw missed and late visits were analysed and detailed the circumstance why the missed or late visit had occurred. However, we found the benefits of new electronic technologies implemented by the service had yet to be fully embedded.

Recruitment and selection of staff was robust with safe recruitment practices in place. This included checks with the Disclosure and Barring Service (DBS). This helped to ensure potential

employees were suitable to work with vulnerable people.

The service had appropriate systems and procedures in place which sought to protect people who used the service from abuse. Staff demonstrated a working knowledge of local safeguarding procedures and how to raise a concern.

Where support with medicines was part of an assessed care need, these were ordered, stored, administered, recorded and disposed of safely and correctly. Staff were trained in the safe administration of medicines and kept relevant records.

Accidents and incidents were appropriately recorded and included details of preventive strategies used by the service to reduce the likelihood of such events occurring in the future.

The staff induction programme was robust and included mandatory training, opportunities for shadowing of more experienced staff and direct observations of practice before new employees were able to work unsupervised with people who used the service.

Services were delivered in line with the Mental Capacity Act 2005 and staff sought consent prior to providing care and offered people choices to encourage people to make their own decisions.

People and their relatives told us they were happy with the care provided. People told us staff treated them with dignity and respect and promoted their independence

People engaged with an initial assessment and were involved in the planning of care. Regular reviews were conducted with people, their relatives and where appropriate, other professionals.

People received appropriate information, including details about the complaints procedure. People told us they were confident that if they were required to make a complaint, the management would respond and resolve their issue promptly.

We found there were systems in place to monitor the quality of the service provided to people which ensured good governance.

People and their relatives spoke highly of the management team and voiced that they would not hesitate to recommend the service to peopl

We inspected SOS Homecare Limited – Statham House (SOS Homecare) on 16 and 17 November 2016 and the first day was unannounced. The previous inspection took place on 8, 10 and 14 March 2016 and at this inspection, we found the service was not compliant in ensuring people using the service received safe and appropriate care that met their needs. We placed the service into special measures and we told the provider to take appropriate action. At this time, the provider agreed to enter into a voluntary undertaking to suspend the provision of services to new customers. This inspection was undertaken to check what progress the service had made to improve since we last inspected and focussed on the safe and well led domains where we had identified significant concerns.

SOS Homecare Limited – Statham House (SOS Homecare Limited) is a domiciliary care agency located in borough of Trafford, Manchester and provides personal and domiciliary care services to adults within their own homes. Care is provided for people with a wide range of needs across areas including Trafford, Urmston, Flixton, Timperley and Sale. At the time of our inspection there were about 150 people receiving services.

There was a registered manager in post and they had registered with the Care Quality Commission in November 2016. 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 and relatives told us they felt safe supported by the staff of SOS Homecare Limited. Staff knew how to keep people safe and were aware of how and to whom they could report any safeguarding concerns. This meant that staff were aware of how to protect people from risk of harm.

Risk assessments were up to date and we saw the service had introduced a risk assessment summary. These documents helped to ensure that staff supported people safely

There were mixed responses regarding the punctuality of people’s care visits. Since our last inspection in March 2016, there had been significant improvement in the number of missed and late visits that people had previously experienced. The provider had implemented an electronic call monitoring system; this should further help to ensure that people were receiving care and support at times that suited them. People were generally satisfied with the consistency of care and told us they had regular care staff supporting them.

The recording of safeguarding incidents had been revised and saw that these records were up to date. This meant the service had an effective system in place to monitor people’s safety and wellbeing. We saw that accidents and incidents that had occurred in the service was recorded and appropriate action taken to help ensure people were kept safe.

People had mixed views on whether or not the service was well led. At our inspection in November 2016, there was a registered manager in post. Staff at SOS Homecare Limited said the manager brought stability to the running of the service and that they were approachable and helpful.

We saw quality checks were undertaken in various areas such as staff spot checks, care plans and risk assessments, staffing concerns, incidents and accidents and complaints. We found that improvements had been made to help ensure the provider and registered manager could effectively monitor the quality and improve the care people received.

The provider had improved communications with staff via regular email updates and the formation of a staff council. This helped staff to feel valued for their contribution towards supporting people’s health and wellbeing needs.

We saw that staff meetings were regularly held and this gave staff the opportunity to meet with managers and colleagues as a group to discuss service related issues.

This inspection took place on 8, 10 and 14 March 2016 and was announced. We gave the provider 48 hours’ notice of our intended inspection to ensure that the interim manager or a representative would be available in the office to meet us.

The previous inspection had been conducted on 18 September 2014. At this inspection, we found that the service was not compliant in ensuring that people using the service received safe and appropriate care that met their needs. We told the provider to take the appropriate action.

SOS Homecare Limited – Statham House (SOS Homecare Limited) is a domiciliary care agency in Manchester which provides personal care to adults within their own homes. Care is provided for people with a wide range of needs across areas including Sale, Urmston, Flixton, Timperley and Trafford. There were about 170 people receiving services from SOS Homecare Ltd during the time of our inspection.

At the time of our inspection, SOS Homecare Ltd did not have 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.

We were told by senior management that the service had suffered as a result of this. The provider had temporarily appointed an interim manager who was registered at one of its other locations. This interim manager had been in post since mid-November 2015.

We found breaches in the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulation 2014. You can see what action we have told the provider to take at the back of the report.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

There had been a high number of missed and late visits to people using the service in the last 12 months.

Risk assessments we looked at did not always document explicitly what actions were required by staff to mitigate risk. In some people’s care files, we also saw no evidence that risk assessments which should have been undertaken had been done.

Overall, people told us they felt safe with the care staff that supported them. Staff we spoke with were knowledgeable in the principles of safeguarding people and knew how to report any allegations of abuse that arose.

We carried out an inspection on 18 September 2014 to check to see if the provider was meeting the essential standards of quality and safety. Following an inspection on 15 July 2013, a compliance action was made as we had concerns the service did not have suitable arrangements in place for the management of medicines. We visited the service again on the 6 January 2014 to see what improvements had been made. Following that visit a warning notice was served as there was still no effective systems in place for the safe management of medicines.

This inspection was carried out by a lead inspector and a pharmacy inspector to ensure the service was safe.

Is the service safe?

At the previous inspections we found there were breaches in regulations in relation to medicines and records. This meant people who used the service were not adequately protected from unsafe care and support as information held about them was not accurate.

At this inspection we looked at care plans of six people who used the service and found some information was out of date. We did however found improvements had been made with the recording of medication and records generally contained enough information to support people safely.

We looked at the essential standard relating to care and welfare as we had received information of concern about the quality of care people were receiving. We found improvements were needed in this area.

In this report, the name of a registered manager appears who was not in post and not managing the regulated activity at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time of the inspection. The service had appointed a new manager who had been in post for a week at the time of this inspection.

Following an inspection on 15 July 2013, a compliance action was made as we had concerns the service did not have suitable arrangements in place for the management of medicines. We visited the service on the 6 January 2014 to see what improvements had been made. Following that visit a warning notice was served as there was still no effective systems in place for the safe management of medicines.

The service then wrote to us explaining what improvements had been made. We visited the service on the 31 March 2014 and the 1 April 2014 to see what improvements had been made.

We spoke with managers and staff about the support provided with people’s medication and looked at how this was detailed within people’s care plans. We found the agency's medicines training package and policy together did not provide consistent guidance for staff about the support offered with medication. Additionally, we found that the support provided with medication did not consistently reflect what had been agreed in people’s care plans. This increased the risk that people may not receive the appropriate level of support to safely manage their medicines.

During our visit we found people were not protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not maintained.

We found care files were not accurate or updated to reflect changes in dependency and care needs.

We spoke with managers about the support provided with people’s medication and looked at how this was detailed within people’s service user plans. We found that information within people’s care plans did not clearly describe how they would be supported with their medicines. Additionally, accurate records were not maintained to show the medicines currently prescribed for each person, or to record when they were administered. This increased the risk of errors and meant that it was not possible to tell whether medicines had been administered correctly.

We found before any services were provided a pre-assessment of care was undertaken with the person who used the service, their relatives or representative.

A relative of a person who used the service told us; “They are very good at involving me when discussing my X’s needs. Nothing is too much trouble. They respect X and involve him in the care. They are very considerate and kind, they can’t do enough”.

We found care was planned and delivered in a way that was intended to ensure people’s safety and welfare.

One person who used the service told us; “I think they are absolutely great, I can’t fault them. I’m happy with the service.”

We found medicines were not administered safely. We could not establish what medication and in what dosage had been administered by staff during visits to people who used the service.

We found that effective systems were in place to ensure staff received regular supervision and development.

We found that the provider had effective systems in place to monitor the quality of the service provided. The provider operated a system of unannounced ‘spot checks’ to monitor the quality of care provided by staff.

“I find that when you ring the office they are always very helpful.”

“We found that we had more than enough information about the service they would provide.”

“My husband has male carers most of the time and they are wonderful: nothing is too much trouble.”

“The carers are always good; they treat me well, always trying to be gentle as possible.”

“I do feel safe with the carers, I have to trust them.”

Our inspection was done over 2 days and included a visit to the head office to speak with staff and to look at care plans, policies and procedures and staff records. We then spent a second day visiting people in their own homes and spoke to them about the kinds of services they had received. As part of this process we spoke with five people and three relatives.

The people we spoke with told us that they felt their needs had been met and that they felt well supported by the staff at SOS. People told us that they felt well respected by the staff and got along with them all very well. One person told us “I have a good rapport with all the staff".

We found that staff had been recruited safely and appropriately by means of the provider conducting appropriate checks before employment had commenced. During the inspection we also found that the provider did not have a formal system in place to regularly supervise staff either on a one to one basis.

We looked at medicines management as part of our inspection and looked at whether people had been supported to receive their medicines in a safe and timely manner. We found that one person had missed their medication on one occasion yet the disclaimer had been signed by staff to say that it had been administered and that they had seen them take it. We raised this with the manager to be actioned.

We found that SOS Homecare had appropriate systems in place to monitor the quality of service provision and to deal with complaints.