At our previous comprehensive inspection of Strada Care Ltd (Then called Care Unlimited) in November 2017 we had found the registered provider was in breach of nine regulations. These related to the safe care of people; safeguarding people from abuse; staffing levels; and the effectiveness of the provider’s quality assurance systems and records. Two warning notices were issued in response to these breaches. In addition, they had failed to submit notifications to CQC. A fixed penalty notice was issued due to this failure. Following that inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions to at least a ‘good’ standard.

This latest inspection took place on 08 and 10 August 2018 and was unannounced. During this inspection we found that the concerns identified at our previous inspection had been dealt with. The provider now needed time to embed the changes and demonstrate they could maintain the improvements.

Strada Care Ltd provide personal care for people in supported living settings, so that they can live in their own home as independently as possible. People's care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

Strada Care support older people and adults with learning disabilities and/or mental health issues. The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. At the time of our visit they were supporting 21 people at four sites across East Surrey and Sutton.

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. The registered manager was at the service during the time of our inspection.

There was positive feedback about the service and caring nature of staff from people who use the service and their relatives.

People who used the Strada Care service received care and support in a safe way. Staff understood their duty should they suspect abuse was taking place. Risks around people’s health and safety had been identified and clear plans and guidelines were in place to minimise these risks. Staffing levels were based on the support hours that people were funded for. There were enough staff to meet people’s needs. The provider used safe recruitment processes to ensure new employees were suitable to support people who use this service. Staff managed the medicines in a safe way and were trained in the safe administration of medicines.

People received effective care and support. Assessments of people’s needs had been completed prior to them using the service. This ensured staff had the skills, knowledge and training to be able to support them. People were supported to have enough to eat and drink, with a good variety of choices available to them. Where specialist diets were needed, staff ensured people were supported with these. People had access to health care professionals if they felt unwell, or if their support needs changed. People’s health and confidence were seen to improve due to the effective care and support they received.

Where people did not have the capacity to understand or consent to a decision the provider had followed the requirements of the Mental Capacity Act (2005). An appropriate assessment of people’s ability to make decisions for themselves had been completed. Where people’s liberty may be

Care Unlimited Domcare Ltd provides care and support to people living in four ‘supported living’ settings, so that they can live as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support. At the time of our inspection 21 people were living at the four locations.

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.

The inspection took place on 13 and 15 November 2017 and was unannounced. We carried out this inspection in response to concerns raised about the standard of care being given to people at one of the locations. At the time of the inspection a police investigation was ongoing with regards to how people’s monies were managed, and a local authority safeguarding process about allegations around staff conduct was also underway.

The lack of good leadership had an impact across all of the five key areas we looked at. It led to people experiencing inconsistent care and support, dependent on where they lived, and staff morale. It affected the safety of the service as medicines and risks where not always managed safely; it affected how effective the service was at meeting people’s needs; it affected how caring and responsive staff were; and how well the service was led. Three of the locations gave a better level of care and support, with the majority of our concerns being with the fourth location.

People were not always kept safe. Lack of safe management of people’s monies had put people at risk of financial abuse. Risks to people’s health and safety had been carried out, but the least restrictive option to keep people safe had not always been explored. Accidents and incidents had not been consistently reviewed to ensure the risk of them happening again was minimised. There were areas for improvement in how people’s medicines were managed.

The provider did not have effective systems in place to monitor the quality of care and support that people received. Quality assurance checks were completed on important aspects of the management of the home; however these had not been used to make improvements to the service that people received. Many of the issues identified by the provider’s consultant in April 2017 were still happening at the time of our inspection, seven months later. The provider had not ensured that notifications where sent to the CQC as required by their registration under the Health and Social Care Act. This meant we had not been told of some accidents and incidents, so could not assure ourselves that the provider had taken appropriate action.

People received the care and support they needed, however the care plans did not always reflect peoples current needs. Care plans were based around peoples support and medical needs and as such did not focus on people’s goals and aspirations, and how staff could support them to achieve them. People’s access to activities was inconsistent, with some receiving good support, and others not receiving activities that were scheduled.

Whilst staff were kind and caring and treated people with dignity and respect we heard one member of staff refer to people in a disrespectful manner. However the failures across the home demonstrated there was a lack of care and attention to following safe systems of work, and to meet the requirements of the Health and Social Care Act. There was positive feedback about the service and caring nature of staff from people who live here, and their relatives.

There were sufficient numbers of staff to meet the needs of the people. The manager regularly reviewed

Care Unlimited provides supported living services and a domiciliary care service for people in their own homes or in support living homes and bungalows in Epsom, Ashtead, Sutton, and Redhill in Surrey. People who used the service were living with a learning disability. On the day of our inspection the service was providing support for up to twenty two people with varied care packages from minimal hours to twenty four hours in a variety of settings, for people with a wide range of care needs.

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 and associated Regulations about how the service is run. The registered manager was present for the duration of the inspection.

People were safe. The service’s risk assessment process enabled people to take risks as safely as possible. The risk assessments identified risks and provided guidance for staff to manage these safely without compromising people’s independence.

Arrangements for the administration of medicines were in place which ensured that people received their medicines safely and in an appropriate way.

Staff recruitment processes were safe. Appropriate checks, such as a criminal record check, were carried out to help ensure only suitable staff worked in the service. Staff met with their line manager on a one to one basis to discuss their work. Staff said they felt supported and told us the registered manager had good management oversight of the service.

Staff received training specific to people’s needs. This allowed them to carry out their role in an effective and competent way.

Staff were aware of their responsibilities regarding safeguarding people from abuse and were able to tell us what they would do if they suspected abuse had taken place. They had access to a whistleblowing policy should they need to use it.

People’s privacy and dignity were respected. Staff were professional and polite and addressed people in an appropriate manner. Gender specific staff were provided for people who made a specific choice and people’s information was handled confidentially.

Staff supported people to keep healthy by encouraging them in their choice of nutritious foods. People were either supported or supervised in their menu planning and shopping.

People had access to health care professional and staff supported people to have regular health checks and to attend appointments and clinics as appropriate. When people became anxious or distressed they had the support of clinical experts for advice and guidance.

People were supported to take part in a range of activities which were individualised and meaningful for them. People were encouraged to maintain their independence and participate in community activities.

Staff had followed legal requirements to make sure that any decisions made or restrictions to people were done in the person’s best interests. Staff understood the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS).

There were sufficient numbers of staff provided to meet people’s needs and support their activities. Staff knew people well and understood people’s needs and aspirations. Staff were very caring to people and responded well to their needs.

The registered manager and project managers undertook quality assurance audits to reflect on practices and aid continuous improvement. Any areas identified as needing improvement were actioned by staff.

If an emergency occurred people’s care would not be interrupted as there were procedures in place to manage this.

A complaints procedure was available for any concerns. This was available in a format that was easy for people to understand. People and their relatives were encouraged to feedback their views and ideas into th

This was a follow up inspection because at our inspection on 18 November 2013 we found the registered person was not fully meeting the regulations set out in the Health and Social Care Act 2008. The registered person sent us an action plan telling us what actions they would take and gave 9 April 2014 as the date when they would become compliant with the regulations.

At this inspection we found the provider had taken appropriate steps to ensure that people who used the service were asked for their consent to care and treatment before this was undertaken. We also saw people who did not have capacity had an assessment in place in line with the Mental Capacity Act 2005.

We also noted at this inspection the provider had written a contingency plan that was service specific to replace a corporate procedure that was written for their care home settings. This is a plan to ensure that people would continue to be cared for in the event of an emergency.

We found that the provider was now compliant in the two outcomes we followed up

At the time of this inspection Care Unlimited Domcare was providing an active service to 19/20 people.

We spoke with the provider, registered manager, administration staff, care staff, three relatives of people who used the service and three people who received care from the service.

People who used the service that we spoke with said they liked the food and that the staff were nice and treated them well. People also told us about activities they were going to do that day, such as going out or shopping. One person told us about their recent birthday party supported by the agency.

The relatives of people who used the service told us they were involved in care planning and reviews, they were kept informed about any changes, contact was good, the staff were nice and they felt their relative was safe. People’s relatives also said they had no complaints but felt the staff were approachable and they would feel comfortable to raise any concerns and felt that they would be listened to. One person’s relative told us the manager and staff were brilliant, the building was always clean and that all the people at the supported living setting cared for by Care Unlimited looked well cared for.

We found that before people received any care or treatment they were not always asked for their consent and where people did not have capacity the provider did not always act in accordance within legal requirements.

We noted people experienced care, treatment and support that met their needs but there were no service specific written procedures in place to plan for all reasonable foreseeable emergencies, other than snow. This meant that if an emergency situation other than snow occurred, there would be no contingency procedures recorded to enable the agency to continue to provide safe appropriate care.

We found that the service had undertaken pre-employment checks with disclosure and barring services, had records of the staff’s photographic proof of identity, qualifications, interview, and contracts, and there were two references. However, we saw that reference requirements for all the staff files sampled contained insufficient evidence about being physically and mentally able to do the job safely, or being suitability to work with the client group, vulnerable adults. None of the six staff files samples contained this information.

We found that although the health and safety of people was reviewed and audited, there was no quality assurance system implemented to record the findings of quality questionnaires, analyse the results, identify action to improve quality, record those proposed actions and feed back to the people who use the service.

We spoke with two people that used the service who both told us that they liked the service and that they felt safe.

We spoke with four staff members that all told us they felt well supported in their roles. When asked about the service one staff member told us “We give people more independence, we don’t just do things for people we guide them to do things for themselves”.

We found that people’s likes, dislikes and preferences were recorded in their care plans and information about their usual routines. We found that people’s needs were assessed and a care plans put in place to ensure that their needs were met.

We saw that the provider had a detailed safeguarding policy in place and a flow chart was available to demonstrate the reporting process. We saw that people had risk assessments with actions for staff to take to reduce the risks associated with abuse.

We found that staff had regular meetings and supervision with their line manager. We saw that some staff were being supported to achieve qualifications that were relevant to their roles. We saw regular audits were carried out to enable the provider to assess and monitor the service.