This was as unannounced inspection on 22 October 2018.

Sunbury is a domiciliary care agency that provides care to people living in their own homes as well as ‘live-in’ care. It provides a service to older people, some of whom may have a physical disability or are living with dementia. At the time of our inspection the service provided a regulated activity to 23 people. At the previous inspection the service was rated Good.

There was a registered manager in post at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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, however risks to people were not always fully assessed and did not provide clear guidance to staff to help reduce the risk of harm to people. Accidents and incidents were not always being recorded by staff. When incidents did occur, there was no analysis being completed to reduce the risk of them happening again. People received their medicines however they were not always managed safely. Medicines Administration Records were checked but not routinely audited to identify errors.

When people first started using the service there was not always a pre-admission assessment completed. This meant there was a risk that the service might not be the most suitable placement for them.

Care plans did not fully reflect people’s needs and interests and had not been reviewed regularly to ensure they were up to date. End of life care planning was not always being completed. Whilst there had been no complaints since the last inspection the complaints policy needed to be updated so people would be aware who they could raise concerns with and a timescale for response.

Audits of the quality of the service were not always taking place to identify areas for improvement and to provide assurance that staff were staying for the correct time at visits. Feedback from people was received and an annual questionnaire completed however the results were not always acted upon.

There were sufficient numbers of staff working at the service and recruitment processes were robust. Staff understood what they needed to do to protect people from the risk of abuse. Staff followed safe infection control practices.

The principles of the Mental Capacity Act were being followed and staff ensured that they gained consent from people before delivering care. Staff had the necessary training and supervision required to carry out their role effectively. People and relatives told us staff were competent and knew people’s needs well in order to deliver the care required. Staff worked with health care professionals to ensure that people were supported with the health care needs. This included being supported with their food and hydration needs.

People and relatives felt that staff were very caring and respectful, treated them with dignity and upheld their privacy. People felt that staff assisted with their independence and included them in any decision-making. People and relatives developed positive relationships with staff.

People, relatives and staff thought the leadership of the service was good and were confident any concerns would be acted upon where necessary. Staff told us they felt supported and valued and they understood the need to provide a good service to people. The service worked closely with other agencies outside the organisation. The registered manager knew what they needed to do should there be a notifiable incident.

There were three breaches of regulations. See the end of the report for actions that we have taken.

This was an announced inspection that took place on 3 November 2015.

The agency provides personal care to people living in their own homes. It is located in the Twickenham area. There were 24 people using the service.

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.

This was the first inspection since a move to new premises and met the regulations.

People said the service provided was what they required and met their expectations. The designated tasks were carried out to their satisfaction, they felt safe and the staff team and organisation really cared. They thought the service provided was safe, effective, caring, responsive and well led.

The service kept up to date records that covered all aspects of the care and support provided for people, the choices they had made and identified and met their needs. The information was clearly recorded, fully completed, and regularly reviewed. This enabled staff to perform their duties well.

Staff where knowledgeable about the people they supported, the way they liked to be supported and worked well as a team. They provided care and support in a professional, friendly and skilled way that was focussed on the individual and their needs. They were well trained, knowledgeable and accessible to people using the service and their relatives. Staff thought the organisation was a good one to work for and they enjoyed their work. They had access to good training, support and there were opportunities for career advancement.

People and their relatives said they were encouraged to discuss health and other needs with staff and had agreed information passed on to GPs and other community based health professionals, if required. Staff protected people from nutrition and hydration associated risks by giving advice about healthy food options and balanced diets whilst still making sure people’s likes, dislikes and preferences were met.

The agency staff knew about the Mental Capacity Act and their responsibilities regarding it.

People said the management team and organisation were approachable, responsive, encouraged feedback from them and consistently monitored and assessed the quality of the service provided.