Supreme Care Services Limited is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. CQC only inspects the service being received by people provided with ‘personal care’, that is help with tasks related to personal hygiene and eating. Where they do this, we also take into account any wider social care provided. At the time of our inspection seventy-eight people were using the service.

At our last inspection of the service in May 2016 we rated the service ‘Good’. This inspection took place on 19 November 2018. At this inspection we found the evidence continued to support the rating of ‘Good’. There was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People told us they were safe with staff. Staff had been trained to safeguard people from the risk of abuse and knew how to report any safeguarding concerns about people to the appropriate person and agencies. Staff understood the risks posed to people and followed current guidance about how these should be minimised to keep people safe from injury or harm. Staff followed good practice to ensure risks were minimised from poor hygiene and cleanliness.

There were sufficient numbers of staff to meet people’s needs. The provider made sure, wherever possible, people received support from the same staff to ensure continuity and consistency in the support they received. The provider maintained recruitment and selection processes and carried out appropriate checks to verify staff's suitability to support people.

People’s needs had been assessed to determine the level of support they required, and this was delivered in line with current legislation and standards and current best practice. Staff received relevant training to help them meet people’s needs. They were encouraged to continuously improve their working practices through regular supervision. Staff were aware of their responsibilities in relation to the Mental Capacity Act 2005 (MCA) and supported people in the least restrictive way possible. The policies and systems in the service supported this practice.

People were involved in planning and making decisions about their care and support package. People’s records contained current and detailed information about them and reflected their preferences and choices for how and when they received support. Staff knew people well, understood their needs and how these should be met. People’s care and support needs were reviewed with them to ensure this was continuing to meet their needs.

Staff supported people to eat and drink enough to meet their needs and keep healthy and well. People received their prescribed medicines as required. Staff communicated with others involved in people’s care so that they were well informed about people’s health and wellbeing, particularly if there were concerns about this. The provider worked closely with other healthcare professionals to ensure a joined-up approach to the support people received.

The provider promoted compassionate, respectful and empathetic behaviours within the staff team. They had introduced initiatives to reduce the risk to people, with no immediate family and friends, of becoming socially isolated. Where staff were responsible for this, they supported people to take part in activities or pursue interests that were important to them.

Staff were caring and treated people with dignity and respect. They asked people for their consent before care was provided and ensured people's privacy was maintained when being supported with their care needs. People were encouraged by staff to be as independent as they could be. Staff only took over when people could not manage and complete tasks safely.

People were satisfied with the care and support they received from sta

We carried out an inspection of Supreme Care Services on 31 May 2016. This was an announced inspection where we gave the provider 48 hours’ notice because the location provides a domiciliary care service and we needed to ensure someone would be available to speak with us.

Supreme Care Services Limited is a domiciliary care agency providing care and support to people in their own homes. The agency supplies care staff both as direct private arrangements, and through a contract with the London Borough of Croydon. At the time of our inspection150 people use the agency, including older people and adults with physical disabilities.

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 time of inspection the registered manager was on leave and an acting manager was in place.

At the last inspection on 29 May 2015 we found the provider was not meeting the regulations in relation to ensuring adequate staff training, supervision and appraisal. We also found there were breaches in regulations concerning the provision of person-centred care and having quality assurance systems that enabled the service to evaluate and develop the quality of their service.

We asked the provider to submit an action plan detailing the improvements to be made.

These actions have been completed and on this inspection we found that the relevant requirements were being met.

People who used the service told us they felt safe. Staff had received training about safeguarding and knew how to respond to any allegation of abuse. Staff were aware of the whistle blowing procedure which was in place to report concerns and poor practice.

There were sufficient staff employed to provide consistent and safe care to people, with people receiving care from the same small team of staff.

People received their medicines in a safe way and staff had received training in the types of medicines people received. Staff recorded medicines taken by people in an appropriate medicines record sheet.

Staff had received training and had a good understanding of the Mental Capacity Act 2005 and Best Interest Decision Making, when people were unable to make decisions themselves. They also received other training to meet people’s care needs.

Staff helped ensure people who used the service had food and drink to meet their needs. Some people were assisted by staff to cook their own food and other people received meals that had been prepared by staff.

Staff knew people’s care and support needs. Care plans were in place detailing how people wished to be supported and people were involved in making decisions about their care. There were regular visits and spot checks carried out by the service to monitor the quality of service and the care practice carried out by staff.

People told us that staff were kind, caring and efficient.

People who received care remained independent and in control of their decision making and choices. People had access to health care professionals to make sure they received appropriate care and treatment. The service maintained accurate and up to date records of people’s healthcare and GP contacts in case they needed to contact them.

A complaints procedure was available and people we spoke with said they knew how to complain, and how to contact the main office. The service maintained records of compliments and complaints and recorded how these were resolved.

People had the opportunity to give their views about the service. There was regular consultation with staff, people and/or family members and their views were used to improve the service. Regular audits were completed to monitor service provision and to ensure the safety of people who used

This inspection took place on 29 May 2015 and was announced. We told the provider four days before our visit that we would be coming.

A previous inspection of this service had been carried out on 3 December 2013. During that inspection we found that people’s care plans were not always followed where two care staff were required to operate equipment. At the inspection carried out on 29 May we found that this had improved, and that people were satisfied with the help they were given in this respect.

The inspection of 3 December 2013 also found that appropriate risk assessments had not always been completed for people who had specific health care needs. The inspection of 29 May identified improvements in this area with better assessments and care plans and closer liaison with external healthcare workers. The field supervisor ensured that assessments included health and social care needs and that information from the local authority was included in care plans.

The inspection of 3 December 2013 had found that the provider did not have effective systems in place to identify, assess and manage risks to the health, safety and welfare of people using the service and others. The inspection of 29 May found that improvements had been made and that such systems did now exist.

The inspection of 3 December 2013 had found that the provider had poor recording systems and that they had failed to notify the Care Quality Commission of incidents or safeguarding issues as required. The inspection of 29 May found that improvements had been made in these areas, with securely held records and notifications having been received by the Care Quality Commission.

Supreme Care Services Limited is a domiciliary care agency providing care and support to people in their own homes. The agency supplies care staff both as direct private arrangements, and through a contract with the London Borough of Croydon. 150 people use the agency, including older people and adults with physical disabilities.

The service had 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.

At the time of inspection the registered manager was on leave and an acting manager was in place. The responsible individual was also aware of our inspection visit as we had given notice in advance to allow them to participate if they wished.

People and their relatives told us they felt safe and that staff treated them well. There were processes in place to help make sure people were protected from the risk of abuse and staff were aware of safeguarding adults procedures and understood how to protect the people they supported.

Risk assessments were carried out to evaluate any risks to the person using the service and to the staff supporting them. This included environmental risks and any risks to the health and support needs of the person.

People were asked to give their consent for care and we saw signed consent forms in people’s care records. Staff told us how they always asked people for their consent before assisting them.

All of the people we spoke with told us staff were caring, kind and treated them with respect and dignity. Staff had a good knowledge of the people they were caring for and supporting. Staff knew the content of people’s care plans and were familiar with people’s needs and how they liked to be cared for.

People we spoke with told us they felt involved and included in deciding and planning their care. People had care plans in their home and knew what they were for.

Staff were aware of people’s preferences and interests, as well as their health and support needs, which enabled them to provide a personalised service. People were asked about their views and experiences. Details of reviews and visits to check the quality of care people received were kept at the service.

Most of the people we spoke with told us that any problems existed more at the weekend than during the week. Problems included lateness, different care staff from regular staff and difficulties with getting through to the office.

The acting manager informed us that systems were being updated to enable staff to work in patches and that staff working in pairs would ensure they arrived at the person’s home together. The acting manager hoped that this would reduce instances of lateness.

Everyone we spoke with had positive things to say about the staff and their attitude, and were happy that there was a culture which was honest about mistakes, treated people with respect and compassion and involved people in the care that was provided.

However, most people and relatives we spoke to were unhappy about the lack of physical communication from the office, particularly with regard to being able to get in touch with the office and with the lack of communication from the office when things were going wrong, for example when care staff were going to be late.

We were not able to learn how the provider used feedback from people to improve and develop the service. The service was unclear as to what happened afterwards, how the feedback and experiences were discussed between staff and how ideas for improvement were shared.

We found breaches in relation to staff training and support. We found inconsistencies with regard to the type and frequency of training provided to staff and we could not be sure that all staff received the appropriate amount or type of training necessary to enable them to carry out the duties they were employed to perform. There was also insufficient evidence that staff received effective supervision or appraisals.

We found breaches in relation to the provider’s quality assurance systems where the current systems failed to demonstrate that the provider had effective ways of evaluating and improving their service.

We have made a recommendation that the provider review and strengthen the arrangements it has with regard to learning from concerns it receives from people about the quality of care.

You can see what action we told the provider to take at the back of the full version of the report.

At the time of our inspection we were told that there were approximately 100 people using the service and 30 to 40 staff employed. We visited the agency and met with two office staff and two of the care staff. We spoke by telephone with eighteen people who used the service or their relatives. We also spoke to a further three members of care staff, the local authority commissioning service and a member of the local authority safeguarding team.

Some of the feedback was complimentary about the care and services currently provided. People told us that the carers did a good job and were polite and respectful. One person said the carers are “friendly and engage with mum in conversation.” Another said “They do the best they can and sometimes they will stay a little later.”

However other people’s experience of the care provided was not as positive and people told us that the care workers were sometimes late and they were not always kept informed by the office. We looked at the care records at the agency and saw that important details were not always recorded on the care plans. Staff were not always provided with sufficient guidance on how to provide care, particularly for people with more complex needs. Important details about people's health was not always recorded in the care plan. This meant at times people were at the potential risk of inappropriate or unsafe care.Some people or their relatives told us the care received had sometimes not been carried out in accordance with the care plan. People were therefore sometimes exposed to potential risk at times

Staff were aware of safeguarding policies and procedures and had received appropriate safeguarding vulnerable adults training. We found that a safeguarding issue arose in the course of our inspection which the provider failed to notify us about in accordance with the regulations.

Staff we spoke with seemed knowledgeable about infection control. There were infection control policies and procedures in place. While the provider had systems in place for quality assurance we found that there were some gaps in carrying these out and problems were not always picked up. In addition, where issues were picked up there was insufficient evidence that these were always adequately addressed.

The provider had a complaints procedure in place and although the policy was out of date they had responded to most complaints effectively. We found there were issues with the electronic recording system on the day of the inspection which were taking some time to resolve. Other records were not always accurate or available or up to date.

At the time of our inspection, there were approximately 75 people using the service and thirty care staff employed. There was a new manager in post whose application to register with us was being assessed. We visited the agency office, we spoke by telephone with ten people who used the service or their relative’s and five members of care staff.

Some feedback was complimentary about the care provided. People felt staff were caring and treated them with dignity and respect. They told us they had regular carers and were kept informed about changes. Comments included, the “girls (carers) that come are excellent,” “my carer understands me,” and “my carer does a wonderful job”. However others had experienced difficulties with late calls, particularly, at the weekends and in being kept informed of changes by the office. We were told that the service had identified an issue with weekend care and recently recruited new staff to address this.

We looked at the records at the service and spoke to the local authority commissioning and safeguarding teams. We were informed that there had been some issues in previous months about staff recruitment and response to safeguarding concerns. We saw that the service had addressed these issues with them and employed more office staff to co-ordinate care. Staff told us that they felt well supported from the office and received appropriate training. There had been some improvements made to the quality monitoring of the service.

We contacted people who use the service and their relatives by telephone to ask them about the service they received.

Overall comments about the service included ‘my relative has been satisfied’, ‘very good’, ‘they are nice to me – they always leave me with a cup of tea’, ‘I’m quite happy with the way they are doing things’ and ‘the care has been brilliant’. One person said ‘they help me to carry on with life’.

Feedback from people who use the service about staff included ‘the carers are smashing’, ‘they are nice’, ‘the carer has a good understanding of how I like things to be done’ and ‘very very good’.

We asked people if they had a consistent carer providing care and support. Comments included ‘it’s settled down – we now have the same girl’, ‘95% the same’, ‘I do get different people but they are very good’ and ‘I get the same carers unless they are on holiday’.

Feedback from the Local Authority was that the agency could further improve its communication with people who use the service and their relatives. This included making sure any concerns are dealt with promptly. One person we spoke to also expressed their concerns about the ability of the office to respond effectively to issues raised with them