About the service:

¿ Supreme Care Services Limited is a domiciliary care agency. It provides personal care to mostly older people living in their own homes in the London Borough of Ealing and the London Borough of Brent. At the time of our inspection the service was providing care and support to 157 people. For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

People’s experience of using this service:

¿ There were enough staff deployed to support people and staff arrived on time at people’s homes. Some people told us this had not always been the case over the last year, but they thought this situation had improved now.

¿ Staff were caring, treated people with respect and promoted people’s dignity and privacy.

¿ The service had set up a local coffee morning for people who used the service and were living in Ealing so they may feel less socially isolated.

¿ People told us that they felt safe. There were processes to ensure people received safe support with their medicines and they were protected from the risks of infection.

¿ Care and risk management plans were individual and met the needs of people using the service. Staff were aware of the people’s individual needs and how they wanted to be supported.

¿ Staff received induction, training and supervision. There was a clear management structure and staff felt supported in their roles.

¿ The provider sought feedback from people, relatives and staff and used this to develop the service.

¿ There were systems in place to monitor the quality of the service and identify when improvements were required.

Rating at last inspection:

¿ We rated the service “good” at our last comprehensive inspection. We published our last report on 14 June 2016.

Why we inspected:

¿ This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Follow up:

¿ We will continue to monitor intelligence we receive about the service until we return to visit as

per our re-inspection programme. We may inspect sooner if we receive any concerning information regarding the safety and quality of the care being provided.

This inspection took place on 09 May 2016. Our last inspection of the service was in July 2014 when we found it was meeting all of the standards we inspected.

Supreme Care Services Limited provides care and support to 51, mainly older people, who live in their own homes in the London Borough of Ealing. The service has two registered managers. 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 using the service and their representatives told us they felt safe with their care workers.

Care workers supported people to manage their medicines safely.

The provider carried out checks to ensure new care workers were suitable to work with people using the service.

The provider organised training, supervision and team meeting to support care workers.

People using the service were involved in planning the care and support they received.

Care workers supported people to maintain a healthy diet.

People received care and support from care workers who knew and understood their needs.

People’s support plans covered their personal, social and health care needs and detailed the support their care workers provided on each visit.

People told us their care workers listened to them, and gave them time to express their views and preferences about the way their care was delivered.

People using the service and their care workers told us they felt able to approach the management team and felt valued by them.

The provider had systems to monitor the quality of the service that people received and to make improvements.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service caring?

• Is the service responsive?

• Is the service safe?

• Is the service effective?

• Is the service well led?

Below is a summary of what we found. The summary is based on discussions with management during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were asked for their consent to the care and support provided. Staff received training in how to engage with people and ensure their agreement before delivering personal care and respect people’s right to refuse care if they wished.

Systems were in place to make sure that accidents and incidents were reported along with complaints and other concerns, and that action was taken when required. This reduced risks to people and helped the service to continually improve its performance.

There were procedures for managing emergencies and staff were aware of relevant contact details to access help and support.

Recruitment practice was safe and thorough and ensured that suitable checks were in place with regard to qualifications, employment history, identity and criminal records. There was suitable induction training for new staff and on-going supervision checks to ensure that staff carried out their duties safely.

Is the service effective?

People using the service experienced care that was planned and delivered to meet their needs and mitigate any risks. People using the service and their relatives were involved in the development of their care plans.

Care needs were reviewed on a regular basis and care plans were modified when needs changed. Records showed that the care delivered reflected the current care plan. There were regular checks and systems to monitor the care delivered and ensure that quality was maintained.

The people we spoke with told us that their care workers were generally punctual and carried out their duties effectively, although two people commented that delays were not always communicated or managed effectively.

The provider recruited and trained staff that were suitably skilled and qualified to fulfil their roles.

Is the service caring?

People we spoke with were generally satisfied with the care and support they experienced.

One person told us, “I’m very well looked after and they provide the care I require.”

Staff we spoke with were aware of the importance of communicating clearly and offering people choices in how their care was delivered.

People we spoke with told us their care workers were kind and gentle although one person told us that the staff who supported them did not always respect their preferences, and remarked, “I’m not always able to have the food I would like as some care workers refuse to prepare certain foods such as pork”. Another person commented that they found it difficult to communicate effectively with some care workers who did not have English as a first language, saying, “They’re very kind but communication is sometimes a problem”.

Is the service responsive?

People using the service received an annual satisfaction survey in which they were asked to rate the quality of the service they received. Results of the latest survey indicated a good level of satisfaction with the service.

The provider made regular telephone calls to people using the service during which people were encouraged to express their views.

There was a written complaints procedure which was readily available for people using the service. All complaints had been recorded and were managed correctly with appropriate action taken when necessary.

Is the service well-led?

The provider had a variety of systems to monitor the quality of service provided and audit their performance.

People using the service and their relatives were provided with information about the service and were contacted regularly to obtain their feedback and views.

There were appropriate procedures for dealing with complaints and reporting accidents and incidents.

Managers conducted regular checks at the homes of people using the service and by telephone to ensure the care delivered was of good quality and in line with needs.

We spoke with five people using the service, five care workers and the agency’s acting manager. People told us they felt well cared for and supported. Their comments included “everything works well, the carer is good” and “the carers are very good, always on time.”

People had care plans that detailed their needs and how these would be met by their care workers. Care workers completed daily logs to show the care and support people received. This showed that people using the service received the care detailed in their care plans.

The provider had taken steps to make sure people were cared for safely. A policy and procedures were in place and care workers received training in safeguarding people using the service.

Care workers told us they felt the agency provided good training to help them work effectively. They also said they felt supported by managers and senior staff. Comments from care workers included “they are a good agency, the training’s good” and “I’ve had all the training I need and it is repeated regularly.”

The provider had procedures in place for responding to complaints from people using the service and others. Complaints were recorded and investigated. However, one person using the service said “they could deal with complaints a bit better.”

We carried out this inspection to follow up issues identified at our last inspection in September 2012. We spoke with the agency’s manager and reviewed information he provided. We did not speak with people using the service as part of this follow up inspection.

We found that the care needs of people using the service were assessed and recorded in their care plans. We saw that each person’s care plan had been reviewed and updated by the agency between November 2012 and January 2013. Risk assessments had also been reviewed and updated.

The service had procedures for monitoring the quality of services provided to make sure that people using the service received the care and support they needed.

People told us staff were polite, treated them with dignity and respect and most people said staff listened to them and provided the care they wanted. Most people said they were happy with the care people received and the staff providing it. Comments received included “the carers are very good and I am very well looked after” and “they are very good and I like them”.

Most people told us they could raise any concerns with the agency or with social services. Where people had been unhappy with the service they had been able to take up their issues with the care agency or social services. Some people commented there could sometimes be a slow response from the 'out of hours' service.

Where people needed equipment to meet their moving and handling needs, some said staff were well trained and understood how to use the equipment and others said they did not know if staff had received training. Staff confirmed they had received training and the branch manager was planning training updates.

Some people said they had received satisfaction surveys but others had not received surveys or telephone calls to ask their opinion about the care they received. Although the majority of people were happy with the care being provided, some said they were sometimes dissatisfied and had not been consulted to get their views. Records were not always complete and up to date.

We spoke with three people using the service, four relatives who cared for people using the service and eight staff.