We undertook an announced inspection of Surecare Doncaster on 9 and 10 July 2018. We gave the registered manager short notice that we would be coming because the location provides a domiciliary care service and we wanted to be sure the registered manager was available.

Surecare Doncaster is a domiciliary care service that provides personal care to people living in their own homes. It provides a service to children, younger and older adults in the Doncaster area.

The last inspection of Surecare Doncaster was on 18 July 2017. At this inspection the service was rated requires improvement. The registered manager sent us an action plan detailing the action they had taken to make sure they were meeting all regulations. At our inspection on 9 and 10 July 2018 we found the service had improved and it is now rated Good.

The service had 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.

Everyone spoken with told us they felt safe in the care of the staff at Surecare Doncaster. Based on feedback from people who used the service, relative and staff as well as our observations during this inspection, we identified there were adequate numbers of staff to safely meet people's needs.

Recruitment was appropriately managed as relevant background checks had been completed prior to employment, to ensure staff were safe to work with vulnerable people.

Risks to people had been identified, assessed and reviewed. Medication procedures were in place including protocols for the use of 'as and when required' (PRN) medicines. Staff had received training in medicines management and medicines were audited in line with the registered provider's procedures.

Where appropriate people were being supported to manage their money, for example, whilst out on activities. We found the financial record for one person had been incorrectly recorded. The registered manager and director dealt with this inaccuracy during and after the inspection so that they could be fully confident the person was not at risk of financial abuse.

Staff completed an induction and received ongoing support through a programme of supervision, appraisal and training.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff were pro-active in ensuring people were supported to access healthcare services and shared recent examples of working together with other healthcare professionals to deliver positive outcomes for people.

Staff were caring and compassionate and engaged people in friendly interaction, respecting their preferences and communication style. Relatives told us staff respected people's privacy and dignity and staff could describe how they managed this. People's cultural and religious needs were met by staff at this service.

People said they had their own regular care workers who knew them well and cared for them as agreed in their care plans. Each person's care plan was updated regularly and changes made where necessary.

People and their relatives felt able to report any concerns and said they were confident these would be dealt with.

The service asked people for their views and opinions about the service they had experienced via annual surveys. We saw evidence actions were put in place in response to people’s feedback.

There were systems in place to assess and monitor the quality of the service and to continually review such things as safeguarding concerns, accidents and incidents and near misses. Where improvements were needed, these were addressed and followed up to ensure continuous improvement.

Further informati

The inspection took place on 18 July 2017. We gave the provider short notice of the visit to the office in line with our current methodology for inspecting domiciliary care agencies. This was to make sure there would be someone in the office. At the last inspection of the service in April 2015, Surecare Doncaster Ltd was given an overall rating of ‘good’. At this inspection, the service was rated ‘requires improvement’ and we found two breaches of regulations.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for "Surecare Doncaster Ltd" on our website at ‘www.cqc.org.uk'.

Surecare Doncaster is a domiciliary care service. They are registered to provide personal care to people in their own homes. At the time of this inspection, 106 people were receiving support from the service.

There was a registered manager in post at the time of this inspection. 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 told us they felt safe and were protected from abuse by staff who were knowledgeable and had the right skills to meet their needs. People said they received high quality care and that staff treated them with dignity, respect, kindness and care.

Risk assessments relating to people’s health needs and the environment helped protect the health and welfare of people who used the service without placing any unnecessary restrictions on them. People were supported to maintain good health and referrals were made to healthcare professionals when required.

There were enough staff employed by the service to cover all care calls and meet people’s needs. However, travelling time was not always factored into care staff rotas which meant some care visits were shorter than the assessed and agreed times to allow staff to travel to the next call. We found that care visit arrivals and departures were logged, however the information was not monitored.

Pre-employment checks were not always effective and we identified some issues with documentation in staff files that needed to be addressed by the provider.

Arrangements were in place to ensure medicines were administered safely by staff who had received training in this area. Medication Administration Records (MAR) were checked each month to ensure no gaps or omissions were present.

The registered provider acted in accordance with the Mental Capacity Act and consent was sought from people and/or their legal guardian.

Although staff told us they felt supported, staff supervisions and appraisals did not always take place with appropriate frequency, or in line with the provider’s policies. There was no planned systematic approach to staff training, supervision and appraisal and no monitoring of this to ensure staff were appropriately trained and supported.

People were involved in their care and support planning. We saw information in care records relating to each person’s likes and dislikes, family life and favourite activities or pastimes.

There was a complaints procedure in place so people could voice their concerns if needed. People we spoke with said they had no need to complain but they knew how to complain if the need ever arose.

The service asked people for their views and opinions about the service they had experienced via annual surveys. We saw evidence actions were put in place in response to people’s feedback.

We found issues around the governance of the service as the systems to monitor the quality and safety of services provided did not cover all aspects of service provision and therefore was not effective. No monitoring was carried out of safeguarding concerns or accidents and incidents. Call monitoring systems were not used effectively and ca

We spoke with five people who used the service and eight relatives. People we spoke with were very positive about the standard of care they received. They told us care staff spoke to them in an appropriate manner and treated them with kindness. Comments included, "The care is very good, the staff can't do enough for you" "The care is fantastic, I can't fault it. Would definitely recommend the service to anyone" and "I would rate the care as very good. We get the same staff, they come on time and have never let us down."

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. We found people who used the service were encouraged to make choices in all aspects of their care, treatment and support. The provider acted in accordance with legal requirements where people did not have the capacity to consent.

There were effective systems in place to reduce the risk and spread of infection. People who used the service confirmed staff followed appropriate standards of hygiene. We found staff had a good understanding of their roles and responsibilities in infection prevention and control and were up to date with their training.

People were cared for, or supported by, suitably qualified, skilled and experienced staff. People we spoke with confirmed staff had the skills and competencies to meet their needs.

The provider had an effective system to regularly assess and monitor the quality of service that people received.

As part of our inspection we contacted eight people by telephone to discuss the service they received from the agency. Where people were unable to speak to us over the telephone we spoke with their representatives. People we spoke with told us they were satisfied with the care and support they received. Comments included: "The care is generally very good, it has improved in the last year. Continuity of care is important to me and this has been improved" " I receive very good care, staff always meet my needs" and "Very good care, the staff come on time and stay for their allocated time."

Evidence showed people's privacy, dignity and independence was respected. People told us staff were respectful, polite and caring.

We found people who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. People we spoke with confirmed they felt safe in the care of the staff.

People were cared for, or supported by, suitably qualified, skilled and experienced staff. Evidence showed the majority of staff had received appropriate professional development, training and supervision.

We found the provider had an effective system to regularly assess and monitor the quality of service that people receive. People who use the service, their representatives and staff were asked for their views about their care and treatment and they were acted on.

The inspection took place on 13 and 20 April 2015 with the provider being given short notice of the visit to the office in line with our current methodology for inspecting domiciliary care agencies. The service was previously inspected on 13 February 2014, when no breaches of legal requirements were identified.

Surecare Doncaster is a domiciliary care service. They are registered to provide personal care to people in their own homes. At the time of our inspection the service was supporting people with a variety of care needs including older people, people living with dementia and younger people with learning disabilities. Care and support was co-ordinated from the services office which is based on the outskirts of Doncaster.

There is a registered manager which manages the day to day operations of the service. 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 our inspection there were approximately 120 people using the service. We spoke on the telephone with 14 people who used the service and their relatives and we visited four people in their own homes. We asked people about their experiences using the agency. The majority of people we spoke with told us they were entirely happy with the service provided while a minority of people highlighted areas they felt could be improved.

People told us they felt safe in their own homes and staff were available to offer support when needed to help them maintain their independence. One person told us, “The staff are very good. They pop in to make sure I am safe; sometimes they will stay for a chat which is nice. A relative we spoke with said, “My relative gets on well with most of the carers but some more than others. Staff know to contact me at any time if there is a problem.”

People’s needs had been assessed before their care package commenced and they told us they had been involved in formulating and updating their care plans. We found the information contained in the care records we sampled was individualised and clearly identified people’s needs and preferences, as well as any risks associated with their care and the environment they lived in.

We found people received a service that was based on their personal needs and wishes. Changes in people’s needs were quickly identified and their care package amended to meet their changing needs. Where people needed assistance taking their medication this was administered in a timely way by staff who had been trained to carry out this role.

Overall we found the service employed enough staff to meet the needs of the people being supported. This included care workers who visited people on a regular basis. People who used the service raised no concerns about how the service was staffed. The majority of the people we spoke with confirmed they had the same group of care staff most of the time. However, eight people commented about having lots of different staff visit them, which they did not like.

People were able to raise any concerns they may have had. We saw the service user guide included ‘how to make a complaint’ This was written in a suitable format for people who used the service. One person said, “No complaints, the carers always see if there is anything I need doing and I would recommend them to anyone. I cleaned the top of my oven and was in agony afterwards and they told me off and said I should have left it for them to do. I give the service 10 out of 10.”

People were encouraged to give their views about the quality of the care provided to help drive up standards. Quality monitoring systems were in place and the registered manager had overall responsibility to ensure lessons were learned and action was taken to continuously improve the service.