This inspection took place on 13 December 2018 and 11 January 2019. Both days of the inspection were announced. The last inspection of the service was in September 2016. At that time, the service was rated good and there were no breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At this inspection the rating of the service had deteriorated to requires improvement.

SureCare Services (Wessex) is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults and adults living with dementia or a physical disability, a mental health disorder or sensory impairment.

Not everyone using SureCare Services (Wessex) receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

There was a registered manager in post. They had worked at the service for approximately 20 years. 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 available throughout the inspection.

At this inspection, we found management responsibilities had not always been fulfilled effectively. This was because audits had not identified some shortfalls and sufficient action had not always been taken.

During the period of the inspection, an allegation of abuse was made. The registered manager took appropriate action regarding the alleged abuser but did not review the procedures and the support of others, in relation to the allegation. This did not ensure additional safeguards were put in place.

People’s medicines were not always being safely managed. Information was not available to staff to ensure ‘as required’ medicines were administered as prescribed. Staff had not consistently given a person their pain relief as they believed it made them sleepy. A review of the person’s medicines had not been requested.

Not all staff had completed up to date training in topics such as the safe handling of medicines, safeguarding and moving people safely. This did not ensure staff had the required skills to support people safely and effectively. Not all staff had been regularly observed whilst working with people. This lack of supervision did not demonstrate staff were working in line with management expectations.

People’s support plans, whilst regularly reviewed, varied in their content. Some information was detailed and showed people’s preferred routines. Other information was not as clear and follow up action was not always documented.

People received a reliable service, which was responsive to their needs. They were supported at a time that was convenient to them. There were no concerns about missed or late visits.

People were supported by a single member of staff or small team. This enabled established relationships to be built. Staff knew people well and were clearly aware of their needs. People were complimentary about the staff supporting them.

New staff were safely recruited. Staff received a comprehensive induction to help them become familiar with their role. Staff felt well supported and were complimentary about the registered manager and their management style.

There was a strong, caring ethos and people were treated with kindness and compassionate. Staff promoted people’s rights to privacy, dignity and independence.

People were fully assessed before being offered a service. This enabled people to discuss their requirements and be assured the service could meet their needs.

People were encouraged to make decisions and direct their suppor

We inspected Sure care Wessex on 05 September 2016. Sure care Wessex is a domiciliary care service and provides support and personal care to people living in their own homes. At the time of this inspection around 50 people were supported by the agency.

There was a registered manager in post at 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.

People told us they felt safe and the support they received was good. Staff knew how to assist people to maintain their safety. Staff understood their responsibility to protect people from harm and abuse and they knew how to report any safeguarding concerns appropriately. Individual risks around people's condition and their environment were assessed and recorded.

The provider had systems in place for the safe administration of medicines. People were supported to receive their medicine when needed. People were supported to maintain good health and were assisted to access to health services when required.

People were cared for by staff that were knowledgeable about their roles and responsibilities and had the relevant skills and experience. Staff received training required for their roles and they told us they were well supported by the management team. There were sufficient staff to meet people's needs and people received their support as planned.

Records relating to the recruitment of new staff showed relevant checks had been completed before staff worked unsupervised with people.

The staff followed the requirements of the Mental Capacity Act 2005 (MCA). This protected the rights of people who may not be able to make important decisions themselves. People benefitted from staff that understood and implemented the principles of the act. People told us they were involved in making decision about support they received.

People told us they were able to form caring relationships with the staff and that staff respected their dignity and privacy. People's confidentiality was respected and their independence was promoted.

People's needs were assessed prior to commencement of the service to ensure their needs could be met. People's care records contained details of people's personal preferences, likes, dislikes and health needs. People's care plans were up to date and reflected people's current needs.

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The registered manager sought people's opinions using satisfaction surveys and spot checks. People told us they knew how to raise concerns and they were confident any issues would be promptly addressed.

The management regularly audited the quality of service delivered. The registered manager had a system to monitor the accidents to identify any trends or patterns. There was an open and positive culture at the service and clear lines of accountability. Staff commented they felt valued and they enjoyed working at the

service.

We visited four people and a relative who used the service and spoke with three other people and a relative by telephone. We spoke with six members of care staff and the manager about the service they provided.

All of the people we spoke with said they were highly satisfied with the service they or their relative received. They told us they usually had regular care staff who knew them and their care requirements. One person said “top class! Excellent! The girls are so friendly. I get the care that I want. They do more than they have to.” Another person told us “lovely. It’s (the care) like heaven. They (staff) are so friendly. I’m always glad to see them come in. We have a bit of banter. They’re like part of the family.” People told us they appreciated the reliability of the care staff and that they were informed if their carer was going to be late.

The staff we spoke with were knowledgeable about the people they cared for. They were able to describe people’s care needs which were in line with the care plans we looked at. Staff gave us examples of how they ensured people consented to the care they received.

We saw from people’s care records there was regular contact with other health care provider’s to enable safe, effective care.

The provider had a system to ensure the safe administration of medicines.

Overall the provider had an effective quality monitoring system.