This inspection took place on 8 August 2018 and was unannounced. This was the first inspection of the service since their registration.

This service 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.

Not everyone using Surrey 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.

At the time of our inspection there were 19 people receiving personal care, which had been in operation for a short time, with earliest delivery having commenced in March 2018. The service covered the geographical areas of Slough and Kingston.

Both the director of the service, and the care co-ordinator were operating as 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. The director told us the registration of both managers was an interim measure until the care co-ordinator was settled in post, and told us they would be applying to cancel their registration in due course.

At this inspection we found that the provider was in breach of the regulations relating to safe care, staffing, person-centred care and good governance. You can see the action we have told the provider to take about these breaches at the back of the full version of this report.

Some improvements were required to ensure that systems at the service were safe and effective. The provider needed more time to embed quality assurance systems, and enable full audit of how people’s needs and care delivery were recorded. The governance framework was clear, however this was not always adhered to ensure that performance was appropriately monitored. The provider did not always ensure that regular staff competency checks were conducted and fully recorded to reflect staff compliance.

Staff recruitment checks did not include records of staff employment history, details of professional and/or character references or records of staff recruitment interview outcomes.

The service was not always able to attend all visits in a timely manner to ensure that all duties were carried out when people needed them. People’s capacity and ability to understand and consent to the requirements of their care was not always clear. People are not supported to have maximum choice and control of their lives and staff do not support them in the least restrictive way possible; the policies and systems in the service do not support this practice People’s care plans did not always fully reflect what people could do for themselves, nor did they always reflect people’s views on how they wished for their care to be delivered.

People’s risk assessments did not cover all potential areas of risk, such as skin integrity and nutrition.

People’s care plans did not include a record of people’s medicines and what they were for, therefore there was not always clear guidance in place to support staff. We found gaps in people’s medicines administration records (MAR), and that they did not always reflect full details of the medicines that people were prescribed.

We also made a recommendation for the provider to streamline their care plan and risk assessment paperwork to ensure that all areas of presenting need were covered.

The provider had appropriate systems in place to support staff to raise any safeguarding concerns, and the provider was open in learning lessons from incidents and improving the service. Staff had access to appropriate personal protective equipment (PPE) to help prevent the spread of infection.

Systems were in plac