The inspection took place on 17 November 2017 and was announced. Our last inspection was in July 2016 where we identified two breaches of regulations relating to risk assessments and governance. At this inspection, the provider had made improvements to meet the requirements of the regulations.

Surrey Children’s Domiciliary Care Service provides support to children with a range of disabilities who have been assessed by a social care team as requiring a personal care service within the family home. Staff supported children with physical disabilities, learning disabilities, autism and managing their behaviours.

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 children who live at home with their families. At the time of our inspection, the service was supporting 35 children.

There was 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.

Risks to children were routinely assessed with clear plans in place to keep them safe. There had been very few accidents or incidents, but staff responded appropriately where they occurred. Staff understood their roles in safeguarding children and we saw evidence of staff responding to concerns correctly. The service regularly played a role in multi-agency plans to keep children safe. Consent was sought from parents or children where they were old enough. Staff understood when the Mental Capacity Act (2005) could apply to the care that they delivered.

Staff worked alongside healthcare professionals and relevant agencies involved in children’s care. Where staff administered medicines, they had been trained to do so and clear records were kept in this area. Children, families and staff had access to support in the event of a child receiving end of life care. Relatives told us that staff were on time and they observed staff following good infection control practice on visits.

Children’s care was delivered in a way that met their needs, preferences and family routines. Staff supported children to attend schools and activities as well as to go on outings and to play. Children’s care was regularly reviewed and any changes were actioned by staff. Children and their families were regularly consulted in the quality of the care that they received. The provider had a clear complaints policy and relatives knew what to do if they wished to raise concerns.

Staff had the training that they needed to support them in their roles. Staff spoke highly of the management at the service and said that they felt supported and had opportunities to make suggestions. The provider had systems in place to enable effective communication between staff and ensured staff had access to secure, up to date records.

Staff routinely ensured children and their families were involved in their care. Choices were offered in line with routines and preferences and relatives told us that staff were respectful when entering their homes. The management had a clear vision for the service and an ongoing plan was in place to improve the service and deliver high quality care.

Surrey Children’s Domiciliary Care Service provides support to children with a range of disabilities who have been assessed by a social care team as requiring a personal care service within the family home. Staff support children with disabilities ranging from physical, learning disabilities, multiple disabilities, autism and challenging behaviours.

The support children received was for tasks such as accessing leisure activities support in the home and to offer their family respite. There were 50 children who received support with their personal care (the regulated activity) at the time of the inspection.

The service was run by a registered manager. The registered manager was off sick on the day of our 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 and associated Regulations about how the service is run. The service had an interim manager (acting up) in post; the person was originally a Domiciliary Care Co-ordinator. The day to day management of the service is completed by the Domiciliary Care Co-ordinators.

The service was not always safe. Staff did not always have written information about risks to children and how to manage these. Risks were identified but a management plan was not always in place. For children who had behaviours that challenge, staff did not have guidance in place to ensure that they kept themselves, others and the child safe. When incidents and accidents occurred, the registered manager had not always followed up on the actions.

The service was not always well led. There were not robust systems in place to monitor, review and improve the quality of care for children and their families. The service did not have a policy on the storage of personal records and some were stored away from the registered office.

The service was responsive. The service completed a care plan and risk assessment on the initial meeting with the child and family. However we recommend that an improvement could be made with regards to the documentation and complete of assessments on pre-admission and on going as required.

Children’s medicines were administered and stored safely. Staff were trained in the safe administration of medicines and kept relevant records that were accurate. There were guidelines in place to tell staff how to administer emergency and as required (PRN) medicines.

Children were protected from avoidable harm. Staff received training in safeguarding children and were able to demonstrate that they knew the procedures to follow should they have any concerns.

There were systems in place to ensure that staff employed were recruited safely. There were enough staff to meet the needs of people.

The Mental Capacity Act 2005 is not applicable to children below 16. For those children aged 16-17 the manager had ensured that the requirements of the MCA had been followed. Family members had consent on the child’s behalf to the care provided.

Children were supported to eat healthy, balanced diets in line with their dietary requirements and their choice. For children who needed extra support with feeding or used a percutaneous endoscopic gastrostomy (PEG) for their nutritional and fluid needs, staff had training.

Children were supported to maintain their health and well-being. People had regular access to health and social care professionals.

Staff were trained and had sufficient skills and knowledge to support children effectively. There was a training programme in place and training to meet children’s needs. Staff received regular supervision and had an annual appraisal.

Positive and caring relationships had been established with children and their families. Consistent staff supported the children.

Children, their families’ and other professionals were involved in pl

We found that that the service had many areas of good practice but there were some areas where there could be improvements.

At the time of this inspection Surrey Childrens Domiciliary Care Service was providing care to 68 children and young people.

We spoke with the registered manager, three care coordinators, five care staff, and eight parents of the children and young people who used the service.

The parents of the children and young people who used the service we spoke with all made very positive comments about the staff and care they provided and had no concerns.

Three parents said their child was always happy to see the support worker.

Parents all said that the service communicated well with them, support staff were caring, usually on time and care was almost always provided by staff who knew their child and their communication methods well. They said their child got on with the worker and they were very happy with the consistency of staff and the service they received.

Parents told us that support workers always asked or made their child aware before moving them or providing support, so their child knew what was about to happen to them and was not startled or confused.

We found that before children and younger people received any care or treatment they were asked for their consent and where people did not have capacity to consent the provider acted in accordance within legal requirements.

We saw people experienced care, treatment and support that usually met their needs and protected their rights. However, we also saw there were no written individual local care plans relevant only to the service’s care provision, to give ease of access to care planning information for staff at short notice. We also saw there were no current procedures in place to plan for any foreseeable emergencies.

This meant that when emergency cover of care had been required, sometimes the staff provided care in the first instance without adequate knowledge of the person’s care needs, and if an emergency situation did occur that threatened the running of the service there would be no written procedure to inform staff of what pre-planned action to take to mitigate the risks that may arise and facilitate continuation of safe, appropriate care.

We also found that people who used the service were not cared for and supported by staff who had appropriate checks undertaken before they began work, to ensure they were suitable to work with the vulnerable children and adults the service supports.

We found that although the health and safety of people was reviewed and audited, there was no quality assurance system in place to analyse the results of quality questionnaires, identify and record action to improve quality and feedback proposed action to the people who used the service, parents and other stakeholders.