This inspection took place between 16 and 26 March 2018 and was announced. We gave the provider 48 hours' notice to ensure someone would be available to speak with us and show us records.

When we last inspected the service we found the provider had breached the regulations relating to safe care and treatment because potential risks to people’s safety were not managed safely. We rated the service as Requires Improvement. Following this inspection, to reflect the improvements the provider has made, we have rated the service as Good.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question(s) is the service safe, responsive and well-led to at least good. We found progress had been made and the provider was now meeting the regulations. In particular, there was now a more robust risk management process in place to help keep people safe from harm.

Synergy Homecare – Washington is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. At the time of our inspection it provided a service to approximately 130 people.

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. People, relatives and staff described the registered manager as supportive and approachable. They told us since the registered manager had started there had been significant improvements made to the service.

The provider did not always maintain accurate records for the medicines people had been given. We found gaps in signatures on medicines administration records (MARs). A similar trend had already been identified through the provider’s own quality assurance checks and action was underway to remedy this.

People and relatives told us the service provided a good level of care. They also said staff were kind, considerate and caring. People, staff and relatives felt the service was safe.

A reliable and consistent staff team provided people’s care. People told us staff usually turned up on time. Some people said they did not always know which staff were due and at what time. The provider had set up individual arrangements with people to improve this.

The provider had effective processes so that new staff were recruited safely.

Staff had a good understanding of safeguarding and the whistleblowing procedure. They told us they did not have any concerns about people’s safety but knew how to raise them if they needed to.

Staff felt the support they received had improved. They confirmed they had regular opportunities to speak with management. They told us training had also improved.

Staff supported people to meet their nutritional and healthcare needs. People told us staff supported them to have enough to eat and drink.

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.

People’s care plans had improved since the last inspection. They were now more personalised and included detailed guidance for staff to follow about how people wanted their care provided.

People knew how to complain if required. There had been no complaints made about the service since our last inspection.

Synergy Homecare-Washington is a domiciliary care service that provides personal care and support to people living in their own homes. At the time of this inspection approximately 125 people were using the service. The service was previously named as Sevacare-Washington. The provider had changed the name of the branch since the last inspection.

At the last inspection in November 2016 we found the provider had continued to breach regulations relating to the management of risk and medicines records. The provider had also continued to breach a regulation relating to the completeness of care records and the governance of the service. This was because the quality auditing systems had not led to required improvements in risk management and accurate records about people’s care. The provider sent us a plan showing what actions would be taken to address this.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met the legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection by selecting the 'all reports' link for Sevacare Washington on our website at www.cqc.org.uk

During this inspection we found some improvements, although work was still on-going. The provider had identified the individual risks to people but about three-quarters of the care records had not yet been reviewed or updated. This meant the provider had not met the timescale it had set to address the previous requirement relating to risk management.

This was a continued breach of breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

The care records that had been updated contained detailed, personalised and complete information about people. These included clear risk assessments that set out how potential risks could be minimised.

We found the provider had addressed the previous beach of regulation relating to effective governance. There were improvements in the way medicines records were checked for completeness and in the way actions were taken to make sure these continued to improve. The provider had an auditor who supported the branch to check records and to identify the cause of any errors. This had led to more targeted support and monitoring of staff members. The audit checks now included details of any the impact on the person who used the service and staff said they now understood the importance of maintaining accurate records.

There were improvements in the way the provider monitored the service to make sure it provided a safe service. A care manager now carried out regular audits of the service and produced action plans with timescales for remedial work to be addressed.

Since the last inspection the registered manager, who had been in the role for only a few months, left the service. The new manager, who had been in post for a few weeks, had begun the process of applying for registration.

There had also been a recent change of office-based staff. The care staff we spoke with were positive about the new management arrangements. They felt communication between the management team, staff and people who used the service had significantly improved.

This inspection took place on 7 and 9 November 2016 and was announced. On 10 November 2016 we held telephone conversations with care staff.

Sevacare - Washington is a domiciliary care agency which provides personal care and support for people living in their own homes to meet their individual social care needs and circumstances. They mainly support people living in the Washington and Sunderland areas. At the time of the inspection there were 135 people using the service who received the regulated activity of personal care.

We last inspected Sevacare – Washington on 13, 14 and 20 April 2016 and found the provider had breached regulations we inspected against. Specifically the provider had breached Regulations 12, 13 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The assessment of risks to the health and safety of service users was not effective. There was a failure to do all that was reasonably practicable to mitigate risks. Medicines were not managed or recorded safely. People were not fully protected from abuse and improper treatment. Systems and processes had not been operated effectively to prevent abuse. Incidents and complaints had not been assessed to identify potential abuse. Systems and processes were not operated effectively to investigate concerns. Safeguarding arrangements for the raising of concerns and alerts had not been followed. Systems and processes were not being operated effectively to ensure compliance.

The provider did not have an effective system to assess, monitor and improve the quality and safety of the service provided. There was a failure to maintain an accurate, complete and contemporaneous record in respect of each person’s care and treatment. There was a failure to act on feedback, in the form of complaints.

During this inspection we found some improvements had been made to procedures for reporting and investigating safeguarding concerns. Audits had been introduced but further improvements were required to ensure regulations were met in relation to medicines management, care records and governance.

We have requested information be provided to us at regular intervals in order to monitor progress.

There had been significant periods of time over the past two years where managers of the service had not been registered with the Commission. A manager was in post at the time of the inspection and they had completed their application to become a registered manager with the Care Quality Commission was being progressed. They had been in post since June 2016.

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 people had not always been identified and mitigated against. Some information noted in risk assessments had not been included in home care and support plans which left people vulnerable. Some care plans did not provide sufficient detail on how staff should deliver care in a safe and appropriate way.

Medicine administration records (MARs) contained gaps were medicines had not been signed for. Audits had identified this and action had been taken in terms of re-training staff and discussions in team meetings, however the required improvement had not been forthcoming and MARs continued to contain gaps.

Audits had been introduced which had led to some improvements but work was ongoing to identify and rectify the concerns noted during the inspection.

Safeguarding concerns, incidents, accidents and complaints were logged, reported and investigated. Action had been taken to address concerns.

Staffing levels were such that all visits to people could be met but some people and all staff were concerned that rotas were not being issued with a weeks’ notice. A care co-ord

This inspection took place on 13, 14 and 20 April 2016 and was announced. This meant the provider knew we were visiting. We last inspected Sevacare – Washington in January 2014 and found it was meeting all legal requirements we inspected against.

Sevacare - Washington is a domiciliary care agency which provides personal care for people living in their own homes to meet their individual social care needs and circumstances. They mainly support people living in the Washington area of Sunderland but also support some people living in Newcastle. At the time of the inspection there were 160 people using the service who received the regulated activity of personal care.

There had been significant periods of time over the past two years where managers of the service had not been registered with the Commission. A manager was in post at the time of the inspection and they were completing their application to become a registered manager with the Care Quality Commission. They had been in post since October 2015 and had previously worked as a care co-ordinator for the provider.

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.

We found a whistleblowing concern had been investigated as a complaint. This related to an allegation of inappropriate practice which the manager had failed to report to the local authority safeguarding team, nor had they raised a statutory notification with the Commission. This is being managed outside of the inspection process.

Investigations in relation to accidents and incidents were not fully recorded. Analysis of complaints, safeguardings, accidents and incidents was not evident so there was a missed opportunity to learn from these events and improve the service for people.

The quality assurance system had not been effective in identifying areas for improvement. A branch audit had been completed in February 2016 but we saw no evidence of audits completed fully before this date. There were no action plans in place to identify who was responsible for improvements and when they should be made by.

Audits of Medicine Administration Records (MARs) had been completed; however the audit was not sufficiently robust and had not identified the concerns noted during the inspection in relation to the administration and recording of prescribed creams.

There were inconsistencies and contradictions found in relation to risk assessments and care plans. Some contained information which did not match; for others risks had been identified but there were no control measures and information had not been included in care plans. Care plans did not always provide staff with the specific detail they needed on how to provide care and support for people.

Recruitment practices were appropriate; there were enough staff to meet people’s needs and people told us they had regular staff that they were very happy with.

People said staff were kind and respectful and went, “above and beyond” to support them.

Staff told us they were well supported by the office staff and manager and had been well trained. They said they had the skills and knowledge they needed to support people. Records confirmed staff received relevant training and the provider’s system for managing training meant staff could not be allocated to visit people if their training was out of date.

Staff understood how to report concerns and were aware of the Mental Capacity Act.

You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

We visited the agency's office to look at records and talk to staff about how they provided safe and appropriate care to people. We spoke with five people who used the service to find out their experience of using the agency.

People we spoke to were happy with the service they received from Sevacare Washington. They said they had regular carers who they were happy with.

People were confident that if they had any problems they could report them to the care workers' supervisors and that their concerns would be dealt with. Some people told us that the agency had contacted them to check that everything was running smoothly.

The people we spoke with all said they had been involved in planning their care and told us that they could contact the main office if they had any queries.

One person said "Staff are great. They are on time and help me out." Another person said "I can always ring the office and they sort out any problems." Another person said "I use them as a relief agency. I have found them really well organised."

Relatives we spoke to said "All the staff I have spoken to are very polite and do what they say they are going to do." Another person said "I ring the manager. He is always helpful." Another person said "My x is happy with the people who come in and help."

People who used the service were positive in their comments about the staff from Sevacare Washington. We spoke with five people and they said:

“I’m very pleased with the service, they are generally on time” and “They are brilliant; I get on well with them all”.

One person did raise some concerns about the timeliness of one of the calls she received and we addressed this at the time of our visit with the service manager to ensure it was resolved.

We found policies and procedures were available in the office. Staff working in people’s homes told us where they could locate them. We looked at staff recruitment and found that the organisation had a policy and procedures in place for making sure there were checks carried out on people applying to work at the service. We also saw the provider had a system in place for checking on the quality of the service it provided which included talking to people who used the service and those who commissioned it.

Staff members also told us they were trained in the use of equipment to assist people’s mobility and were clear on what to do if they felt equipment was faulty.