Date of Assessment: 19 July to 5 November 2024. Supreme Care Services Ltd is a domiciliary care agency that provides care and support to people living in their own homes. At the time of our assessment 65 people were receiving support with personal care. The last rating for this service was requires improvement (report published 1 December 2021), when we identified a breach of regulation in respect of good governance. We carried out this assessment to follow up this breach and make sure the provider had made the required improvements. We looked at a selection of quality statements for the key questions of safe, effective, caring and responsive and all the quality statements for well-led. We were satisfied that enough improvements had been made to the record keeping and governance systems and the provider was no longer in breach of any regulations. The overall rating for this service is now good. People received a safe service, were protected from abuse or neglect and had their human rights promoted. The service followed safe recruitment processes and there were enough staff deployed to support people. There were effective processes to ensure people’s medicines were managed and administered safely. Care and risk management plans were individual and met the needs of people using the service. Staff knew people well and understood how they liked to be supported with their individual needs. There was a clear management structure and staff felt supported in their roles. The provider sought feedback from people, relatives and staff and used this to develop the service. There were effective systems in place to monitor the quality of the service and identify when improvements were required.
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Supreme Care Services received an overall rating of Requires Improvement following a focused inspection of the Safe and Well-Led key questions, driven by a breach of Regulation 17 due to inaccurate and incomplete care records, missing capacity/consent documentation, and inconsistent management oversight. The Safe domain remained Good, with adequate staffing, medicines management, infection control, and safeguarding arrangements in place.
Concerns (7)
criticalRecord keeping: “The registered person was not always maintaining up to date and accurate records regarding people's care and the management of the service”
criticalGovernance: “This demonstrated a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.”
moderateCare planning: “this support was not always clearly set out in the person's care plan...not always an accurate and complete record of the decisions taken regarding the person's care”
moderateConsent / capacity: “Some people's care plans did not always clearly record who had the legal authority to consent to their care arrangements if the person lack the capacity to make this decision.”
moderateMissed or late visits: “a local authority found that for over half of commissioned care calls staff were not logging their visits in real time on this system.”
moderateLeadership: “There was no branch manager in post at the time of our inspection...Some staff commented that there had been frequent changes of office and management staff.”
minorCommunication with families: “an adult social care professional told us the provider was recently asked to share information in a more timely and transparent manner”
Strengths
· Staff completed medicines administration records and competency checks; relatives reported no concerns regarding medication management.
· Robust infection control arrangements including PPE supplies, regular COVID-19 testing, and vaccination promotion.
· Staff knew how to report safeguarding concerns including whistleblowing; adult abuse discussed in team meetings.
· Incident and accident documentation system in place with learning fed back to staff via team meetings and emails.
· Positive staff culture with care workers reporting feeling supported by office staff.
Supreme Care Services Limited received a Good rating across all five key questions at its May 2016 inspection, demonstrating safe medicines management, robust recruitment, person-centred care planning, and effective quality assurance systems. Minor shortcomings were noted around weekend communication with families and inconsistent frequency of monitoring calls against the provider's own policy.
Concerns (2)
minorCommunication with families: “During the week it's fine but at weekends it can be difficult to know who is coming. It would be better if they told us in advance who the carer will be”
minorGovernance: “We saw evidence of phone calls to people using the service...although these were not always in line with the frequency described in the provider's policy.”
Strengths
· People felt safe with care workers and relatives reported confidence in their safety during visits
· Medicines administration records completed correctly and appropriate risk assessments in place
· Robust recruitment procedures including DBS checks, references and employment history for all new staff
· Regular supervision, team meetings and annual appraisals supported care worker development
· Care Certificate policy implemented with plans to extend to existing staff
Supreme Care Services Limited received a Good rating across all five key questions at its February 2019 inspection, demonstrating safe, person-centred care for 157 people in the London Boroughs of Ealing and Brent. The service showed particular strengths in safeguarding, staff support, individualised care planning and a commitment to continuous improvement.
Strengths
· Consistent staffing and timely visits, with electronic monitoring systems to track care delivery
· Robust safeguarding systems with regular audits, staff training and clear reporting processes
· Individualised, person-centred care and risk management plans reviewed regularly with people and families
· Staff received induction, mandatory training, regular supervision and annual appraisals
· Provider proactively addressed social isolation through free coffee mornings and a developing befriending service