We carried out this inspection on 17 October 2016 and it was announced 48 hours in advance in accordance with the Care Quality Commission's current procedures for inspecting domiciliary care services. The service was last inspected in February 2014; we had no concerns at that time.Lanhydrock Care is a domiciliary care agency that provides care and support to adults, of all ages, in their own homes. The service provides help to people with physical disabilities and dementia care needs in Bodmin and surrounding areas. The service mainly provides personal care for people in short visits at key times of the day to help people get up in the morning, go to bed at night and support with meals.
At the time of our inspection 38 people were receiving a personal care service. The services were funded either privately or through Cornwall Council or NHS funding. The service employed 19 staff including management.
The service did not have a regulatory requirement to have a registered manager in post. The provider was registered with the Care Quality Commission to manage the service. 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.
There was an unclear management structure in the service which did not provide clear lines of responsibility and accountability. The effect of this could be seen in the management of the administration of the service. This meant that the service was not entirely well-led because the provider had not sufficiently assessed the financial risk to the service of falling behind with the invoicing of fees.
People who used the service, families and health and social care professionals told us they felt the service was safe. Comments included, “They are good; dependable. I have nothing but praise for them” and “Nothing is too much trouble”.
People told us staff always treated them respectfully and asked them how they wanted their care and support to be provided. People and their relatives spoke well of staff, commenting, “The staff are lovely. Very satisfied with them”; “I’m more than happy with them” and, “Nothing is too much trouble for them. They go the extra mile for you.”
People told us they normally had a team of regular, reliable staff, and they knew the approximate times of their visits and were kept informed of any changes. Wherever possible the service had worked to find suitable and agreed times for people. No one reported ever having had any missed visits. People told us, “We have a team of about five ladies who come out over the week and we usually know which staff will be coming to us. If there are any changes the office rings to let us know,” and “I have regular carers.”
Care plans provided staff with direction and guidance about how to meet people’s individual needs and wishes. Regular reviews of care plans took place. Changes in people’s needs were communicated to staff in daily records and directly to staff by the provider and deputy manager.
Staff were not consistently recruited safely. The current uptake of reference checks for new employees did not follow the service’s recruitment policy, which had last been updated in 2010. Recruitment processes were not properly established or operated effectively and people were potentially at risk of being supported by unsuitable staff.
New staff received an induction, which incorporated the care certificate. Staff received appropriate training and supervision. We found gaps in staff training which were being addressed. There were sufficient numbers of suitably qualified staff available to meet the needs of people who used the service.
Staff had received training in how to recognise and report abuse. All were clear about how to report any concerns and were confident that any allegations made would be fully investigated to help ensure people were protected.
Management had an understanding of the Mental Capacity Act 2005 and how to make sure people who did not have the mental capacity to make particular decisions for themselves, had their legal rights protected.
There was a positive culture within the staff team and staff spoke positively about their work. Staff were complimentary about the management team and how they were supported to carry out their work. The provider was also passionate about providing quality care and was clearly committed to providing a good service for people. Staff told us, “It’s quite a small company and everyone looks out for each other”; “I’ve been here since the beginning and love my job” and “People come first. There is a genuine desire to do the best for the people we support.”
Effective quality assurance systems were in place in most areas of the service to help ensure any areas for improvement were identified and action taken to continuously improve the quality of the service provided. People told us they were asked for their views about the quality of the service they received by the provider.
There was a complaints procedure in place and the provider had responded appropriately to complaints. The service had a contingency plan in place to manage any emergencies. There was 24 hour telephone contact available, so that people were able to contact staff in an emergency. This demonstrated the provider had prioritised people's care provision during such an event.
The service worked successfully with healthcare services to ensure people's health care needs were met and had supported people to access services from a variety of healthcare professionals including GPs, occupational therapists and district nurses to provide additional support when required. Care records demonstrated staff shared information effectively with professionals and involved them appropriately. One healthcare professional told us, "No issues with them at all. They are good at seeking advice when needed and keeping us informed of changes in people’s needs.”