Home Care provides personal care to people living in their own homes throughout Cornwall. At the time of this inspection the service was supporting over 350 people and employed approximately 200 care staff. Most people were supported by staff who provided domiciliary care visit at keys time throughout the day. During these visits staff assisted people with specific tasks or activities to enable people to continue to live as independently as possible. In addition, the service provided 24 hour supported living care for six people who lived in the own homes. The service’s management structure had changed since our previous inspection. One registered manager was now responsible for overseeing both the domiciliary care and supported living services which had been integrated.
People were extremely happy with the quality of care and support they received and numerous people told us the service they received could not be beaten. Peoples’ comments included, “They are brilliant. I give them ten out of ten for everything”, “I couldn't have better, they have been like part of the family. I am very lucky and appreciate everything they do” and “They couldn’t be better. I would recommend them to everybody”. Relatives told us, the service also provided them with reassurance and support when required. One person’s relative commented, “It’s amazing. They know him and chat to him. They have a good relationship with others in the household too. It feels like team work. If I am feeling down I get a hug. They support the three of us.”
People and relatives consistently praised staff for their caring attitudes and it was clear during our conversations with staff and managers that the service was fully focused on meeting people’s care needs. During our visit to a person’s home we saw that staff knew people well and provided care with compassion and understanding.
People told us they had never experienced missed care visits and call monitoring systems were used appropriately to ensure all planned care visits were provided. People told us, “They have never missed any calls” and “I have never had a missed call, even when it is snow of the ground” while staff commented, “I honestly can’t remember the last time that happened”. The service visits schedules were well organised and included appropriate amounts of travel time between care visits. Staff reported their visits schedules did not change often and that there was a system in place to ensure visits were not missed as a result of changes.
We reviewed rotas, call monitoring data and daily care records. We found there were enough staff available to provide all planned care visits and that people’s care visits were routinely provided on time and for the correct duration. People consistently told us their staff arrived on time and that they did not feel rushed while receiving support. People’s comments included, “They are never rushed. They manage what they have to do very nicely” and “I don’t feel rushed at all when they are here”.
The service’s on call system ensured people and staff could contact managers for support easily when the office was closed. People told us, “I never have a problem getting through to them” and “I can contact them anytime I need them”. While staff said, “On call, that works fine” and explained that action was promptly taken when staff members were unwell to ensure people’s care needs were met.
Staff and managers had received safeguarding training had a good understanding of local processes for protecting people from abuse. Everyone who used the service and all staff had been provided with details of local safeguarding contacts to ensure this information was readily available if required. Risks both within people’s home environments and in relation to their support needs had been appropriately assessed. Staff had been provided with clear guidance on how to manage risks while enabling people to be as independent as possible.
Staff understood the requirements of The Mental Capacity Act 2005 and the importance of respecting people’s decisions and choices. Where managers had become concerned that people cared for by the supported living team were being deprived of liberty this issue had been raised with commissioners and necessary applications made to the court of protection.
Staff were well trained and sufficiently skilled to meet people’s care needs. Staff told us the training provided was of high quality and regularly updated. A health and social care professional told us, “I consider the staff to competent and well trained. It is evident that they are very much client-centred and have a wealth of experience between them all”.
The service recruitment practices were robust. All new staff received comprehensive induction training in accordance with current best practice. In addition all new staff completed numerous shadowing shifts before they were permitted to provide care independently. People told us, “If they have got a new carer they come with an experienced carer” while a manager commented, “Staff don’t support people they don’t know.”
Everyone told us staff respected their privacy and dignity. People’s care plans included guidance for staff on how to protect peoples’ dignity and peoples’ preferences in relation to the gender of the care staff were respected. People told us, “The carers are very respectful towards me, but are still friendly” and “They are very respectful, but will have a laugh with me which I like”.
People’s care plans were informative and detailed. They provided staff with clear instructions on how to meet people’s individual care and support needs. All of the care plans we reviewed were up to date and accurately reflected each person’s current needs and wishes. Staff told us, “The care plans are very detailed” and "People’s care plans are always updated".
People understood how to make a complaint and told us that any minor issues they raised had been addressed and resolved. We saw that the service regularly received compliments and thank you cards from people and their relative for the quality of care provided.
Staff told us they were well supported by the service’s managers. They said, “My manager is really supportive”, “I have not got a bad word to say about [the managers]” and “The registered manager is brilliant”. There were systems in place to provide staff with confidential support if required and staff told us they felt confident any concerns they raised would be addressed. There were formal systems in place to support the registered manager who received monthly supervision.
Commissioners recognised that the service was very well managed and had asked the service to take over a failing domiciliary care provider in July 2016. This had been done successfully and staff who had transferred to Home Care told us, “Defiantly, [Home care] is better and much more organised”.
Learning and career development was actively encouraged by all levels of management. Staff were encouraged and supported to complete additional training and presentation ceremonies were held to celebrate individual staff achievements. In addition, the service actively participated in the provider internal staff recognitions schemes and we heard managers nominating staff for awards during our inspection.
Quality assurance processes were robust and designed to drive improvements in overall performance. People and staff feedback was sought regularly, any issues raised were fully investigated and acted upon.