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Inspection carried out on 11 December 2018

During a routine inspection

This inspection took place on 11,13 and 19 December 2018. We gave the service 48 hours’ notice of the inspection visit because it is a small domiciliary care agency and the registered manager works as part of the care team. We brought this inspection forward because of a safeguarding concern in connection with one individual. The outcome of a safeguarding meeting was for the registered manager and the nominated individual to investigate the allegation.

Harcombe Valley Care Limited is registered with the Care Quality Commission (CQC) to provide personal care to people within their own homes. At the time of our inspection, the service was providing personal care and support to 33 people. When we visited 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.

People who used the services and the feedback was overwhelmingly positive about their experiences. The registered manager and their staff went the ‘extra mile’ to help prevent people being socially isolated and responded quickly at times of personal crisis for people using the service. People said "They are lovely. They are all very nice and all very caring”, "I can’t fault them, they are lovely" and “The carers are always extremely courteous and helpful.” Relatives were equally positive about the approach of the care workers. One relative commented “They are kind to her. This service was recommended by a friend and I have to say that I find them impressive.” Another relative said “They are kind. I find them wonderful, I really do."

People were treated as individuals and were not judged when their behaviour was challenging towards staff. They recognised the frustrations of people when they became reliant on others and the impact this could have on their mental wellbeing. Staff were clear only experienced staff would be rostered to work with the person. They described how they altered their body language, voice tone and topics of conversation to reduce areas of potential conflict which meant the person accepted the support they needed.

People were supported by staff who were skilled and understood their needs. Since the last inspection, steps had been taken to improve the staff group’s knowledge of the Mental Capacity Act 2005 (MCA). Information was in place to ensure people’s legal rights were protected. A relative said “They seem to know exactly what her needs are and what needs doing.” Staff spoke confidently about the care they delivered and understood how they contributed to people’s health and wellbeing. People said “From day one it was obvious they were well trained.”

People's nutritional needs were met; staff supported some people with meal preparation. Care plans for each person held detailed information about their dietary needs, including likes and dislikes. People said “I tell them what I want for lunch and they do it. They know how I like things cooked.”

Referrals were appropriately made to health care services when people needs changed. Staff recognised the importance of maintaining people’s mental well-being, for example taking time to reassure them and address any misunderstandings due to the person’s anxiety. To help ensure care staff understood people’s needs there were fact sheets to help them understand people’s medical conditions.

People said they felt safe because the staff group were kind and reliable. People continued to be supported by staff who respected their privacy and dignity. Staff relationships with the people they supported continued to be caring and supportive. There was a stable staff group which helped ensure a consistent approach. Staffing arrangements were flexible to meet people’s individual needs and to res

Inspection carried out on 22 November 2016

During a routine inspection

This inspection took place on 22 and 29 November 2016 and was announced. The provider was given notice of the inspection on 18th November because the location provides a domiciliary care service and we needed to be sure that someone would be in. The last inspection took place on 15 January 2014 and no concerns were identified with the five standards inspected.

Harcombe Valley Care Ltd is a small domiciliary care service registered to provide care for people living in their own homes. It is a family business in Sidmouth, in which the manager employs her two daughters as assistant managers. The business provides both domestic care and personal care to people living in and around Sidmouth. At the time of the inspection, there were 45 people receiving the service, of whom 37 people received personal care. Personal care includes assistance with eating food and monitoring fluids, washing hair, teeth, shaving, bathing, showering and administration of medicines and creams. We only looked at the service for people receiving personal care, as this is the regulated activity that is registered with the Care Quality Commission (CQC).

In addition to the three managers, there were 17 care assistants, two of whom were senior care workers , (one of these being an office administrator) and five bank care staff. Times of visits ranged from 30 min to 1 hour, with occasional overnight sleeping duties. The frequency of visits ranged from once a week to several times every day of the week. The owner of the service was also the 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 using the service said they felt safe whilst being cared for by Harcombe Valley staff in their own homes. They liked being informed in advance who was coming and there was no evidence of any missed calls. One person said, "They send out a list [of care assistant names] every weekend and they come on time." One person liked the fact that this was a family business because "Those managing the business are themselves experienced carers who know their clients and take part in caring themselves." People felt that the care provided to them was good and this was confirmed by other healthcare professionals who praised the service for being responsive and proactive.

The service had trained staff in the principles and practice of safeguarding. Risks to individuals were managed by a series of risk assessment processes. This included assessment of the environment in each person's home. Records were kept in each person’s care plan and reviewed regularly. Spot checks were undertaken to ensure that staff were adhering to safe principles in moving and handling and use of equipment. Staff are aware of signs of potential abuse and were aware of how to respond. Records were kept of incidents and accidents and learning from them was disseminated to care assistants. When there were issues, they had been responded to promptly by management until resolution was reached. Staffing levels were kept safe by not taking on new people if staff numbers could not support this. People received assistance in taking medicines and creams from staff trained to administer medicines. External consultants advised on all health and safety issues and undertook annual audits.

The service had undertaken all the necessary checks before employing people to ensure they were suitable to be care assistants. There was a system of mandatory training in place for all care assistants which was regularly reviewed.

Staff had the opportunity to update their knowledge at regular intervals and were supervised regularly. A lack of understanding of the full implications of the Mental Capacity Act 2005 was evident on da

Inspection carried out on 15 January 2014

During a routine inspection

Harcombe Valley Care Ltd, provides personal care and support to people living in their own homes. During our inspection we visited four people using the service. We spoke to five relatives, a community matron and six members of staff.

People receiving the service spoke very positively about the services. One person told us they felt the service passed “with flying colours” another told us “they are always willing to do that bit extra” People told us they were involved at all times about their care needs, and their preferences in how that care was given. We saw the weekly letter received by the person using the service showing times and dates of visits with the name of the carer who will be giving that care.

We saw the care plans were well documented and a daily record of care was kept and signed by care staff.

People told us that communication was excellent; they were always informed of any delay or changes. People told us they could contact one of the senior carers and speak to them directly. If they called the office, any time, a call was always answered by “A real person”

We spoke to the Community Matron who told us they found the service provided “excellent service, always professional” They also felt communications were very good, and they were confident that concerns would be passed to them and any instructions they gave would be carried out.

We saw how staff received training, which reduced the risk of vulnerable people being abused and observed safe working practises during our visit. We saw evidence of training having been provided and how working practises were monitored. We also saw training planning in place for future training needs, with individual needs identified. During routine monitoring and auditing of the services provided the people who used the service and their relatives and carers were involved in this process.

Inspection carried out on 5 July 2012

During a themed inspection looking at Domiciliary Care Services

We carried out a themed inspection looking at domiciliary care services. We asked people to tell us what it was like to receive services from this agency as part of a targeted inspection programme of domiciliary care agencies with particular regard to how people's dignity was upheld and how they could make choices about their care. The inspection team was led by a CQC inspector and joined by an Expert by Experience, who has personal experience of using or caring for someone who uses this type of service.

We visited three people in their own home as part of this review and we also spoke with a relative who called into the agency office while we were there. The purpose of our discussions with people, and their relatives, was to find out about their experiences of the support they had received. We spoke with four senior staff and one care worker during our visit to the agency office. We met one care worker during our visits to people who received a service. We also spoke with 15 people who received a service from this agency over the telephone.

People praised the service they received. Comments included “Very, very good”, and “They went the second mile”.

People told us their care was personalised to suit their individual preferences and choices. Their care workers understood their individual health and personal care needs and the way they wanted the tasks to be carried out. They assured us that personal care tasks were carried out in a dignified and private manner. Their care plans had been drawn up in consultation with them and had been regularly reviewed. The agency had asked people the names they preferred to be known by.

People said that care workers always arrived on time, or very close to the time they were expected to arrive. They told us they had good communication with the provider and all members of the agency office, and they would have no hesitation in ringing the office if they had any concerns.

Care and treatment was planned and delivered in a way that ensured people's safety. We heard examples where care workers had checked regularly for signs of health problems and had acted immediately to notify relevant health professionals when concerns were noted. We also saw evidence of this in the records of the care provided on each visit. Relatives told us this gave them confidence that they could go out, or carry on with other things they needed to do, safe in the knowledge that their loved ones were being cared for by competent care workers. Comments included “I can count on them.”