Penhellis Community Care Limited

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community in all areas west of Truro. The packages of care provided range from short visits at key times of the day to 24-hour care dependant on the person's care needs. At the time of the inspection the service was supporting approximately 250 people.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

People’s experience of using this service and what we found

People using the service consistently told us they felt safe and that staff were caring and respectful. Their comments included, “I feel safe because the staff are so competent at what they do", "[The staff] are absolutely lovely, they spoil me" and “I feel respected, I just feel it.” Relative were also complementary of the service and the quality of support it provided.

The service’s rotas were well organised and there were enough staff available to provide all planned care visit. A mobile phone call monitoring application was used to ensure all visits were provided and to share information securely with staff. No one reported having experienced a missed care visit and staff told us, “I have never known of any missed visits”.

Risks had been assessed and staff were provided with guidance on how to manage and mitigate risks while providing support. The service had appropriate procedures in place during periods of adverse weather and operated a lease car scheme to reduce the risk of visits being missed due to vehicle breakdowns.

All necessary recruitments checks had been completed and people were safely supported to take their medicines as prescribed.

People told us, “All the carers that come here are trained and know what they doing” and records showed staff had the skills necessary to meet people’s needs. Training was regularly updated, and staff were well supported by their managers.

People enjoyed the company of their staff who they described as, “lovely”, “Jolly” and “Wonderful”. Rotas showed people received support from small teams of staff who visited regularly. Staff told us, “I see the same people every week” and “I like my job and I like looking after people”. Staff were keen to support people to remain living in their own homes and people told us their care was never rushed.

People were able to make choices and staff respected their decisions.

People and their relatives were involved in the development and review of care plans and told us these documents were accurate and up to date. They included clear guidance on the support required during each visit and staff told us, “There is enough information in the care plans”.

People were supported to access healthcare services, staff recognised changes in people's health, and sought professional advice appropriately.

Staff were well motivated and there was a positive open culture within the service. People’s feedback was valued, and records showed action had been taken to address and resolve any issues reported to managers. Staff said, “They listen, everything we report gets addressed” and “I love working for them, it is probably the best job I have ever had”.

The service was well led. Management roles were clearly defined and there were effective quality assurance processes in place. People were complimentary of the service and relatives told us, “I don’t think they can improve on anything”. Staff said, “It is brilliant here, everything just runs along nice and smoothly.”

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service good (published 20 April 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Penhellis Community Care is a Domiciliary Care Agency that provides care and support to adults of all ages, in their own homes. The service provides help with people’s personal care needs throughout Cornwall. 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 provide support with meals. These services were funded either privately, through Cornwall Council or NHS funding.

At the time of our inspection 513 people were receiving a personal care service. The care provision for 272 people, who lived in the west of the county, was managed from the registered office in Helston. The care provision for 241people, who lived in the middle and east of the county, was managed from an office in Roche, opened in June 2016. The provider advised us that they intended to register the Roche office as a separate location.

There was a registered manager in post who was responsible for the day-to-day running of the service. 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 and associated Regulations about how the service is run.

At this inspection we looked at the concerns raised with us. We found where people had raised concerns with the service about staff practice this had been dealt with appropriately. Records showed that investigations had taken place and disciplinary action had been carried out and some staff had been dismissed from the service.

We found the service had given notice to stop providing care to some people. This had been in specific geographical areas where the service had experienced staff shortages. Records showed the required four weeks notice had been given to the local authority. The quality manager explained that in some cases this message was not relayed to the person. We judged that the service had made these decisions because at the time there were not enough staff available to provide a safe service for people.

We had mixed responses from people in relation to the timing and reliability of their visits. Most people told us they received a reliable service, they knew the times of their visits and were kept informed of any changes. Comments included, “They’re not often late and they’ve never missed”, “They are generally on time”, “The carer arrives at 11.20am. She always phones when she’s on her way”, “I have nothing to complain about”, “A few visits have missed but they’re straight on the phone and get someone to come” and “In the last 18 months, they’ve been on time every day.”

Of the 54 people and 11 relatives we spoke with 14 people told us the service was not always reliable and they were not always informed of changes to times. However, the provider’s records did not confirm these missed visits and we found no evidence that anyone had come to harm as a result of a missed or late visit. People’s comments included, “They don’t always arrive on time and they never ring”, “Two or three times I’ve been left with no-one”, “They’re sometimes late if there’s an emergency. They don’t usually call” and “I am a 10.00am call but they come at 10.30-11.00am, consistency is not good, it would be nicer to have a regular time.”

We found the service did not keep a central log of missed or late visits. From discussions with management and the supervisors it was clear the service took appropriate action when people, or staff, told them that visits had been missed or were late. There was not a robust ‘live’ system in place to identify if visits had been missed, or were late, shortly after the allotted time. This meant people who were unable to alert the service if a care worker did not arrive were at risk. We have made a recommendation about the effectiveness of the monitoring of the service delivery.

Nearly 50% of the people we spoke with commented that they would like to know the names of the staff who were booked to visit them each week. Comments included, “I don’t get told who is coming, we don’t get a list, I would like to know who is coming and when”, “I never know who is coming or when they should be here”, “I don’t know who is coming, apparently they tell me I should get a slip of paper telling me who will be coming but I haven’t got one yet.” Some people told us they received a list of staff names and they appreciated knowing who was coming. The supervisors told us they sent lists to some people who had requested them. We have made a recommendation about the lack of a consistent approach to providing lists for people.

People told us they felt safe using the service. Relatives also said they thought the service was safe. Comments included, “I feel safe when the carers are here. They have an ID badge on their uniforms”, “I feel safe because they are very pleasant and I trust them”, “I feel comfortable and safe” and “Yes I feel safe. They’re quite good.”

Staff were recruited safely, to help ensure they were suitable to work with vulnerable people. Staff had received training in how to recognise and report abuse. Staff received appropriate training and supervision. New staff received an induction, which incorporated the care certificate. At the time of this inspection there were sufficient numbers of suitably qualified staff available to meet the needs of people who used the service.

Appropriate systems were in place to plan rosters and provide staff with details of their work. Rosters were divided into eleven local areas with a service supervisor responsible for each area. Supervisors had good knowledge about the people using the service and local knowledge of the area which meant they could plan work that minimised travel time. We saw that runs of work were being developed in all areas to help ensure people had a consistent and reliable service. Staff were positive about their rosters and the support they received from their supervisor.

People received care from staff who had the knowledge and skills to meet their needs. Comments from people included, “I know they have training as they mention it. When new ones start they have training and shadow an experienced carer. They all know what they are doing”, “I think they are sufficiently trained” and “I feel they know what they are doing.”

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, “My husband is treated with dignity. The carers coming here are brilliant. I’m at ease with it all”, “They respect my privacy and dignity. They are very good”, “They treat mum with dignity and respect around personal care” and “With personal care, I feel comfortable and very good.”

Care plans provided staff with direction and guidance about how to meet people’s individual needs and wishes. People’s care plans were regularly reviewed and any changes in people’s needs were communicated to staff. Staff told they were kept informed of people’s changing needs. Any risks in relation to people’s care and support were identified and appropriately managed.

There was a positive culture within the staff team and staff spoke passionately about their work. Staff were complimentary about their managers and how they were supported to carry out their work. There was a management structure in the service which provided clear lines of responsibility and accountability. People told us they were regularly asked for their views about the quality of the service they received. People had details of how to raise a complaint and told us they would be happy to make a complaint if they needed to.

At the time of our inspection on 7 and 8 March 2016 the service was providing care and support to approximately 650 predominantly older people. The service was previously inspected on 18 and 19 February when it was found to be fully compliant with the regulations.

The organisation was led by five directors, one of whom was 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 and associated Regulations about how the service is run.

People told us they felt safe and were well cared for by Penhellis Community Care. People’s comments included; “I do feel safe” and “The carers are very good.”

People who used the service were happy with the care they received but some people reported their staff did not consistently arrive on time. People told us that Penhellis Community Care headquarters would “usually” phone them if a care worker was going to be late which gave them reassurance that their visit would still continue. The registered manager was aware of these concerns and had taken appropriate action to resolve them where possible.

A call monitoring system was used to record staff arrival and departure times from each care visit. This information was monitored by office staff to ensure visits were not missed. In addition this data had been used to review the travel time required between consecutive care visits to ensure the care visit schedules were appropriate. Our analysis of call monitoring data, daily care records and staff visit schedules found care staff normally arrived on time and provided the planned care.

The service had robust and effective procedures in place to ensure that all planned care visits were provided. This included on-call management support, arrangements for additional staff to be available at short notice each weekend and a system for monitoring the provision of care visits in real time to ensure all visits were provided.

The service’s visit schedules were well organised and at the time of our inspection there were a sufficient number of staff available to provide people’s care visits in accordance with their preferences.

The registered manager and quality assurance manager were confident about the action to take if they had any safeguarding concerns and had liaised with the safeguarding teams as appropriate. Risk assessments clearly identified any risk and gave staff guidance on how to minimise the risk. They were designed to keep people and staff safe while allowing people to develop and maintain their independence.

The service’s systems for the induction of new members of staff were effective and fully complied with the requirements of the care certificate. Training was provided in accordance with the 15 fundamental standards. The service had commissioned a training academy to provide the induction and further training courses to their staff team. Staff said they were encouraged to attend training to develop their skills, and their career.

Staff received regular supervisions and annual performance appraisals. In addition ‘spot checks’ by managers were used regularly to confirm each member of staff was providing appropriate standards of care and support.

People were supported by stable and consistent staff teams who knew people well and had received training specific to their needs. People told us they were introduced to new staff before they supported them in their home. People confirmed they had consistent carers to support them and had built up positive relationships with staff.

People’s care plans were detailed, personalised and provided staff with sufficient information to enable them to meet people’s care needs. The care plans included objectives for the planned care that had been agreed between the service and the individual. All of the care plans we reviewed were up to date and accurately reflected each person’s individual needs and wishes.

Penhellis Community Care had a complaints process and details of how to raise concerns was accessible to people, their relatives and staff. We reviewed the services complaint process and found that people’s complaints were responded to promptly and that a full investigation into the concerns they had raised was undertaken. Some relatives told us they had raised concerns with the managers which were usually in respect of the timing of home visits. The majority felt that they were heard and that appropriate action was taken to resolve their issues.

From our conversations with staff, people and records we found that Penhellis Community Care management team provided effective leadership and support to the staff team. Staff told us they could approach their managers with any concerns or suggestions and felt they would be listened too.

Below is a summary of what we found. The summary is based on information gathered during conversations with people who used the service , relatives, staff and management of Penhellis Community Care.

Is the service safe?

We found that Penhellis Community Care provided safe care and support to people who used the service. Everyone we communicated with reported that they felt safe with their care staff.

The care staff that we spoke with had a good understanding of local safeguarding procedures. Staff records showed Disclosure and barring service checks had been completed for all staff prior to their employment and training records demonstrated all staff had received formal safeguarding training.

We found most care plans included appropriate risk assessments and all of the care plans we inspected had been regularly reviewed to ensure they accurately reflected people care needs.

Is the service effective?

The service was effective. We sent surveys to 61 people who used the service, 39 of whom provided responses. Our survey asked 'over all how would you rate the care provided? 58% reported that the service was 'excellent' while 39% reported that the service was 'good'.

People and their relatives told us the care they received was effective, their comment included 'I am very pleased with the care' and 'carers are very good and do everything I want them to do'.

We saw that assessments of care needs had been completed with the person who used the service and that care plans had been developed from this information and information supplied by the commissioners of the care.

We found that although all of the care plans we inspected included sufficient information to direct staff that there was some variation in the quality and quantity of information provided to staff. However, staff that we spoke with told us 'I think they have enough information and they do get updated quite often' and 'they are pretty good, up to date and have the right info'.

Is the service caring?

We found that the service was caring and that staff were proud of the organisation they worked for. People told us they were well cared for by their regular carers, their comments included 'I am so happy with the treatment and what they do for me. I have various carers come, they are all pleasant and cheerful and this sets me up for the day. Before they leave they always ask if there is anything else they can do for me' and 'I am absolutely delighted with my carers, I couldn't wish for better'.

Our survey asked 'Do the care workers treat you with respect?' 90 % of people who responded reported they were 'always' treated with respect while the remaining 10% reported that they were treated with respect 'most of the time'.

The 14 staff we spoke with reported that they enjoyed their work, they told us 'It's my favourite job', 'It's never boring, I enjoy the job' and 'I wouldn't want to work for any other care company'.

Is the service responsive?

The service was responsive, we found the service had appropriate complaints procedures and people who had previously made complaints were happy with the manner in which their complaints had been resolved.

We saw the service was in the process of completing a survey of everyone who used the service. We reviewed the information responses received at the time of the inspection and found that people were generally satisfied with care they had received.

Some people who used the service told us they were unhappy with the manner in

in which office staff dealt with them on the telephone, these comments have been shared with the provider.

Is the service well led?

Penhellis Community Care was well lead and it's manager was registered with the Care Quality Commission.

We saw the operations managers had completed an effective investigation into matters that we had raised with them prior to the inspection. As a result of this appropriate arrangements had been made to provide additional support to staff based from the Liskeard office.

The service had appropriate quality assurance systems in place. We saw regular staff spot checks had been completed and that all daily care records had been effectively audited on their return to the office. Where issues had been identified actions had been taken to address them.

We also sent a survey to 61 people who used this service, we received 18 responses. The survey asked, 'Overall how do you rate the care you receive from Penhellis community care?' 69% of people said the service was 'good' or 'excellent' with the remainder indicating that the service was 'satisfactory'.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

People were cared for, or supported by, suitably qualified, skilled and experienced staff.

The provider had an effective system to regularly assess and monitor the quality of service that people receive and there was an effective complaints system available.