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Inspection carried out on 4 September 2017

During a routine inspection

Westcountry Home Care provides personal care to people living in their own homes in North Cornwall from its office in Launceston. At the time of this inspection the service was supporting approximately 60 people and employed around 25 care staff. The service provided domiciliary care visit at keys times throughout the day. During these visits staff assisted people with specific tasks or activities to enable people to continue to live at home as independently as possible.

The service’s was led by a registered manager who is also the providers nominated individual with responsibilities for overseeing the performance of the providers other registered services. The day to day leadership of the service was normally the responsibility of the service’s care manager who was supported by a deputy. The care manager had resigned prior to the inspection and appropriate arrangement had been made to ensure the staff team were supported while a new manager was recruited. On the day of our inspection the new care manager joined the service.

At our previous inspection in 2015 we found that although the service was good overall improvements were required in relation to our question is the service responsive? This was because people’s care plans were not always detailed which meant staff did not always have the information they needed to support them.

At this inspection we found the quality of people’s care plans had improved. Detailed assessments of individual needs had been completed before the initial care visit. Information gathered during the assessment process had been used to develop detailed and informative care plans. These documents now gave staff guidance on how the person preferred to be supported and detailed instructions on how to provide their care. Care plans were available in each person home and staff told us, “They have enough information. It lists everything you have to do during the visit.” People’s care plans were regularly updated to ensure they accurately reflected people current care needs. People were involved in this process and able to request changes to both the timing of visits and the contents of their care plans.

All staff had been trained in how to support people with their medicines. Daily care records included details of the support each person had received with their medicines. However, these records did not include details of which medicines the person had been supported with. We have recommended the service reviews its processes to ensure they reflect recently issued guidance.

Everyone who responded to our survey reported that their staff were kind and caring. People and their relatives were complementary of the care and support provided. Their comments included, “I could not do without them. They are good”, “[The staff] are great, very helpful”, “You could not wish for a better team than they have got there” and “I’m very pleased, more than satisfied and couldn’t manage without them.”

There were enough staff available at the time of our inspection to provide all planned care visits. The service had recently experienced issues due to unexpected levels of staff sickness during the summer holidays. Appropriate action had been taken to address this situation with support from the provider’s other local services. One person told us “They had a bit of a hit by a summer bug, they were very short staffed but still managed to turn up.” A targeted recruitment programme was planned to address these issues and the service was only accepting new care packages where staffing capacity was available.

We received some mixed feedback in relation to the pace at which support was provided and staff arrival times. Some people felt staff were under time pressure while others reported, “They do a good job, they don’t rush me”, We reviewed the service’s staff rotas and daily care records and found that people normally received their visits on time and for the correct duration. Relative told us, “Time is not a pr

Inspection carried out on 12, 13, 14 and 17 August 2015 and 3 September 2015

During a routine inspection

The inspection took place on 12, 13, 14 and 17 August 2015 and 3 September 2015, and was announced.

Westcountry Home Care Limited provides domiciliary care services to adults within East Cornwall. On the days of the inspection Westcountry Home Care was providing support to 60 people including those with physical disabilities, sensory impairments, mental health needs and people living with dementia. At our last inspection in July 2013 the provider was meeting all of the Essential Standards inspected.

The service had 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 told us care staff were kind, caring and promoted their independence. Staff had a good understanding of how to respect and promote people’s privacy and dignity. People told us staff were respectful at all times and felt safe when they were being supported in their own homes.

People told us staff were not always on time, and had complained about this. Action was being taken to make improvements. Staff told us they felt their rota was geographically managed to help ensure they had enough travelling time between each person, however, sometimes they ran late because of traffic delays . Staff felt there were enough staff but the recruitment of additional staff would help to reduce traveling time and the likelihood of arriving late. People were supported by staff who had been recruited safely, which meant they were suitable to work with vulnerable people. The registered manager and staff had a good understanding of how to report any safeguarding concerns. Staff received training and support to help them to meet people’s individual needs. However, an external health professional felt staff required further training in respect of moving and handling and continence care.

People had care plans in place, to provide guidance and direction for staff about how to meet a person’s needs, for example how people wanted to be supported with their personal care. However, some care plans were not always reflective of people’s needs. The registered manager was taking action to make improvements to care records. People’s consent was demonstrated in care plans and people’s care plans took into consideration the Mental Capacity Act to make sure people who did not have the mental capacity to make decision for themselves, had their legal rights protected. Staff explained they always sought the person’s consent before speaking to the person’s family or their GP if they had concerns.

People were supported with their medicine, and had care plans in place and staff had received training. People were encouraged to eat and drink. When staff were concerned about whether a person was eating and drink enough, they were responsive in reporting any concerns. Staff were observant of the deterioration in someone’s health and wellbeing and took the necessary action, for example contacting the person’s GP or a district nurse. A health care professional told us there was not always effective communication which meant information about people’s care was not always shared.

People had been apologised to, when things had gone wrong. People felt they could complain and that their complaints would be investigated and resolved. People’s feedback was valued and used to facilitate improvements.

People were complimentary about the prompt response of administrative staff and management when they rang to make a complaint or ask for any changes to be made. Staff enjoyed working for the organisation and told us the registered manager was supportive. The registered manager had systems in place to monitor the quality of the service, but because of a change in the management team, some of the checks had not been completed recently, however, action was being taken to address this. The registered manager worked positively with other external agencies.

The director took an active role in the operation of the service and the registered manager felt well supported.

Inspection carried out on 10 July 2013

During a routine inspection

We spoke with ten people who used the service and one relative. They told us that every thing was absolutely fine. Several people told us the carers are usually on time and that they often get the same ones, this is good for continuity. Two people told us the carers are often late. These people said “They will phone us to say why they are late”. Another person said, “I receive good care and am kept informed”. One person said, ”The carers are fantastic, they understand my complex needs, they are a skilled team”.

During our inspection, we spoke with the nominated Individual(head of service), deputy manager, two care staff and the administrator. They demonstrated a good knowledge of the care needs of people who received a service and they spoke fondly of each person.

We found peoples’ views and experiences had been taken into account in the way the service was provided and delivered in relation to their care.

People’s privacy and dignity was respected and people experienced care, treatment and support that met their needs and protected their rights.

We found that people who used the service were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse happening.

We saw there were appropriate checks undertaken before staff commenced work for the service.

Inspection carried out on 25 March 2013

During a routine inspection

We spoke with seven people who used the service or were related to people who used the service. They told us that it was usually the same carers who visited, and people were positive about the carers themselves saying that they had no complaint about them as individuals or the care provided. People did say that carers were sometimes late. People said they had confidence in the agency, and comments included: “we work together as a team” and “they help out a lot”.

People told us they were aware of their care packages, and we found the care provided met people's expectations and needs.

People’s privacy, dignity and independence were respected.

People experienced care, treatment and support that met their needs and protected their rights.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

People were protected from the risk of infection and from unsafe or unsuitable equipment.

People were protected by the agency’s robust recruitment procedures.

Staff were mostly supported with training and supervision.