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Inspection carried out on 17 December 2018

During a routine inspection

We inspected this service on 17 and 18 December 2018. The inspection was unannounced. At the last inspection, in September 2016, the service was rated ‘Good.’ At this inspection we have rated the service as ‘Good.’

North Hill Homecare, provides people with personal care in their own homes. At the time of the inspection the service provided support for approximately 130 people for people in the St Austell area. The service works primarily with elderly people.

The service had a 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.

The service had satisfactory safeguarding policies and procedures to keep people safe. Staff were trained to recognise abuse, and knew what to do if they suspected abuse was occurring. Suitable risk assessment procedures were in place, and risk assessments were regularly reviewed. Where appropriate management and staff had submitted safeguarding referrals to the local authority.

Recruitment checks for new staff were satisfactory. For example, the registered provider obtained a Disclosure and Barring Service check and written reference check when the member of staff was recruited. When staff started to work at the agency they were required to complete a staff induction programme, which included relevant training which assisted the member of staff to carry out their job. The registered provider had a suitable system of staff supervision and annual appraisal.

Medicines procedures were safe, and we saw evidence that supported this, including administration records and systems to support people with medicines. Staff were trained in procedures to minimise the risk of infection. People and their relatives said staff were always well presented in their individual roles.. Staff said they were provided with disposable gloves and aprons to support them in their roles.

There were satisfactory procedures to assess people to check they were suitable to receive support from the service. Subsequently staff developed comprehensive care plans for people and these were regularly reviewed.

Some people received support to prepare meals. Where necessary procedures to monitor the food people had eaten and their fluid intake, were satisfactory.

Where people lacked mental capacity, the agency provided people with the correct support to ensure their rights were protected.

Staff worked with people to maximise their independence. We received positive support about staff attitudes. Comments included; “They send the loveliest girls and my life would be terrible without them…They are wonderful.” and “They are not carers they are more like our friends.”

The service had a complaints procedure. People said they would approach staff or management if they had a concern. People told us where they had raised concerns or complaints these had been managed sensitively and resolved appropriately.

Management were viewed positively by the people who used the service and staff who we contacted.

The staff team told us they worked well together. People and their relatives viewed staff positively and staff were viewed as caring.

Quality assurance processes were satisfactory to monitor the service was working effectively, and pick up and address shortfalls in service provision.

Inspection carried out on 20 September 2016

During a routine inspection

North Hill Homecare provides personal care and support to approximately eighty people in and around St Austell, Mevagissey and the ‘Clays’. At the time of our inspection a team of forty four staff were operating from the main office in St Austell.

The service is required to have a registered manager and at the time of our inspection there was a registered manager in post. A registered manager is a person who has registered with the CQC 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.

Recruitment checks had not been completed for all staff before they began working at the service. In one instance a Disclosure and Barring Check (DBS) had not been requested until after the staff member had begun work with the agency. However, further records showed this was an isolated incident and there was evidence the staff member was not working alone but with a more senior staff member.

We have made a recommendation about the management of recruitment practice.

The service had a three month probation period which included one day office induction, spot checks and supervision reviews. However, the induction day did not always occur at the beginning of a person’s employment. This meant staff may not have the necessary information regarding policies, procedures, and safeguarding information at the beginning of their employment with the agency. We discussed this with the registered manager who recognised the need for induction to be an initial first step and agreed to act upon this with immediate effect.

People told us they felt safe and were well cared for by North Hill Homecare. Their comments included; “Very happy. Lovely girls”, “They chat and make me feel comfortable”, “They (staff) always make sure the door is locked when they leave and that makes me feel very safe.” A family member was positive about the support their relative received. They said, “They make sure all the equipment is there.”

The registered manager was confident about the action to take if they had any safeguarding concerns and had liaised with the safeguarding teams as appropriate. Staff told us they had attended both classroom training and e-learning (computer based training) to learn what action to take should staff witness or suspect abusive practice.

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.

Visit schedules included appropriate amounts of travel time for staff between visits. Call monitoring data and daily care records showed that staff normally arrived on time and provided visits of the planned duration. People said, “They stay as long as they have to” and “On the odd occasion they have been delayed the office give me a ring and let me know.”

People told us they thought the staff knew their needs and how to meet them. Training records showed staff had been provided with all the necessary training which had been refreshed regularly. A staff member told us, “I have good access to all the training I need. We also have specialist training when people need certain equipment or specialist feeding.”

Suitable medicine procedures were in place should the service be required to administer medicines. Staff told us they had received training which gave them confidence to support people with medicines safely. Auditing of medicine records meant errors were identified and acted upon quickly.

The management team had systems in place to regularly measure the service’s performance and look at ways of developing the quality of service they provided. There were processes in place to seek people's views on the service and monitor the quality of the service. Information from customer surveys and the actions