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Continuum Care (Cornwall) Requires improvement


Inspection carried out on 17 May 2019

During a routine inspection

About the service: Continuum is a domiciliary care agency which provides support to people in their own homes. It operates in Falmouth and Truro and the surrounding areas. At our previous inspection only four people were using the service and there were very few staff employed. At this inspection the service had grown and 23 people were using the service. Care visits lasted between 30 minutes and three hours and usually took place at key points in the day when people needed assistance getting up or going to bed or support with meals.

People’s experience of using this service: Care plans were in place and covered a wide range of areas including communication, mobility, health history and descriptions of routines where these were important to people. Medicine care plans lacked detail and were not completed in line with the relevant national guidelines.

Some people had been identified as being at risk due to their health or living situation. Risk assessments were developed to inform staff but these lacked guidance and did not consistently reflect people’s circumstances.

During the inspection we identified three members of staff who were working without the appropriate background checks in place. We raised this with the registered manager who assured us these staff would be taken off the rota until the checks had been completed.

There had been a recent turnover of staff and more staff were being recruited at the time of the inspection. Visits were being covered by existing staff with occasional support from agency workers. The registered manager frequently covered shifts and was well known and liked by people using the service.

People told us visits were not missed or late without their prior knowledge and agreement. They were highly complimentary of the service provided and of the registered manager. Staff were caring and supportive in their approach. One person commented; “They have never, never been disrespectful.”

Staff told us they were well supported by the registered manager and senior care worker. Team meetings were held regularly and management were described as approachable. One member of staff told us; “One of the best bosses I’ve ever worked for, he listens and is fair.”

Systems to audit, monitor and develop the service were not sufficiently embedded or consistently followed. For example, there was no training matrix in place and audits had failed to highlight the need to complete pre-employment checks.

Rating at last inspection: Due to the small size of the service we did not award a rating at the previous inspection. (Last report published November 2018)

Why we inspected: This was a scheduled inspection which was planned to enable us to rate the service.

Enforcement: Please see the ‘action we have told the provider to take’ section towards the end of the report

Follow up: We have asked the provider to produce an action plan addressing the areas of concern found at this inspection. We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at

Inspection carried out on 3 November 2018

During a routine inspection

Continuum is a domiciliary care service that provides care and support to people living in their own homes. At the time of the inspection the service provided personal care to four people. When we inspected two people were regularly using the service. The other two people only received care occasionally. Due to the small number of people using the service we were not able to provide a rating for Continuum because of the limited evidence available. We will complete a further inspection in the future to ascertain if we can obtain sufficient evidence to rate the service.

We inspected Continuum on 3 November 2018, the inspection was announced in advance. This was because the service is small and we needed to be sure someone would be available to talk with us. This was the first time the service had been inspected.

The owner of the agency 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.

There were no other staff employed at the service at the time of the inspection and the registered manager was providing care with occasional support from a volunteer. The volunteer had the appropriate checks in place to verify they were suitable for the role. Two new employees were in the process of having pre-employment background checks completed. Plans were in place for new employees to complete an induction and initial training before they started to deliver care independently.

People were protected from identified risk. The registered manager knew people well and was aware of the support people needed to help keep them safe. There was a safeguarding policy and people had access to contact details of external agencies if they wanted to raise any concerns. One person was having limited support with medicines and this was documented in their care plan.

Care plans contained clear descriptions of people’s routines where this was important to them. The care plans were relevant to people’s individual circumstances. Copies were made available to people in their homes.

People and their relatives were largely positive about the caring approach of the registered manager. They told us they felt in control of arrangements for their care and support and would be able to ask for any changes if necessary.

The registered manager had a clear vision for the development of the organisation. In our conversations with the registered manager, people and relatives, there was a recurrent theme of the flexible approach to care and support.