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Continuum Care (Cornwall) Requires improvement

We are carrying out a review of quality at Continuum Care (Cornwall). We will publish a report when our review is complete. Find out more about our inspection reports.


Inspection carried out on 13 July 2020

During an inspection looking at part of the service

About the service: Continuum care (Cornwall) is a domiciliary care agency which provides support to people in their own homes. It operates in Falmouth and Truro and the surrounding areas. The service had grown significantly since our previous inspection and now supports around 40 people. It consists of two parts, a traditional domiciliary care service that provides short regular visits to predominantly older people living in the own homes and a supported living service which provides longer visits to support people with learning disabilities.

This targeted inspection was completed in response to information of concern related to people's privacy and dignity that was reported to the Commission. As a result, we reviewed the service’s risk management procedures, staffing arrangements and incident investigation processes to ensure people receiving supported living care were safe.

The service’s risks management procedures were appropriate and designed to ensure people’s safety. Individual areas of risk had been identified and staff were provided with specific training and guidance on how these risks should be managed.

All incidents had been documented and investigated by the registered manager, to identify any areas of learning or changes that could be introduced to improve the quality of support people received. Records showed that learning from incidents had led to people’s care plans being updated so all staff were aware of people’s current support needs.

The service was well staffed and all planned support visits had been provided during the COVID-19 pandemic. The service’s recruitment practices were now safe and all necessary checks had been completed to ensure staff were suitable for employment in the care sector. Staff had received appropriate training and were confident they had the skills and knowledge necessary to meet people’s support needs. They told us, “I have all the support I need”, “[The registered manger] had a very cautious approach to putting you to work on your own. He definitely didn’t leave you until you were completely ready.”

People and relatives felt the service was safe and had impacted positively on people’s wellbeing. A relative told us, “We are seeing really positive changes in [persons name’s] communication and we can’t thank them enough for that. One person said, “I feel safe with them, they do what I need them to do.”

Staff told us they were well supported by their managers and had received regular supervision and support. Staff comments in relation to the service management included, “They are really on the ball. [the registered manager] is a fair guy always ready to listen and open to suggestions”, “I am very impressed with the company and the fact that [the registered manager] and [care manager] work with the clients and understand their needs” and “[the managers] are very nice people, very caring and thoughtful. They do look after us very well”.

Rating at the last inspection

This service was previously inspected in May 2019 when it was found improvements were required in relation to people’s safety and the service’s leadership.

Why we inspected

We undertook this targeted inspection to follow up on specific concerns which we had received about the

service. The inspection was prompted in part due to concerns received about service’s systems for the management of risk, staffing arrangements and incident investigation processes. A decision was made for us to inspect and examine those risks.

CQC have introduced targeted inspections to investigate specific concerns or follow up on Warning Notices during the COVID 19 pandemic. They do not look at an entire key question, only the part of the key question we are specifically concerned about.

Targeted inspections do not change the rating from the previous inspection. This is because they do not

assess all areas of a key question.

Follow up

We will continue to monitor information we receive about the service until we return to

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.