The Care Quality Commission
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Archived: Trenovissick Domiciliary Care Agency Limited

5 Westward Business Centre, Mill Street, Crediton, Devon, EX17 1HB (01363) 774010

Provided and run by:
Trenovissick Domiciliary Care Agency Limited

Important: This service was previously registered at a different address - see old profile

All Inspections

15, 16 January 2014

During an inspection looking at part of the service

At the time of this inspection the agency provided a domiciliary care service to 134 people. The purpose of this inspection was to follow up a compliance action issued at the last inspection in May 2013 relating to the care and welfare of people who used the service.

We visited the agency office where we spoke with the registered manager, a senior care worker and a senior manager representing the provider. We looked at four care plans and the agency computer records. Following our visit we spoke with 15 people and/or their relatives on the telephone. People told us they were completely satisfied with the care they received and praised the care workers. Comments included 'Yes, it could not be any better!' and 'They are perfection! They understand me well.'

Most people received visits on time, or within a few minutes of the expected time of arrival. The incidence of missed visits due to care workers unexpectedly being off sick had reduced significantly since our last inspection.

Care plans clearly explained how the person wanted each task to be carried out. The plans were up to date and had been reviewed at least every six months. Risks associated with personal and health care needs had been assessed. Care workers had been given information and training on specific risks such as prevention of pressure sores. This showed that actions had been carried out by the agency since the last inspection to make sure people received a safe and reliable service that met their care and welfare needs.

21, 22 May and 4 June 2013

During a routine inspection

We checked outstanding compliance actions. We visited four people in their homes and spoke with 10 people and their relatives on the telephone and six care workers. Most people we spoke with were complimentary about the agency and told us they were generally satisfied with the service. Comments included 'I am very, very lucky with them. The girls are very good' and 'The carers are well trained and know what to do.'

We saw improvements in all areas of the service. Every care plan had been reviewed and the standard of information was significantly improved. The reliability of the service had improved, although some people continued to experience missed visits, or visits much earlier or later than expected. Most people we spoke with or visited told us care workers always visited them close to the expected times. The providers told us they were continuing to take actions to improve the reliability of the service further.

Procedures for administering medicines safely were improving. We saw some evidence of poor recording of medicines administered. However, the agency had already identified these matters and they were in the process of taking actions to prevent recurrence. We also found evidence of improvements in staff recruitment, induction, training, supervision and support systems. The providers recognised that further actions were needed to improve staff morale, and we saw that a range of actions were being followed to achieve this.

12 December 2012

During an inspection looking at part of the service

This visit was to follow up the warning notices we issued following our previous inspections during August and October 2012. We required the provider and registered manager to become compliant with the outcome standards on care and welfare of people who use services, and assessing and monitoring the quality of service provision by 30 November 2012. During that inspection we also issued four further compliance actions.

We visited three people in their homes and spoke with nine people or their relatives. We also spoke with five care workers. People told us they were satisfied with the care they received from their regular care workers. However, some people had not received weekly timetables to let them know who would be visiting them, and this had caused some upset. We heard of no examples of missed visits in the previous month but people told us they had experienced some visits much later than the expected times. The agency told us that recent staff sickness had caused disruption to their service but they expected this to improve when sickness levels reduce.

We found that the providers had carried out audits and quality assurance procedures to help them identify the actions they needed to improve the quality of the service. They had made improvements and we will check on all outstanding compliance actions in the next three months. They had drawn up detailed action plans and they had begun to implement changes.

23 August 2012

During a themed inspection looking at Domiciliary Care Services

We carried out a themed inspection looking at domiciliary care services. We asked people to tell us what it was like to receive services from this home care agency as part of a targeted inspection programme of domiciliary care agencies with particular regard to how people's dignity was upheld and how they can make choices about their care. The inspection team was led by a CQC inspector joined by an Expert by Experience, who had experience of using or caring for someone who uses this type of service.

We visited five people in their own home as part of this review and spoke with them and their relatives about their experiences of the support they have received. We also spoke with two relatives on the telephone. We also spoke with fourteen people who received a care service, two relatives and twelve care workers on the telephone. During our visit to the agency office we met and spoke with the manager and a senior manager who was present on behalf of the provider.

We saw evidence to show that most people usually received visits within 30 minutes of the times they had requested. However, we found that some people had experienced missed or late visits. We heard that people had not always been contacted by the agency to let them know when care workers were running late. Some people had been expected to manage at times without a visit from the agency. The agency told us they had recently increased staffing levels and they were confident would prevent people experiencing missed or late visits in future.

Most people told us they were satisfied with the standard of care they received from the care workers. Comments included 'They are all lovely people! The care workers 'go the extra mile'. However, some people said they were not satisfied with the service provided by the agency office. Comments included 'The office is chaotic', and 'The administration is awful.'

Care plans provided information about people's needs and the tasks to be carried out. However, some care plans did not contain sufficient information to ensure care workers met people's needs fully. There were systems in place to ensure care plans were reviewed regularly. Despite these systems some care plans were out of date, and some were not dated.

At our last inspection of the agency we found that the agency was not ensuring that care workers were administering people's medications safely. During this inspection we heard that the agency had taken some actions to improve the way medicines were administered and recorded safely. However, the records we saw during this inspection showed that people remained at risk of medication errors or omissions.

Most care workers had not received regular formal supervision or support. Some care workers said they were able to visit or contact the office for informal support or advice. However, some care workers told us they did not feel they received the support they needed. The agency did not have systems in place to gather the views of care workers or to identify areas of concerns or problems. No staff meetings were held.

Most people told us the agency had not asked for their views or comments on the service. Comments included 'No-one has asked us for any feedback, sadly this service has been gradually going downhill over the last eighteen months', and 'Never been asked. I would have commented about different people coming all the time, I don't know them'. However, we saw evidence to show that the agency had sought the views of some people on the quality of the service provided though annual surveys. The results of the surveys had been collated and analysed. However, the agency's quality monitoring systems did not include systems to regularly monitor all aspects of the service to ensure the service ran smoothly.

During this inspection we were contacted by two people who raised concerns. We passed these concerns to the local authority safeguarding team for the concerns to be investigated.

During this inspection we found that the agency did not have suitable systems in place to seek people's views and comments on the service. Systems to monitor the quality of the service were flawed and did not enable the provider to identify problems with the reliability or consistency of the service, or to ensure that people were protected from harm or abuse. The agency failed to adequately seek the views of care workers or to address concerns or complaints raised by them. We will be meeting with the provider to discuss our findings and to ensure they have an action plan in place to address areas of non-compliance.

We visited the agency again on 16 October 2012. We found that plans had been made to make improvements. These plans had not been fully implemented at the time of our visit and therefore we found that people continued to be at risk of receiving a poor care service.

28 November 2011

During a routine inspection

This review of compliance took place over two days. On 28 November 2011 we visited the offices of Trenovissick Domiciliary Care Agency to look at records and we talked to the manager and other members of the management team. On 1 December 2011 we visited four people who receive a care service in their homes. In addition we spoke to six people on the telephone and three relatives. We also talked to two care workers.

People praised the care workers for their caring manner. Comments included, 'I am very lucky indeed. I am well looked after', 'The care workers are always very pleasant ' I like all of them', and 'Exceptional!'

All of the people we spoke to told us that their regular care workers always treated them with respect and kindness. One person said they had the same team of care workers for several years. The care workers knew her well, never missed a visit and always arrived on time. 'We have a bit of fun ' they always do an excellent job!'

The agency sent out a weekly timetable to every person to let them know the names of the carers who would be visiting the following week, and the date and time of each visit planned. People told us they appreciated the timetables as it meant they knew who would be visiting them.

Most people said they had never had any problems but said they would ring the agency office if they needed to. However one person told us they had complained to the agency four times because of care workers arriving late. She praised the care workers but said they were always rushed because the agency did not allocate any travel time between visits. She said that a number of care workers had said they had given in their notice in recent months because of the pressure they were under to get to each person on time and complete all of the tasks in the time allocated.

The relative of another person who received a service from the agency told us 'The carers are variable, with some excellent. They appear rushed'. The person said that time was not allowed between jobs for travel, and they complained that additional visits were frequently inserted into the care workers schedules without actual slots existing. The relative said their mother had recently seen a decline in the morale and initiative of the care workers.

We talked to the manager and a senior manager about the way the agency allocated travel time between visits. The managers told us they were considering allocating some travel time between visits in future.

We looked at four care plan documents held in the agency office and we also looked at the care plans of the four people we visited in their homes. We found that many of the care plans provided a short list of the tasks each person needed assistance with but did not give a full explanation of how the person wanted the tasks to be carried out. Two care plans we looked at had recently been reviewed and provided very good detail about each task, and were clear and easy to follow. The manager told us they were planning to draw up all care plans in future with a similar level of detail.

We looked at the way the agency helped people to take their medication. We found that the agency had incorrectly assessed some people as requiring prompting only, even though people relied on the care workers to administer their medicines. Records of medicines administered were poor, and some of the records had many unexplained gaps. Care workers had received training on the safe administration of medicines, but, despite the training, they had failed to alert the agency office when they visited people and found incomplete records of administration. This means there was a risk that people may experience medication errors or omissions.

The manager had received training by the local authority on safeguarding adults, and all new staff had received training on this topic during their induction period. The manager had a good awareness of local safeguarding reporting procedures.

The manager told us that the agency had policies and procedures and good recording systems in place to protect people from financial abuse. However, two people we visited had received assistance from care workers with shopping tasks but no financial recording sheets had been completed by the care workers each time they handled cash. This means that the care workers could not provide evidence that the transactions had been completed correctly and people had received their shopping and change correctly.

We looked at the way the agency recruited and trained new staff. We found they had taken up all required checks before new staff began working. We were given details of training the staff had received and we found the agency had provided training on a wide range of topics relevant to the needs of the people who received a care service.

The agency had a range of procedures in place to check the quality of the services provided. These included questionnaires sent to people to find out what they thought about the services provided by the agency.