The inspection took place on 14, 18, 21 May, 08 June and was announced.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community and in six extra care housing units across Plymouth. It provides a service to older adults who may have dementia or a sensory or physical disability.

Extra care housing is purpose-built or adapted single household accommodation in a shared site or building. The accommodation is rented, and is the occupant’s own home. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for extra care housing; this inspection looked at people’s personal care and support service.

Not everyone using the service receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

A registered manager was employed to manage the service locally. 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 owner, who was also the Nominated Individual was also involved in the day to day running of the service. Each extra care housing unit had a team leader in place who was responsible for the day to day running of the unit.

People often experienced calls that were too early or too late for their needs. They also weren’t always informed of changes to call times and didn’t always have consistent staff members. Staff told us they felt the organisation was short staffed and they or other staff were pressured to fulfil extra calls as a result.

Risk assessments were not always in place to guide staff how to reduce risks relating to people’s health and social care needs. Staff identified people’s changing health needs but it was not always clear whose responsibility it was to contact the relevant healthcare professional. People received their medicines safely from trained staff; however these were not always recorded or monitored in a safe way.

Safe recruitment procedures were in place, however when new staff shadowed experienced in people’s homes, people had not been told the staff member may not have an up to date DBS in place.

People’s care plans did not include information about how they liked their care delivering. Staff told us care plans were not always up to date. People preferred methods of communication had not always been sought. However, where these were known by staff they were respected.

Where staff had got to know people well, they used their knowledge of them to ensure their wellbeing was promoted and their preferred routine, likes and dislikes were respected. However this information was not always included in people’s care plans. Information about people’s gender, sexuality or communication needs had not been sought by the service. This meant staff may not have been protecting people’s human rights in relation to these characteristics.

The registered manager and provider had not ensured that when people lacked capacity, a mental capacity assessment was completed. This meant their rights may not have been respected.

The registered manager and provider had not ensured there was an effective quality assurance system in place that enabled them to have a clear overview of all aspects of the service. Where senior staff checked aspects of the service or information on the quality of the service was collected from people, there was no clear plan to improve any areas of concern.

People told us staff were caring and treated them with respect. Staff gave examples of how they supported people to maintain their independence and prote

The inspection took place on 8, 9, 17 and 18 March 2016 and was announced.

1st Call Homecare Ltd provides a personal care service to people living in their own homes and within six extra care housing locations. On the day of the inspection 198 people were supported with their personal care needs.

A registered manager was employed to manage the service locally. 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 extra care housing locations each had a team leader in place who were responsible for the day to day management of the staff team. The team leaders were overseen by one of two deputy managers. The part of the service which provided care in people’s private homes was overseen by another manager.

People told us they felt safe comments included, “I’ve been with them 10 years so that tells you how safe I feel.” All staff had undertaken training on safeguarding adults from abuse, they displayed good knowledge on how to report any concerns and described what action they would take to protect people against harm. Staff told us they felt confident any incidents or allegations would be fully investigated.

People were protected by the service’s safe recruitment practices. Staff underwent the necessary checks which determined they were suitable to work with vulnerable adults, before they started their employment.

Staff told us they did not receive much travel time between calls which resulted in them starting their calls early or cutting the time they spent with people. The registered manager addressed this during the inspection.

People’s preferences were sought and respected but these were not recorded in detail in people’s care plans or risk assessments to enable staff to provide consistent care. The registered manager had begun to implement more detailed, personalised records by the end of the inspection.

People had their medicines managed safely. People were supported to maintain good health. Referrals were made quickly to healthcare professionals, such as GPs, physiotherapists and occupational therapists when people’s needs changed.

People knew how to raise concerns and make complaints. People and their relatives who had raised concerns confirmed they had been dealt with promptly and satisfactorily.

Staff put people at the heart of their work; they exhibited a kind and compassionate attitude towards people. Strong relationships had been developed and staff treated people and their loved ones with respect. Staff were motivated to provide good care and appreciated the importance of respecting people’s privacy and dignity. Comments included, “I love my job, I’m passionate about improving things for people.”

Staff described the management as open, supportive and approachable and talked about their jobs in a positive manner. Comments included, “I think it’s great. If I’ve ever had any issues at all, I just call or pop in and they are supportive and help me.”

There were quality assurance systems in place. As a result of feedback from the inspection, the registered manager decided to implement a new quality assurance system to ensure any gaps were highlighted quickly and easily.

At our inspection on 11 November 2011 we had concerns about staff training including safeguarding, staff support from management including supervision and quality assurance of the service. As part of our inspection carried out on 11 January 2013 we followed up on how the service had progressed in addressing these concerns.

We found that the service had implemented a new assessment and care planning system. This system was individual to each person and provided information and instructions to staff on how to meet people’s needs. People told us they were involved in their care planning. Staff told us care plans helped them to meet people’s needs.

We saw that the service had a training matrix. We saw 69 staff had received safeguarding training in 2012, 13 staff in 2011 and three staff in 2010. From this we could see that the majority of staff (85 of 94) at the service had received recent training. People told us that they felt safe. Staff told us what procedure they would follow if they needed to report abuse. Staff told us that they felt supported and we saw that they had received supervision and appraisals.

We saw that the service had sent questionnaires out to people who used the service and had collated the information. We saw from the audits that there was an improvement in the service. We saw evidence that the service had discussed areas of concern raised by people using the service and in response had put together action plans to find ways to address the issues.

People we spoke with told us they felt staff treated them with respect and listened to them.

People said that the care staff usually arrived at the correct time. One person told us that there were occasions when staff had to go to someone else at short notice before visiting them. This means that the staff could be around 20 minutes late. One person told us that if staff had finished they would leave 10 minutes early to get to their next appointment.

People we spoke with told us that they usually have the same care staff. One person told us that they had a main care worker, who they got on with very well. Other people who used the service raised the issue of having different care workers with less continuity. People were not always made aware of the change to their care worker.

People told us that the staff were all very good and were happy that the staff met their needs appropriately. People who used the service and had been asked for feedback commented ‘Thank you very much for the help & kindness shown to me by all of the care staff’; ‘I am very pleased & grateful for the help & comfort I receive from your service’; ‘I am happy with the service & it is a comfort to know that some-one is coming in twice a day’ and ‘Lovely way to start the day seeing the carers, they are now my friends’.

People we spoke with told us that they felt safe.

People we spoke with told us that they felt staff knew how to meet their needs. One person commented that staff sometimes forgot to do things and another person said that some staff could do with more training.

We received concerns over quality at the agency from Plymouth City Council (PCC). The local authority funded the care for around 95% of the people who use the agency. They carried out a quality review of the agency on 3 and 4 November 2011. They raised a number of issues in relation to complaints; care workers not staying the full length of time; lack of continuity of care staff attending visits; staff recruitment, training and supervision. Further to the review, Plymouth City Council told us that they planned to meet with the provider to discuss their report and actions that the provider would take to address the issues.

During this inspection we visited the head office of 1st Call Homecare and met with the Registered Manager and the Deputy Manager. We met with 26 people receiving care from the provider, attended a resident's meeting in one of the supported housing projects and visited seven people in their own homes. We spoke with 21 staff working across the organisation, reviewed nine staff files and read seventeen care plans. In addition, we sent a questionnaire out to 61 people who were using the services of 1st Call Homecare. We received 35 returned questionnaires with positive responses about the care and support people and their families received.

We considered our inspection findings to answer the following five questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This is a summary of what we found.

Is the service safe?

All of the people we met during this inspection received care and support in their own homes. Everyone told us that they felt safe and that the staff visiting them always ensured they had their alarms on before they left them and that they left their properties secure. In the questionnaire responses we received, 96% of people told us they always felt safe when 1st Call Homecare visited them.

We found care plans and risk assessments in relation to people's care, their medicines and their environment were in date and in most cases reflected their current needs. Staff felt able to request reviews of people's care when their needs had changed. In the questionnaires we received, 60% of families told us they had felt involved in care planning, 30% feeling they did not need or wish to be involved.

We saw that where people needed support to manage their medicines safely, arrangements were in place to protect people for example by using lockable safes.

The personnel records we reviewed were well organised and contained the necessary information required to ensure staff were of a good character. References and police checks had been conducted prior to new staff commencing work, staff received an induction and there was on-going monitoring of the quality of their work. 100% of respondents to our survey felt care workers had they right skills to support their care. This told us people felt staff had the right qualities and training to support them to meet their needs.

Is the service effective?

People told us "I'm happy, I have good care"; The carers are kind"; "Things are okay"; "They walk in...hello, can I make you a tea?...They must know I'm a tea addict!" and "I have never met one (carer) I didn't like."

People were happy with the care and support they received. Some people and staff mentioned the organisation of visits, consistency of staff visiting and communication with them could be improved when changes were made to their schedules. One person who had complained felt listened to and was confident similar issues would not arise in the future. Our survey responses indicated that 90% of people were satisfied with their care, 40% stating the service and support they received was excellent.

Is the service caring?

People told us "I'm happy with the care....we get on well and have a giggle". Another person told us "They are polite, caring, never missed a visit" and "They are very sympathetic". In the questionnaire responses we received people told us that staff were "friendly, helpful and very caring".

People told us all of the staff were kind and caring when they visited. Our conversations with staff indicated they cared about the people they worked alongside and they enjoyed their jobs. Staff were knowledgeable about the people they supported and we saw staff speaking with people with respect and treating them with dignity. 88% of people told us they were always treated with respect by the care workers and had never experienced any kind of discrimination.

Is the service responsive?

People's needs were assessed prior to them receiving care from the provider. Care plans were developed alongside people and their families as soon as possible. Care plans reflected people's preferences and diverse needs. Where necessary the provider liaised with external agencies to support people's changing needs such as occupational therapists as people's mobility declined.

People told us they felt able to complain if they needed to and we saw that complaints had been thoroughly investigated and learning had taken place following complaints. 84% of people who responded to our questionnaire knew what to do if they had a concern about the service and 20% had felt able to raise a complaint with the provider. 80% of families who responded to the survey we sent to them knew how to make a formal complaint. This told us people and their families were familiar with the complaints process and felt able to raise a complaint when they needed to.

Is the service well-led?

There were quality assurance processes in place to monitor and improve aspects of service provision. People had the opportunity to feedback through quarterly questionnaires and through regular residents' meetings in the housing projects. There were policies in place to support staff in their work. Regular audits of medicines had helped to improve the management of medicines in people's homes. Staff told us they were clear about their roles and responsibilities and felt supported by colleagues. There were systems in place to monitor the quality of staff's work such as one to one meetings, group supervision sessions and spot checks.