Axe Valley Home Care Limited provides personal care and support to people living in their own homes in towns and villages in East Devon; this includes Seaton, Honiton, Exmouth, Sidmouth and Axminster. At the time of our inspection there were 190 people receiving a service. The provider has a main office in Seaton and a sub-office in Sidmouth. Visits are planned by staff in the Seaton office.

At the last inspection in June 2015, the service was rated Good overall, although the Responsive domain was rated as requires improvement as we found a breach of regulations. We asked the provider to submit an action plan of how they would address the breach.

This inspection took place on 22 and 25 May 2017 and was announced. The provider was given short notice because the location provides a domiciliary care service and we needed to be sure that someone would be in. At this inspection we found the service remained good in the Safe, Caring and Well-led domains and had addressed the breach of regulation in the Responsive domain.

The inspection team consisted of two adult social care inspectors and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses domiciliary care services. The expert by experience and one inspector spoke by telephone with people and their relatives following the second day of 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 and nominated individuals, 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 registered manager understood their responsibilities and worked with other senior managers and staff to maintain and improve the quality of the service. This included undertaking quality assurance checks and audits to monitor the service.

At this inspection the service remained Good overall. However, the service was not fully effective as most staff had not completed regular training updates. However the registered manager had recognised that this was an area where improvement was required. Staff received some supervision, although not all staff had had the supervisions described in the organisation’s supervision policy. Where staff were not performing to the standards required, there was evidence that this was addressed with them and support was given for them to improve.

Staff were recruited safely and were provided an induction when they joined the service. This included undertaking training as well as work shadowing colleagues.

The service had recognised they needed to improve their responsiveness to changes in people’s care needs. A new electronic care record system had been introduced which allowed care records to be revised and updated during a visit by staff. This meant that people received care which met their needs more fully. The service was able to respond more quickly where a visit did not occur at the right time.

People were supported to have choice and control of their lives by staff who were kind and caring. Feedback from people was mainly very positive and included comments such as “They’re always chatty, cheerful, happy”, “They make you feel they would do anything you ask them” and “Very kind, very very very kind.”

Staff supported people to take their medicines safely and also ensured that where required, people were supported to access health and social care professionals as well as have sufficient to eat and drink.

Staff understood their responsibilities in terms of safeguarding vulnerable people. Staff also understood and worked within the requirements of the Mental Capacity Act (2005).

The agency provided care for about 250 people in their own homes and employed approximately 100 staff. We spoke with ten people and relatives who used the service and asked them about their experiences, we looked at six people’s care records. We spoke with eight staff including the registered manager and asked them about how they met people’s care needs.

People and relatives we spoke with confirmed staff arrived on time and stayed for period agreed. One person said “the carers always chat, they have a friendly approach, I don’t know what I should do without them”, another person said care workers “have a cheerful presence and do the job willingly and well”. One relative we spoke with said the care workers visits were a positive experience for the person, they said “he is always delighted to see them”, another relative said, “If it wasn’t for them, I wouldn’t see anyone at all, they are all so cheerful”.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. We found people experienced care, treatment and support that met their needs and protected their rights. We found safe and appropriate arrangements in place to manage people’s medicines. Appropriate checks were undertaken before staff began working at the agency. Comments and complaints people made were responded to appropriately.

We found the service was meeting the five standards we inspected.

We (The Care Quality Commission) carried out an unannounced inspection to Axe Valley Home Care Limited on 18 January 2012. This domiciliary care agency provides services for about 280 people in their own homes and employs more than 90 staff. We spoke with nine people who used the service as well as a relative and a carer about the care and treatment provided. We looked in detail at the care for four people, including looking at their care records. We spoke with 11 staff, including office and care workers and the registered manager about the care provided, staff training and development as well as support offered.

People’s experience was that care workers were reliable, arrived on time and stayed for the length of time agreed. Where changes were made, people said the agency mostly let them know in advance and visits were never missed. People were very positive about the professionalism and caring attitude of staff. They reported that care workers treated them with dignity and respect, were discreet and involved them in making choices about their care.

People we spoke to confirmed that care staff knew how to provide the care they needed and said their care records accurately reflected their needs and the care being given to them.

Everyone we spoke to said they felt safe having care workers coming into their home and said they knew how contact the agency if they had any concerns and were confident they would receive a response quickly.

Everyone we spoke to confirmed they thought their care workers had the skills to provide the care they needed and four people described how care workers skills were regularly assessed by the agency.

The agency had a range of systems in place for monitoring the quality of care and demonstrated how they improved the service following feedback from people, staff and in response to incidents and complaints.

This inspection took place on 24 June and 21 July 2015 and was announced. The provider was given short notice because the location provides a domiciliary care service and we needed to be sure that someone would be in. The inspection team consisted of two inspectors and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses domiciliary care services. Inspectors also visited people in their homes by prior arrangement on 26 June and 2 July 2015

The expert by experience spoke by telephone with people and their relatives following the first day of inspection.

Axe Valley Home Care Limited provides personal care and support to people living in their own homes in towns and villages in East Devon, including Seaton, Honiton, Exmouth, Sidmouth and Axminster. At the time of our inspection there were 262 people receiving a service.

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 and nominated individuals, 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.

People said they felt safe and cared for by staff.

Staff did not always record the care they provided. Staff also did not always record the medicines they administered accurately and completely. People’s needs and risks were assessed and care plans developed to meet these, when the service commenced, although we found some evidence that care plans were not always updated to reflect changes in people’s needs.. However the registered manager said they would take action to audit records and make improvements where needed.

Axe Valley Home Care had quality assurance systems in place, although these did not always identify all the concerns. The registered manager provided assurance that they would act on this.

Axe Valley Home Care employs people from the local area and people from overseas with English as a second language. Some people commented that they had some difficulty understanding some of the staff at times. They also said some of the care workers did not understand how to prepare food in a way people expected and were accustomed to.

People described how care workers were kind and often offered to do additional tasks if time permitted. We also found evidence of some care workers showing compassion and kindness to people and their families at difficult times, for example during a bereavement. There were isolated examples of times when care workers did not show consideration to people, for example when they conversed in the language of their country of origin rather than in English when in a person’s home. However, the registered manager took actions to address these concerns as soon as they were made aware of them.

The provider had recognised the need to introduce more robust supervision and appraisal systems for staff and was recruiting additional senior staff to ensure this happened.

The registered manager responded to all complaints and concerns raised in a timely way, and there was an action plan to improve the delivery of care following an annual survey.

The provider took steps to ensure the staff they recruited were fit to work with vulnerable people by undertaking effective checks including interviews, references and other checks before they started work. There was an induction into working with Axe Valley Home Care which followed nationally recognised standards. The induction comprised training as well as work shadowing so staff were introduced to people they were going to be working with by an experienced member of staff.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.