This inspection took place on 28 and 29 March 2017 and was announced.

Braunton Care Limited is an established domiciliary care agency. It provides care to people in their own homes in the Braunton area of North Devon. At the time of our inspection, the service provided personal care and support to approximately 60 people. The time of visits ranged from 15 minutes to two and half hours. The frequency of visits ranged from once a week to 28 a week.

The service employed 21 care workers who worked both full and part-time.

The service has a 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 2008 and associated Regulations about how the service is run.

At the last inspection in January 2016, we asked the provider to take action to improve: the management of the service and record keeping; staff training; management of medicines; assessments, risk assessments and care plans, and staff training. Four requirement notices were issued. The provider sent us an action plan outlining how and when they would meet their legal requirements. We found this had been followed and all necessary actions had now been completed.

People were happy with the service provided. Comments included, “All the people have been wonderful …. they are all too nice” and “They are all very good”.

People were supported by a regular team of staff who arrived on time, stayed for the required time and did not miss visits.

Care workers were safely recruited, trained and received supervision in their job roles. They felt valued, included and listened to and enjoyed working for the service. Regular staff meetings took place to update care workers on important issues and any concerns could be discussed.

Staff knew how to recognise the signs of abuse and the correct action to take if they had any concerns.

When people started to use the service, an assessment of their needs was carried out. Each person had a care plan which identified risk assessments. Where needed, risk assessments were developed to help staff keep themselves and people safe. Medicines were given out safely and people were assisted to eat and drink meals of their choices. Care workers monitored people's health needs and involved health professionals where necessary.

People confirmed staff sought their consent before providing any care and where people lacked capacity. Care workers demonstrated an understanding of the Mental Capacity Act (MCA) (2005) and how this applied to their practice.

People developed positive and meaningful relationships with a team of regular care workers they knew well. People were treated with dignity, respect and privacy. Their independence was maintained and encouraged.

People knew how to raise any concerns or complaints and felt confident to do so. Where concerns were raised these were investigated and the appropriate action taken.

The service was open and inclusive and regular feedback was sought. The management team carried out care calls when necessary. People and staff were very positive about the

leadership of the service and felt communication was good.

The provider had a range of quality monitoring systems in place which included spot checks, regular staff meetings and a range of audits. Annual surveys were sent out to gain people's feedback to improve the service.

We gave short notice of this inspection as the agency is small and we needed to be assured there would be someone at the registered office. We visited the registered office on 11 February 2014 and spoke with the registered manager and nominated individual. We also looked at care plans and daily records relating to people's care and support. We checked how complaints were responded to and discussed how the agency had learnt from any issues identified from complaints.

We saw the service had robust recruitment processes in place to help protect vulnerable people. Staff all had copies of policies and procedures relating to medication management and had received training to ensure the supported people in a safe and consistent way.

We spoke with 12 people who used the agency following the office visit. They all said they knew how to make a complaint and felt confident any issues would be dealt with quickly. People were very complimentary about the staff providing the care and support. Comments included ''They are all very good, any little issues, I speak to the office and it has been sorted.'' Another person said ''They bend over backwards to do things for you, I have found them very flexible and this gives me the confidence I need.''

We found the provider was complaint with all five outcomes we inspected.

We gave short notice of 24 hours to this agency as they are small and we needed to ensure that someone was available in the office. We spent time looking at care plans, risk assessments and staff training details. We spoke with six people who receive a service and to two relatives of people who use the service. We heard that people were positive about the care and support received. Comments included ''Yes, they do exactly what is written in my plan. Some go that extra mile and offer to do more, some finish once they have done everything that is listed, but they all do a good job.'' Another person told us, ''They usually come at the time they should. Of course sometimes traffic holds them up, but if they are running very late we normally get a phone call to tell us why.'' One person stressed the importance of having the same carers for consistency and we heard that for the most part this had been honoured.

We saw that staff were supported and trained to do their job well. Care plans and risk assessments ensured that people's needs were clearly understood and care was delivered safely and at a time that suited them most of the time.

The agency has systems in place to review the care and support they provide and ensured they listened to people who use their service and staff who work for them

This inspection took place over three days on 11, 18 and 25 January 2016. The provider was given short notice because the location provides a domiciliary care service and we needed to make sure that someone would be in.

We previously inspected this service on 11 February 2014 and did not identify any concerns or breaches of regulations.

Braunton Care Limited is a small domiciliary care agency registered to provide personal care to people living in their own homes. The agency covers Braunton and the surrounding areas of North Devon. The service is managed from an office in Braunton which is easily accessible for people, relatives and care staff who need to visit. Times of visits ranged from 15 minutes to one hour. The frequency of visits ranged from one visit a week to four visits a day. At the time of inspection, the agency was providing a service to approximately 60 people and employed 17 care staff.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act and associated regulations about how the service is run.

People and their relatives felt safe, cared for and supported by care staff in their own homes. They were treated with kindness and respect. They told us: “They (care staff) are kind and respectful to me … absolutely”, “I am more than happy with the care”, “I like all the girls … they are very caring” and “I am more than happy … they (care staff) do a good job.”

Staff were recruited safely. They received the training they needed to do their jobs properly. However, they did not receive supervision to discuss their care practice and identify any further training needs. There had been a recent shortage of staff but the management team were actively recruiting more staff.

People’s medicines were not managed safely and improvements were required in how medicines were given out and recorded.

People did not always have an assessment and an up to date plan of care in place, with risks identified. Care staff were knowledgeable about how to manage people’s individual care needs. However, this was from experience and information which had been shared verbally between them.

People were supported to eat and drink from care staff who knew what their food preferences were. Care staff assisted people to visit health and social care professionals when needed.

Care staff asked for people’s consent before they gave any care. They had an awareness of the Mental Capacity Act (2005) and knew when to report any changes.

Some staff felt valued and supported in their work whilst others did not. Some staff reported low morale at the service. Staff meetings did not routinely take place and staff felt communication needed improving. This had been identified and the management team were addressing the issue.

People knew who to contact if they had a problem or complaint. Concerns were taken seriously and investigated.

The checks necessary to monitor and continually improve the service had not been completed. The management team felt this was due to recent staff shortages and the need for them to provide hands-on care to prevent any disruption to the service. The shortfalls we found in record keeping had not been identified although the management team were aware records needed improving.

We found four breaches 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.