The first day of this inspection was unannounced. The second day, we gave short notice to enable the registered manager and directors to be available.

Chapter care provides personal care and support to people’s own homes in and around the Barnstaple and Bideford area of North Devon. They currently support up to 70 people in their own homes. The service can range from a short welfare check to complex packages of care four times a day and if needed overnight care. The registered manager was supported by a finance director, trainee manager, care manager, care coordinators and administrators in the office. There were also up to 39 care staff, six of whom were new to the service at the time of the inspection, so still completing their induction process.

The registered provider was also the registered manager. 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.

Recruitment processes did not always ensure only staff who were suitable to work with vulnerable people were employed. This was because employment gaps had not been explored and one staff file did not have an up to date police check.

Care plans gave staff a good account of the tasks to be completed on each visit and risks had been assessed and were reviewed as needed. They did not always have details of people’s past histories and things that were important to them. We fed this back to the registered manager who agreed to review the information within care plans to ensure a more person centred approach. We also made a recommendation.

A number of effective methods were used to assess the quality and safety of the service provided. People knew who the registered person was and trusted them to provide good care. They said they were very knowledgeable, kind, approachable and listened to them.

Staffing levels were adequate for the packages of care being commissioned. Staff said they had support and training to do their job effectively. This included regular supervision, appraisals and spot check son their work.

Staff understood how to protect people’s rights as they had received training in understanding the Mental Capacity Act. Staff ensured people’s consent was gained before providing any care and support.

People were supported to manage their medicines safely and effectively.

People were complimentary about the care and support and said care workers were ‘‘very kind’’ ‘‘always willing to help with anything’’ and ‘‘All the chaps and girls who come are lovely, I can’t say a bad thing about one of them.’’ Some people had particular praise for individual staff, describing them as ‘‘special and always eager to help.’’

We made two recommendations to improve the service and these can be found in the main body of the report.

This is our second visit to Chapter Care Ltd in 2011. Our first visit was a responsive review in August 2011 in response to a concern about an individual person, which resulted in two meetings with a range of professionals and a member of the management team from the agency.

In our first inspection we focussed on specific standards that linked to the concern. After this inspection, the agency was required to produce an action plan as all seven standards that we had inspected were not compliant with the Health and Social Care Act 2008 (HSCA).

We returned on 23, 25 and 29 November 2011 to carry out a planned, unannounced inspection, which included essential standards under the HSCA to check on improvements. The purpose of our second inspection was to check for improvement against the action plan that Chapter Care Ltd had supplied. On this visit, we also looked at the standard for safeguarding because of information we saw during our office visit, which raised concerns about how the agency responded to safeguarding issues. After our second inspection the Care Quality Commission (CQC) held a management review meeting to help us decide what actions we would take because of this concern. We have requested that the company meet with us in January 2012.

What people told us and experienced

This second inspection took place over three days; one day was spent in the office during which we met with staff and looked at the agency’s records. This part of the inspection was unannounced. We were given a list of 77 people who used the service and we chose a random group of people to speak with in order to gather their views on the service. On the second day, we rang a range of people with different care needs who used the agency. We spoke by phone with five people who used the service, and we also spoke with two relatives and one private care worker. On the third day, we met with three people in their own homes, and with two relatives. We then requested further information from the agency, which was supplied by 9 December 2011.

We asked eight people about the reliability of the service. One person told us that there had been one recent missed visit. The other seven people said that the service was very reliable.

Most people’s experience was that care staff were generally on time, and if they were not, they were informed by office staff that there would be a delay. For some people, punctuality was particularly important as they were dependent on care staff helping them out of bed or getting ready to attend a social activity.

We asked people about their views regarding the attitude of staff who supported them in their own home. People’s responses were very positive about the staff members’ professionalism and caring attitude. People made comments such as they are “good girls”, while another said that the male care workers that supported them were “fantastic”. This person said these care workers used their initiative and did not need to be asked twice to provide help. A third person said “they treat me well” and a fourth person said they could not fault the care staff. A fifth person described the care workers as being “professionals”.

Most people told us that staff never breached confidentiality and they were not told about the needs of other people that the care workers supported. However, confidentiality could become blurred when two people who both received a service from Chapter Care knew each other. For example, one person told us a care staff member had told them an acquaintance had been unwell. They considered that the care worker had done the right thing.

We asked eight people if care staff knew how to provide the care they needed. They all confirmed that care staff knew what to do and how they liked their care to be provided. One person said that occasionally staff would check with them but generally this was not necessary. People said they were treated as individuals, and one person said that staff knew exactly how they liked their cup of tea made, which was important as they could not perform this task.

Eight people told us about or showed us their care plans, which were kept in their home. This was a brief care plan about the type of the support they needed. Most people said they did not bother to read it as they had no problems with the care provided.

We spoke with thirteen people who either used the service, or were relatives of people who used the service or were a private care worker. They all told us that Chapter Care staff were helpful, professional and knew what to do.

We asked eight people whether staff administered their medication, helped them with eye drops or applied prescribed creams. Five people told us they managed their own medication or a relative helped them. One person did not have any medication and another could not answer this question. The final person said that a care worker had met with their district nurse in order to learn where and how to apply their prescribed cream. They told us that the instructions for application had been written accurately in their care plan, and staff were competent in this task.

We spoke with thirteen people who either used the service, or were relatives of people who used the service or were a private care worker. None of them raised concerns about the suitability of staff.

We spoke with thirteen people who either used the service, or were relatives of people who used the service or were a private care worker. None of them raised concerns about the skills of staff. People told us that staff knew what to do.

We asked eight people if they knew how to make a complaint about the care they received. Eight people told us that there were numbers they could ring to contact the office on the front of their care plans and people told us they would be confident that the issue would be addressed by the agency. Most people said they had no reason to complain. One person expressed unhappiness with the attitude of one staff member in the office, but most people expressed satisfaction with how they were treated and said office staff were helpful.

We considered our inspection findings to answer 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.

This planned inspection was undertaken as part of our ongoing monitoring but also to follow up on that required improvements which had been made in relation to management of medicines and recruitment processes, following our previous inspection in September 2013. Following the inspection the provider sent an action plan to us detailing the improvements being made.

At the time of this inspection, the agency was providing care and support for up to 85 people in their own homes.

We spoke with 10 people and/or their relatives about their experiences of using Chapter Care for support. We also spoke with two health care professionals who had regular contact with the agency. We talked with seven staff including the registered manager.

Is the service safe?

We found the service was safe because following our last inspection the agency had put in place more robust measures to ensure new staff had the right checks in place before they began working with vulnerable people.

The agency protects their workers by ensuring a risk assessment is completed in each environment they were working in. The assessments identified any potential risks and made sure these had been minimised such as ensuring people were aware of dark pathways and where key safe boxes were located.

We saw that where people had been identified as having complex needs, the agency worked closely with other professionals including occupational therapists to ensure care workers had the right equipment and training to deliver care safely.

Is the service effective?

The service was effective because we found people’s health and care needs were assessed and their care plans and assessments were reviewed with them on a regular basis. Where specialist support was required for complex care needs, these had been clearly identified and staff had training and support to ensure they delivered effective care in accordance with assessed needs. For example where people had specialist medical issues, staff had received training and support from the community nurse team.

It was clear from speaking with people and staff, they had a good understanding of people’s care and support needs and they knew them well. One person we spoke with said ''The girls know me very well, they know how to care for me and they always make sure I am comfortable.''

Is the service caring?

We found the service was caring because they listened to people's requests about how they wanted their care to be delivered and tried to accommodate these, including any extra support needs people may have. We heard from staff, about how they felt their role included emotional support to people they cared for.

Is the service responsive?

The service was responsive because they had systems in place for ensuring people's views were listened to. Where people had made formal complaints, these had been responded to promptly and actions taken to resolve any identified issues.

Where people's needs had changed, care coordinators made sure this was recorded and care staff working with people were made aware of any changes, such as needing to go to hospital, or returning home following a period in hospital.

Is the service well-led?

The service was well-led by the registered manager, care manager and operations manager who worked together to ensure the agency responded to people's needs, delivered care and support at the right times and had systems in place to review and monitor the quality of the care and support being provided. These included completing spot checks on care staff and meeting with people who received a service to ensure they were happy with their care provision.