We carried out this announced inspection on the 23 and 25 January 2019. The service was given two days’ notice of this inspection so arrangements could be made for people to be contacted by telephone to provide feedback on the service’s performance. At the last inspection in June 2016, the service was rated Good in all areas. At this inspection we Identified a breach of regulations and found that the service required improvement in relation to our key questions ‘Is the service safe’ and ‘Is the service well led’.

Corcare is a domiciliary care agency. It provides personal care to predominantly older people living in their own homes throughout Cornwall. The service was set up to provide home care support for people living in rural areas not covered by other care agencies. At the time of our inspection the service was providing support to approximately 70 people. The service provides short visits at key times of the day to support people with specific tasks to enable people to continue to live in their own homes.

People told us, “I’d tell anyone they won’t go far wrong if they can get on the list for them” and “My daughter has been so pleased that she has recommended the Service to other people in the village on several occasions.”

For the last two years the service had been working closely with hospital staff as part of the “Hospital System Response Team” pilot project. This project aimed to improve patient flows through the Royal Cornwall Hospital Trust by facilitating timely discharges to home care services. The close working relationships developed during this project enabled the service to accept packages of care and provide initial care visits based on information provided by hospital staff. This meant people could be discharged earlier and the service was often able to provide initial care visits on the same day they were requested.

This project had been significantly expanded in December 2018 in an attempt to manage expected winter pressures. Corcare was provided with nine additional agency staff each day. This was intended to provide the service with additional capacity to enable more people to be discharged home from hospital. However, this had impacted on the service’s overall performance and reliability.

Issues in how people’s details and needs were communicated to the new agency staff had significantly increased the risk of information being miss transcribed and un-necessarily increased the risk that planned visits would be missed. Team leaders told us, “A lot of time is used explaining rotas to [agency] staff because they cannot access our system” and “The impact is on the team leaders they have been spending huge amount of time sharing information with [agency staff] who do not know the area. It has caused an awful lot of extra work and frustration from our customers.”

The majority of the agency staff used were based outside Cornwall and some were traveling significant distances from “beyond Bristol” to complete 12 hours care shifts. This meant they had very limited knowledge of local geography and that traffic issues on the main roads into the southwest impacted on the timing of people’s care visits. During our inspection one agency staff member was over an hour late to their first visit as a result of travel disruption on route to Cornwall. Agency staff told us, “Mostly I am on time but if something happens on the road you can run late” and, “You sometimes run late where it is a rural area and the postcode does not work. The most difficult bit is just finding the houses in this area.”

Since December 2018, three visits had been missed, there had been an increase in the number of visits provided more than 30 minutes late and, people were not being supported by staff they knew well. People told us, “They are late more often than not, especially all the new carers who can’t find the house”, “I am getting all new carers these days, from Wales and Birmingham and everywhere so they don’t know me like th

We carried out this inspection on 25, 26, 27 and 28 July 2016 and it was announced 48 hours in advance in accordance with the Care Quality Commission’s current procedures for inspecting domiciliary care services. This was the first inspection for the service since registering as a new provider, Cormac Solutions Limited, in October 2015. Cormac Solutions Limited is a company wholly owned by Cornwall Council. The service was last inspected in December 2013, when the registered provider was Cornwall Council, we had no concerns at that time.

There are two different services registered to provide personal care, to people in their own homes, from this location. These are St Austell STEPS (Short Term Enablement and Planning Service) and CORCARE, which provides on-going long-term care packages.

The STEPS service provides care visits for periods of up to six weeks in the St Austell and surrounding areas. The aim of the service is to re-enable people to maximise and re-gain their independence, within their own home, after a period of illness and/or hospital stay. The service provides support to adults of all ages. On the days of the inspection the service was providing personal care to 33 people and employed 23 staff. Referrals for packages of care were made to the service by health and social care professionals. These included; hospital discharge teams, physiotherapists and occupational therapists.

The CORCARE service provides on-going care packages across the county of Cornwall. The service provides care and support to adults of all ages. This includes people with physical disabilities and dementia care needs. The service mainly provides personal care for people in short visits at key times of the day to help people get up in the morning, go to bed at night and support with meals. On the days of the inspection the service was providing personal care to 67 people and employed 30 staff. Referrals for packages of care were made to the service from Cornwall Council’s brokerage team and were mostly taken from the ‘unmet needs list’. This list comprised of people who, usually because they lived in difficult to reach locations, had not been provided with their assessed care package through the usual contracting processes.

There were two registered managers in post. One was responsible for the day-to-day running of the STEPS service and the other for the day-to-day running of CORCARE. 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 and associated Regulations about how the service is run.

People and their relatives told us they felt safe using both services, commenting, “[Persons’ name] is comfortable with all the staff”, “I trust the staff and because of that I have let go of caring for [the person]” and “Excellent service, can’t fault it.” People told us staff were kind, caring and compassionate; whilst being respectful of their privacy and dignity. Comments from people and their relatives included, “Staff are cheerful and very helpful”, “[Persons’ name] is very happy with all the staff” and “Fantastic, nice and helpful girls.”

People received care, as much as possible, from the same care worker or team of care workers. Rotas were planned in such a way as to minimise changes of staff. People told us they had regular staff and the times of their visits were agreed with them. Everyone told us the service was reliable, visits were never missed and they were kept informed of any changes to the time of their visits. People said, “I am amazed how staff keep to the times” and “If they are going to be late they ring me.”

Staff were recruited safely, which meant they were suitable to work with vulnerable people. Staff had received training in how to recognise and report abuse. All were clear about how to report any conc