We carried out this announced inspection on 15 and 17 January 2019. At our last inspection, in July 2016, we rated the service overall Good with requires improvement in Safe, because some people told us they had experienced missed or late visits. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Four Seasons Community Care is a Domiciliary Care Agency that provides care and support to adults of all ages, in their own homes. The service provides help with people's personal care needs in Torpoint, Saltash, Liskeard and Looe areas of Cornwall. 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.

At the time of our inspection approximately 160 people were receiving a personal care service. These services were funded either privately or through Cornwall Council or NHS funding.

Everyone we spoke with told us they were happy with the quality of the care provided. They said they felt safe using the service and trusted the staff who supported them. Comments included, “I feel very safe, nothing is too much trouble”, “We are very happy with them” and “They keep my dignity and respect. I have no family, [worker’s name] is my family, and friend.”

People had a team of regular, reliable staff, they had agreed the times of their visits and were mostly kept informed of any changes. Staff told us their rotas allowed for realistic travel time, which meant they arrived at people’s homes as close to the agreed times as possible. Staffing levels were managed in a way to ensure staff were available to provide a consistent service to meet the needs of people who used the service. Rotas were well managed and the registered manager knew the location and times where new packages could be accepted.

Staff were knowledgeable about the people they cared for and responded appropriately as people's needs changed. Staff spoke positively about the people they supported and were motivated to provide an individualised service in line with people's needs and preferences.

Each person had a care plan, that had been developed with them, and was personalised to their needs and wishes. There was a system in place to review care plans every three months, or sooner if people’s need changed. The review of some care plans had fallen behind and we were assured that these care plans would soon be updated.

Risk assessments clearly identified any risks and gave staff guidance on how to minimise the risk. This included any environmental risks in people’s homes and any risks in relation to the care and support needs of the person. They were designed to keep people and staff safe while allowing people to develop and maintain their independence. People who needed help taking their medicines were appropriately supported by staff.

People were supported by staff who knew how to recognise abuse and how to respond to concerns. The service held appropriate policies to support staff with current guidance. The service had robust recruitment practices, which meant staff were suitable to work with vulnerable people. Management provided staff with appropriate training and supervision. Staff told us they found the training to be beneficial to their role and said they were encouraged to attend training to develop their skills and career.

Management and staff acted within the legal framework of the Mental Capacity Act 2005(MCA). Management and staff understood how to ensure people who did not have the mental capacity to make decisions for themselves had their legal rights protected.

There was a posi

The inspection took place on 7, 8 July 2016 and 19 August 2016 was announced.

Four Seasons Community Care provides domiciliary care services to adults within East Cornwall. On the day of the inspection Four Seasons Community Care was providing personal care support to 100 people including those with physical disabilities, sensory impairments, mental health needs and people living with dementia.

The service had a registered manager in post; the registered manager was also the registered provider. 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 our last inspection on 12, 21, 22, & 26 May 2015 we asked the provider to make improvements to how people’s care was recorded, to ensure staffing met people’s needs and preferences, and to demonstrate how people consented to their care. Improvements were also required in respect of how risks associated with people’s care were managed, and how the provider monitored the ongoing quality of the service. During this inspection we looked to see if improvements had been made and we found that action had been taken.

People were critical of late or missed visits. People told us they had raised their concerns, but were frustrated because action had not always been taken to rectify the problem. Overall, staff told us they had enough traveling time between each person; however, some staff told us rotas were not always effectively designed. However, a new computer system was being put into place at the time of our inspection, which we were told by the registered manager, would help to improve this.

People told us they felt safe when staff entered their homes to provide care. People were protected from abuse, because staff knew what action to take if they suspected someone was being abused mistreated or neglected. People’s risks associated with their care were managed to help ensure they were kept safe. Risk assessments relating to health care needs, such as diabetes were not always in place, but the registered manager told us she would take immediate action to rectify this. People’s medicines were managed safely and staff received training.

People received care from staff who had undertaken training to meet their individual needs, and additional training was organised if staff felt they required further knowledge. People had consented to their care and had their human rights protected, because the registered manager and staff understood their responsibilities in respect of the Mental Capacity Act 2005 (MCA). People were encouraged to eat and drink, and were supported to access healthcare services to maintain their health and wellbeing.

People told us staff were kind and caring. Staff understood the importance of respecting and promoting people’s privacy and dignity. People received individualised care and had detailed care plans in place to enable staff to know how to support them. People were involved in decisions relating to their care, and were invited to take part in the review of their care plans, to ensure they were reflective of their wishes and preferences. People’s complaints were investigated and used to make improvements to the service.

People and staff had an increased confidence in the management and leadership of the service. Plans were in place to recruit a deputy manager, who would assist with the day to day running, management and quality monitoring of the service.

There was a culture of honesty and openness which reflected the requirements of the duty of candour. The registered manager was open and transparent when working with external professionals; they listened to advice and implemented changes as required. The registered manager valued feedback about their service to enabl

The inspection took place on 12, 21, 22, and 26 May 2015 and was announced.

Four Seasons Community Care provides domiciliary care services to adults within East Cornwall. On the day of the inspection Four Seasons Community Care was providing support to 140 people including those with physical disabilities, sensory impairments, mental health needs and people living with dementia.

At our last inspection in March 2013 the provider was meeting all of the Essential Standards inspected.

The local authority were not commissioning with the provider at the time of our inspection. This was because they had received concerns from people who used the service and had an agreed action plan in place with the registered manager for improvement.

The service had a registered manager in post. 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.

People told us care staff were kind, caring and promoted their independence. Staff had a good understanding of how to respect and promote people’s privacy and dignity. People told us staff were respectful at all times and felt safe when they were being supported in their own homes.

People were supported by staff who had been recruited safely, which meant they were suitable to work with vulnerable people. The registered manager and staff had a good understanding of how to report any safeguarding concerns. People told us there were not always enough staff because staff ran late and on some occasions their visit had been forgotten. Staff did not always inform people when they were going to be late, which had resulted in people not being able to plan their day or experiencing a significant delay in the care and support they required. Staff told us they felt their rota was not always geographically managed to ensure they had enough travelling time between each person.

People did not always have a care plan and risk assessments in place to provide guidance and direction to staff about how to support them. People’s consent was not demonstrated in care plans and people’s care plans did not consider the Mental Capacity Act to make sure people who did not have the mental capacity to make decision for themselves had their legal rights protected. Staff explained they always sought the person’s consent before speaking to the person’s family or their GP if they had concerns. People were supported with their medicine, however staff were not always trained to administer medicine and there was an inconsistent approach about what was expected of staff. For example, some staff told us they “prompted people” whilst others told us they “administered medication”. People’s care plans were not reflective of the support which was required, which meant staff may not always provide a consistent approach.

People were encouraged to eat and drink. When staff were concerned about whether a person was eating and drink enough, they were responsive in reporting any concerns. Staff were observant of the deterioration in someone’s health and wellbeing and took the necessary action, for example contacting the person’s GP or a district nurse. A health care professional was complimentary about this and told us they always reported any concerns, listened to any advice and implemented requests.

People felt they could complain and that their complaints would be investigated and resolved. People’s main complaints had been in respect of late or missed visits. People’s feedback was valued and because of recent concerns, the registered manager had brought forward the annual survey to obtain people’s feedback about the service so necessary improvements could be made.

People and staff felt at times the service was disorganised and not always run effectively. Staff enjoyed working for the organisation and told us the registered manager was supportive. The registered manager did not have systems in place to monitor the quality of the service, but was in the process of reviewing this. The registered manager worked positively with other external agencies.

We found 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.