The inspection took place on 30 October, 2 and 5 November 2018 and was unannounced.

At our last comprehensive inspection in February 2016, a breach of a legal requirement was found so we issued a requirement notice. This was because the provider had not ensured people’s care plans were effectively reviewed, met their needs and preferences and were reflective of the care being delivered. We also asked the provider to make improvements to how people’s complaints were recorded. After the comprehensive inspection the provider submitted an action plan to tell us what they would do to meet the legal requirement in relation to the breach.

On 21 July 2017, we undertook an announced focused inspection to check that improvements had been made in these areas. We found the provider had met the legal requirement notice as issued at the previous inspection.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older and younger adults within Plymouth. At the time of the inspection the service was providing personal care to 481 people, including those with physical disabilities, sensory impairments, mental health needs, and people living with dementia. The service also provided care to people who were at the end of life. The provider had taken action when other providers were not able to continue their services, to provide care to the people affected and employ the staff members concerned. They told us they did this with the aim of maintaining quality services across the city of Plymouth.

A registered manager was employed to manage the service locally. 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.

When people had risks associated with their health or care needs, these had not always been assessed. Information was not always available to staff detailing how to help reduce these risks. When people had mental health needs, individualised information was not always available to staff to help reduce risks to people or recognise concerns. Clear information about people’s medicines needs were not always available, particularly in relation to prescribed creams and lotions. Staff had received training to administer medicines but had not had regular assessments of their competency.

Staff had not always been recruited safely. There was an ongoing training programme, however not all staff whose training was out of date had been identified as needing refreshing; and the provider did not have evidence that some staff who had transferred from another organisation had up to date training in place.

The registered manager and providers had not monitored the service effectively. They had not ensured they had oversight of work delegated to other staff members. They had not identified the concerns highlighted during the inspection.

People told us they felt safe using the service. Staff had received training in how to recognise and report abuse and were confident in reporting concerns. We received mixed feedback about the consistency of staff people were supported by and whether they received communication about any changes. People told us calls were not missed and staff were not rushed.

People told us they received support from staff who had the knowledge and skills to meet their needs. People and their relatives spoke highly of the staff and the support provided and told us staff treated them with care. People were treated with dignity and respect and the service was working to increase staff knowledge of human rights. People’s care plans contained information about their likes, dislikes and preferences and people confirmed these were respected by staff.

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Gemcare South West Limited provides domiciliary care services to older and younger adults within Plymouth. On the days of the inspection the service was providing personal care to 400 people, including those with physical disabilities, sensory impairments, mental health needs, and people living with dementia. The service also provided palliative care to people who were at the end of life.

We carried out an unannounced comprehensive inspection of this service on 02 and 03 February 2016. A breach of a legal requirement was found so we issued a requirement notice. This was because the provider had not ensured people’s care plans were effectively reviewed, meet their needs and preferences and were reflective of the care being delivered. We also asked the provider to make improvements to how people’s complaints were recorded. After the comprehensive inspection the provider submitted an action plan to tell us what they would do to meet the legal requirement in relation to the breach.

We undertook this focused inspection on 21 July 2017, 01 and 02 August 2017 to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Gemcare South West Limited on our website at www.cqc.org.uk

The service had 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.

People had care plans in place which were reflective of their needs. People’s care plans were reviewed with them to ensure they reflected their needs and preferences. People told us they felt that their care plans were effective and provided good, current information about their care needs and that staff referred to them when they visited to provide care and support.

People’s complaints were effectively recorded. Records detailed whether people had been satisfied with how their complaint had been resolved. People’s complaints were listened to and used to help facilitate ongoing change. People told us they knew who to complain to and that when they contacted the agency, they felt that they were listed to and that proactive action was taken to resolve their unhappiness.

This meant that the provider had met the legal requirement notice as issued at the last inspection.

The inspection took place on 2 and 3 and February 2016 and was announced.

Gemcare South West Limited provides domiciliary care services to older and younger adults within Plymouth. On the days of the inspection the service was providing personal care to 450 people, including those with physical disabilities, sensory impairments, mental health needs, and people living with dementia. The service also provided palliative care to people who were at the end of life.

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 compassionate, commenting “The care is unequivocally superb for both myself and my wife, I can’t say a single bad thing about it” and describing the interaction from staff as “Excellent”. People also told us staff were respectful of their privacy and dignity, and promoted their independence, one person telling us, “They are first class. I was just sitting all day but they said to me, let’s see what we can do, and they’ve changed my life completely”. Staff spoke about people in a caring way and how they enjoyed brightening up a person’s day. Staff were inspired by the caring values of the Directors.

People were supported by a small staff team which helped to provide continuity of people’s care and assisted in the development of positive relationships. Staff had been recruited safely, which meant they were suitable to work with vulnerable people. The Directors and staff had a good understanding about safeguarding procedures and were able to tell us what action they

should take if they felt some one was being abused, mistreated or neglected.

The vision of Gemcare South West Limited was to ensure people were at the heart of the service. Their vision was underpinned by strong leadership, inclusiveness and communication. The service values of, “Inclusion”, “Integrity”, and “Competence” were demonstrated by the management team, and reflected in staffing practice, culture and care delivery.

The registered manager and Directors all took an active role within the running of the service and had a good knowledge and a passionate approach, for the staff and for the people they supported. There were clear lines of responsibility and accountability within the management structure which staff understood.

People felt safe when staff entered their home. Staff arrived on time and when they were going to be late, people were generally informed of this. However, some people told us they did not always get a call, which meant they were left wondering when staff may arrive. The Directors told us this was an ongoing problem which was continually discussed with staff, but they would strive to make improvements. Staff felt there were enough staff to meet people’s needs and had adequate travelling time. Staff were protected from risks associated with lone working. People were protected from the spread of infection because staff followed infection control procedures.

People were supported by staff trained to meet their needs, and who were motivated and inspired by the Directors to provide quality care. All staff were trained to meet people’s needs and had regular supervision to focus on their development. New staff received a through induction. Staff told us they enjoyed working for the organisation, were well supported and that there were adequate opportunities to obtain further training and qualifications. Pre-assessments of people’s care were carried out to help ensure staff had the right skills and experience to meet people’s needs prior to people joining the service. When staff did not have the right skills, specialist training was arranged.

People were in