About the service:

Hartley Home Care is a domiciliary care service that provides personal care and support to people living in their own homes in the community. When we inspected the service was providing the regulated activity, personal care, to approximately 127 people in the Camelford, Bodmin, Bude and surrounding areas in Cornwall.

People’s experience of using this service:

¿ People were at risk of harm because they did not always receive the care and support they needed at the agreed times. Most people did not know when staff would be coming and the times of their visits were inconsistent. People were not always told about changes to their times or if staff were running late. There had been some missed visits.

¿ Rotas were not effectively managed. Systems to record people’s agreed times were not robust, which meant rotas were completed without the correct information about the times some people needed. While the provider had identified the issues about rota management they had failed to take sufficient action to improve the situation.

¿ People told us they did not always have consistent staff. However, they were happy with all the staff who provided care for them. People said staff always stayed for the full time of the visit and were competent in their roles.

¿ Staff were recruited safely. Recent vacancies had been recruited to and eight staff were waiting to work unsupervised because employment checking were still outstanding. In the meantime, management and other staff were covering for these vacancies. Staff received regular supervision, training and support from management.

¿ Assessments were carried out to identify any risks to the person using the service and to the staff supporting them.

¿ People were supported to access healthcare services, staff recognised changes in people's health, and sought professional advice appropriately.

¿ There was a new management structure in the process of being developed and some management roles were still being defined. People knew how to raise any concerns and the service regularly sought people’s views.

Rating at last inspection: Overall Good (Safe rated Requires Improvement). The report was published on 3 November 2017.

Why we inspected: The planned inspection was brought forward due information of risk or concern received by CQC. These concerns were about the service being unreliable, poorly managed rotas, staff working unsupervised without the relevant employment checks and training and insufficient staffing levels.

We issued breaches of the regulations. Please see the end of the report for details of the action we have told the provider to take.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

The full details can be found on our website at www.cqc.org.uk

Say when the inspection took place and whether the inspection was announced or unannounced. Where relevant, describe any breaches of legal requirements at your last inspection, and if so whether improvements have been made to meet the relevant requirement(s).

Provide a brief overview of the service (e.g. Type of care provided, size, facilities, number of people using it, whether there is or should be a registered manager etc).

N.B. If there is or should be a registered manager include this statement to describe what a registered manager is:

‘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.’

Give a summary of your findings for the service, highlighting what the service does well and drawing attention to areas where improvements could be made. Where a breach of regulation has been identified, summarise, in plain English, how the provider was not meeting the requirements of the law and state ‘You can see what action we told the provider to take at the back of the full version of the report.’ Please note that the summary section will be used to populate the CQC website. Providers will be asked to share this section with the people who use their service and the staff that work at there.

This inspection took place on the 11 May 2017 and was announced. We followed the inspection up with phone calls to people who used the service and their relatives on 12 May 2017. On 14 May 2017 we visited people in their own homes who received support from the service.

There was 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 they felt safe using the service. People were supported by staff who knew how to recognise and report signs of abuse or mistreatment. Staff were aware of how to prevent the spread of cross infection through following robust infection control practices. Where people required support with their medicines, staff who supported them had received training in medicines management. The services followed robust recruitment practices, ensuring that staff were suitable to work with vulnerable people and that checks such as DBS (disclosure barring service) had been made ahead of them commencing their employment.

People were supported by staff who received regular training in order to carry out their role effectively. There was a system in place to remind them when it was due to be renewed or refreshed. Staff who were new to the service underwent a thorough induction period, which included shadowing more experienced staff. Staff were supported by a programme of regular supervision, competency checks and an annual appraisal.

People and their relatives told us staff were caring, kind and compassionate. People said staff used appropriate humour and could share a laugh and joke with them, brightening their day. One person said; “They are caring people and we get along well”. Staff were happy in their role and committed to providing a good quality service. Staff spoke about the people they supported with warmth and affection. The service was not fully staffed at the time of the inspection, however there was a recruitment campaign targeted at the areas where the service was short staffed. The registered manager had not taken on any new packages of care for three weeks to ensure this did not affect the care delivered to people.

People had detailed care plans in place which provided staff with the correct level of guidance to meet their needs. Care plans were well organised, easy to navigate and regularly reviewed and updated. People were involved in writing their care plans and a copy was kept in their home. Not all of the care plans we reviewed had a consistent amount of personalised information in them. This was highlighted to the registered manager who felt that people varied in their willingness to provide such information.

The registered manager sought feedback on the running of the services and took on board any comments and suggestions received. The service employed a quality assurance officer. Their role was to visit people in their home to complete a feedback questionnaire and also to check that all the necessary documents were in place. The registered manager undertook a range of regular audits to monitor the quality of the service and was committed to driving continuous improvement. There was a complaints policy in place. People told us they knew how to make a complaint and felt confident it would be resolved to their satisfaction. One person said; “They do deal with complaints. They want you to contact them if you have a problem”.

People told us staff stayed for the allotted time and there were few missed visits. Some people told us they felt timings were not always adhered to, meaning their visit was either too early or late. However, people we spoke with told us staff would let them know if they were not going to visit on time and this was generally not a concern for peop