Home Care provides personal care to people living in their own homes throughout Cornwall. At the time of this inspection the service was supporting over 350 people and employed approximately 200 care staff. Most people were supported by staff who provided domiciliary care visit at keys time throughout the day. During these visits staff assisted people with specific tasks or activities to enable people to continue to live as independently as possible. In addition, the service provided 24 hour supported living care for six people who lived in the own homes.

The service’s management structure had changed since our previous inspection. One registered manager was now responsible for overseeing both the domiciliary care and supported living services which had been integrated.

People were extremely happy with the quality of care and support they received and numerous people told us the service they received could not be beaten. Peoples’ comments included, “They are brilliant. I give them ten out of ten for everything”, “I couldn't have better, they have been like part of the family. I am very lucky and appreciate everything they do” and “They couldn’t be better. I would recommend them to everybody”. Relatives told us, the service also provided them with reassurance and support when required. One person’s relative commented, “It’s amazing. They know him and chat to him. They have a good relationship with others in the household too. It feels like team work. If I am feeling down I get a hug. They support the three of us.”

People and relatives consistently praised staff for their caring attitudes and it was clear during our conversations with staff and managers that the service was fully focused on meeting people’s care needs. During our visit to a person’s home we saw that staff knew people well and provided care with compassion and understanding.

People told us they had never experienced missed care visits and call monitoring systems were used appropriately to ensure all planned care visits were provided. People told us, “They have never missed any calls” and “I have never had a missed call, even when it is snow of the ground” while staff commented, “I honestly can’t remember the last time that happened”. The service visits schedules were well organised and included appropriate amounts of travel time between care visits. Staff reported their visits schedules did not change often and that there was a system in place to ensure visits were not missed as a result of changes.

We reviewed rotas, call monitoring data and daily care records. We found there were enough staff available to provide all planned care visits and that people’s care visits were routinely provided on time and for the correct duration. People consistently told us their staff arrived on time and that they did not feel rushed while receiving support. People’s comments included, “They are never rushed. They manage what they have to do very nicely” and “I don’t feel rushed at all when they are here”.

The service’s on call system ensured people and staff could contact managers for support easily when the office was closed. People told us, “I never have a problem getting through to them” and “I can contact them anytime I need them”. While staff said, “On call, that works fine” and explained that action was promptly taken when staff members were unwell to ensure people’s care needs were met.

Staff and managers had received safeguarding training had a good understanding of local processes for protecting people from abuse. Everyone who used the service and all staff had been provided with details of local safeguarding contacts to ensure this information was readily available if required. Risks both within people’s home environments and in relation to their support needs had been appropriately assessed. Staff had been provided with clear guidance on how to manage risks while enabling people to be as independent as possible.

Staff understood the requireme

My Choice is the domiciliary care agency part of Cornwall Care Limited. The agency provides a service throughout Cornwall. During the inspection we spoke with six people who used the service, two relatives and nine members of staff. We looked at nine care plans and fifteen comment cards. People told us, "I am happy with the service, the staff are kind". Other comments were, "Wonderful couldn't wish for anything better."

One relative told us, "They participate with X and us, we couldn't be happier with the service. They make sure we know when they are visiting. The attention to detail is great".

Staff commented, "We listen to people, if they want things changed we speak with our team leader". We do our best to ensure people's needs are met". People's choices were respected.

We looked at six recruitment records. The provider had effective recruitment and selection procedures in place.

During the inspection we looked at five outcomes of the Health and Social Care Act 2008. We found that the provider was compliant in all five areas inspected.

We spoke with seven people who used services, talked with staff, the manager and deputy manager and looked at records of people who used services.

People told us that the staff who visited them were good timekeepers, that it was usually the same carers, and that the agency were “quick to resolve any issues”. People were positive about the carers themselves saying they had no complaint about them as individuals or the care provided. People said they had confidence in the agency, and comments included: “I know all the team and I like them all”, “very compassionate and caring”, and “polite and professional”.

People told us they were aware of their care packages, and we found the care provided met people's expectations and needs. People were protected from abuse, and the staff were supported by training and supervision.

People were protected from the risk of infection and from unsafe or unsuitable equipment.

Care documentation was of a good standard, with some variation in the level of detail provided.

My Choice is the collective name for two distinct services that provide personal care from Cornwall Care’s head office. One service that we will subsequently refer to as the supported living service provides personal care in supported living settings to 10 people with complex care needs including learning disabilities and mental health needs. This service employs approximately 65 staff and aims to provide bespoke care that enables people to live independently within their local communities.

The other service subsequently referred to as the home care agency provides supports to over 300 predominately older people in their own homes. This service employs around 180 staff and operates throughout the county of Cornwall.

Each service is led by a registered manager who reports to different directors on the provider’s board. 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 consistently told us their staff were caring and respectful. People said; “Yes, they do treat me with respect, they are a fantastic group”, “They are all very kind, they have a very nice attitude and are very respectful.” and,” They are wonderful. I couldn’t wish for better carers and I couldn’t do without them.”

Both services provided staff with appropriate inductions and subsequent training to ensure staff were sufficiently skilled to meet people’s care and support needs. All staff received regular supervision and coaching to help further develop their skills.

Staff and managers of both services knew people well and understood people’s specific care and support needs. Staff spoke of the people they supported with kindness and compassion while people described extra tasks and little jobs that staff had completed in addition to their specific care responsibilities. The registered manager of one service commented, “We are really lucky because I know all the staff will go the extra mile for the clients.”

People received a visit schedule each week including details of their planned visit times and names of care staff. People valued this information and commented that information was reasonably accurate with the, “odd glitch”.

Visit schedules showed that people normally received care from consistent staff teams and that people’s preferences in relation to care staff were respected. Call monitoring data and daily care records showed most visits were provided on time and of the planned length.

Care plans were up to date, accurately and sufficiently detailed to enable staff to meet people’s care and support needs. Care plans had been developed based on information from commissioners, people’s wishes and staff experiences of providing care to the individual. One person told us; “I do think the care is personalised, they have been caring for me during the time my condition has worsened and have adapted the care they give.” There was some variation in the quality of care plans used by different teams within the home care service. The manager was aware of this issue and had taken appropriate steps to ensure care planning documents were of a consistently high standard.

Both services were well led and there were appropriate systems in place to support each registered manager. Quality assurance systems were designed to ensure compliance with relevant legislation and people’s feedback was valued by managers.

The home care service had recently experienced management challenges as a result of significant numbers of staff resignations. This situation had been well managed. Where the service had been unable to continue to meet people’s care needs the service had worked collaboratively with commissioners to arrange for people’s care to be safely transferred to other providers.