This announced inspection took place on 12 and 13 July 2017. We previously inspected the service on 2 and 9 December 2015 when it was rated Good overall. Two breaches of regulations were identified at the previous inspection, we identified increased risks for people related to medicines management and staff recruitment. This was because staff were not following the agency’s policies and procedures for medicine management. Some recruitment checks lacked all the information needed to confirm staff were suitable to work with vulnerable people. The provider sent us an action plan outlining improvemnets being made in these areas, which have now been addressed.

HomeLife Carers (Okehampton) is registered to provide personal care, primarily to support older people who want to retain their independence and continue living in their own home. Staff visit people living in the areas of Cheriton Bishop, North Tawton, Okehampton, Hatherleigh and Holsworthy. In March 2017, the provider took over another care agency, so increased the numbers of people they cared for and their staff team. At the time of the visit approximately 100 people were receiving a personal care service.

The service did not currently have a registered manager. The previous branch manager had left due to ill health. A new branch manager was appointed in October 2016, they have now successfully completed their induction and probation period, and were in the process of registering with the Care Quality Commission. The provider notified us about those changes. A registered manager is a person who has registered with the CQC 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 received their medicines safely and on time because medicines systems had improved. All staff had competency assessments to check their medicines management skills and knowledge, which were regularly reassessed. Recruitment processes had improved to ensure people were cared for by suitable staff. The provider had robust recruitment checks which were completed in full to ensure fit and proper staff were employed. Any unexplained gaps in employment were identified and followed up at interview. Police checks, checks of qualifications and identity and references were obtained on all staff applicants to ensure staff recruited were suitable to work with people who use care and support services.

People felt safe using the service and said it was reliable. People knew care staff well and said they usually arrived on time and stay for expected length of time. They let them know if they were running late. Staff knew about the signs of abuse and worked closely with health and social care professionals to implement measures to safeguard people. Staff were aware of risks and risk assessments identified steps staff needed to take to promote people’s safety and welfare.

Staff had the skills and training needed to carry out their role and undertook regular training relevant to needs of people they cared for. People confirmed staff sought their consent before providing any care. Where people lacked capacity, staff demonstrated a good understanding of the Mental Capacity Act (MCA) (2005) and how this applied to their practice.

Staff developed positive and caring relationships with people. People confirmed staff respected their privacy and treated them with dignity and respect. People's care was individualised to their needs. People were consulted and involved in decisions about their care. People signed their care plans to confirm they agreed with their content.

People, relatives and professional feedback consistently showed the service was person centred and responsive to people’s individual needs and preferences. This enabled people to remain as independent as possible. Care staff were motivated, people matt

People we visited or spoke with by telephone who currently use the agency told us that they found the care staff very supportive and helpful. Everyone said they were satisfied with the care received and the manner in which it was delivered by staff. Comments included: “I am involved in developing my care plan and have a copy to refer to”; “The staff involve me fully in my care and ask me how I want to be supported” and “The staff always ensure that my modesty is protected.”

People we spoke with who received a service from the agency said that their care and welfare needs were being well met. We were told by people that staff supported them appropriately with daily living tasks, including personal care and meeting nutritional needs.

People confirmed that they felt safe and supported by staff from the agency. They had no concerns about the ability of staff to respond to safeguarding concerns. They felt that their human rights were upheld and respected.

People we spoke to said that staff were supportive and helpful. Staff were able to speak confidently about the care practices they delivered and understood how they contributed to people’s health and wellbeing.

People confirmed that the agency sought their views about the quality of the service they received and that this information was sought by questionnaires.

The inspection took place on 2 and 9 December 2015 and was announced.

Our previous inspection visit in October 2013 found that the service did not always gain consent before providing care. The provider sent us a comprehensive action plan following that inspection and this action has been completed when we did a desk top review of the information December 2013.

HomeLife Carers (Okehampton) is registered to provide personal care, primarily to support older people who want to retain their independence and continue living in their own home. Visits included the areas of Cheriton Bishop, North Tawton, Okehampton, Hatherleigh and Holsworthy and so most were rural. 76 people were receiving this service.

There was a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 were receiving their medicines as prescribed but not in accordance with their plan of care and the agency’s policies and procedures for medicine management. This had the potential to increase risks of mistakes and misuse of medicines.

Recruitment checks had not confirmed staff were suitable to work with vulnerable people. Some information was lacking from which recruitment decisions had been made.

Staffing arrangements ensured no visits were missed and people said staff arrived on time and stayed the full length of the contracted visit.

Staff had a good understanding of how to protect people from abuse and harm and procedures for how to alert any potential abuse.

People felt they received an effective service but raised three issues they felt staff could be improve upon. For example, not checking a hearing aid in use had a battery. All staff received an induction to their work, close supervision, on-going training and a lot of support from senior staff and agency management. Community professionals had confidence in the skills and knowledge of the staff.

People’s consent to care was always sought and staff understood how to protect people’s legal rights. People were treated with respect and dignity.

There were many examples of how caring and responsive the agency staff were. Community professionals praised how hard care workers worked to understand and meet people’s needs. One said, “I am always impressed by the lengths the staff will go to in order to make a situation work.”

Where people let the registered manager know of any issues they were dealt with promptly and effectively. The complaints procedure was clear and available to each person.

The agency was well organised. There was a clear understanding of the standards of service to be delivered and a clear structure of how to achieve this.

There were two breaches of regulation. You can see what action we told the provider to take at the back of the report.