About the service:

Lanhydrock 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 36 people in Bodmin and the surrounding areas in Cornwall.

People’s experience of using this service:

People using the service consistently told us they felt safe and staff treated them in a caring and respectful manner. Comments included; “They are absolutely invaluable to me”, “I'm very satisfied with the care”, “They are very helpful, they just do anything I want” and “Their personal care, friendliness and kindness is amazing.”

Staff had a good knowledge and understanding of people’s routines, likes and dislikes. If they had any concerns about anyone’s well-being this was reported to the office and action taken to help ensure people were safe and happy.

People had agreed the times of their visits and were kept informed of any changes. No one reported ever having had any missed visits.

Assessments were carried out to identify any risks to the person using the service and to the staff supporting them. Care plans were personalised to the individual and recorded details about each person’s specific needs and wishes. These were kept under regular review and updated as people’s needs changed.

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

New staff completed an induction which involved training and a period of ‘buddying’ more experienced staff. Training was refreshed so staff were up to date with any changes in working practices.

There was a positive culture in the service and management and staff were committed to ensuring people received a good service. Staff told us they were well supported and had a good working relationship with each other and the management team.

People, their relatives and staff told us management were approachable and they listened to them when they had any concerns or ideas. All feedback was used to make continuous improvements to the service.

Rating at last inspection: Good. Report published on 8 November 2016.

Why we inspected: This was a planned inspection based on the previous rating.

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

We carried out this inspection on 17 October 2016 and it was announced 48 hours in advance in accordance with the Care Quality Commission's current procedures for inspecting domiciliary care services. The service was last inspected in February 2014; we had no concerns at that time.

Lanhydrock Care is a domiciliary care agency that provides care and support to adults, of all ages, in their own homes. The service provides help to people with physical disabilities and dementia care needs in Bodmin and surrounding areas. 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 38 people were receiving a personal care service. The services were funded either privately or through Cornwall Council or NHS funding. The service employed 19 staff including management.

The service did not have a regulatory requirement to have a registered manager in post. The provider was registered with the Care Quality Commission to manage the service. 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.

There was an unclear management structure in the service which did not provide clear lines of responsibility and accountability. The effect of this could be seen in the management of the administration of the service. This meant that the service was not entirely well-led because the provider had not sufficiently assessed the financial risk to the service of falling behind with the invoicing of fees.

People who used the service, families and health and social care professionals told us they felt the service was safe. Comments included, “They are good; dependable. I have nothing but praise for them” and “Nothing is too much trouble”.

People told us staff always treated them respectfully and asked them how they wanted their care and support to be provided. People and their relatives spoke well of staff, commenting, “The staff are lovely. Very satisfied with them”; “I’m more than happy with them” and, “Nothing is too much trouble for them. They go the extra mile for you.”

People told us they normally had a team of regular, reliable staff, and they knew the approximate times of their visits and were kept informed of any changes. Wherever possible the service had worked to find suitable and agreed times for people. No one reported ever having had any missed visits. People told us, “We have a team of about five ladies who come out over the week and we usually know which staff will be coming to us. If there are any changes the office rings to let us know,” and “I have regular carers.”

Care plans provided staff with direction and guidance about how to meet people’s individual needs and wishes. Regular reviews of care plans took place. Changes in people’s needs were communicated to staff in daily records and directly to staff by the provider and deputy manager.

Staff were not consistently recruited safely. The current uptake of reference checks for new employees did not follow the service’s recruitment policy, which had last been updated in 2010. Recruitment processes were not properly established or operated effectively and people were potentially at risk of being supported by unsuitable staff.

New staff received an induction, which incorporated the care certificate. Staff received appropriate training and supervision. We found gaps in staff training which were being addressed. There were sufficient numbers of suitably qualified staff available to meet the needs of people who used the service.

Staff had received training in how to recognise and report abuse. All were clear about how to report any concerns and were confident that any allegations made would be fully investigated to help ensure people were protected.

Management had an understanding of the Mental Capacity Act 2005 and how

At our last inspection 20 November 2013 we had concerns regarding staff support and records at Lanhydrock Care. We set compliance actions in this regard. These are actions the provider must take in order to meet the essential standards. The provider sent us an action plan stating how the service would meet these standards. We carried out this inspection to review the compliance actions.

Lanhydrock Care employed 17 staff who provided care and support to 34 people at the time of this inspection. We spent time with the provider and general manager and reviewed documentation and procedures in order to reach our judgement.

We saw people were supported by staff who were properly supported to deliver care and treatment safely and to an appropriate standard.

We found people were protected from the risks of unsafe or inappropriate care and treatment as information was consistently collated and held securely.

The agency sent us a list of the 32 people who received a service from Landydrock Care. We called seven people on the telephone to seek their views. All comments about the service were positive and included “I would recommend them to anyone” and “no problem at all, they do anything I ask of them”.

We spoke with the office manager, six staff and reviewed the records of nine people who received support from the agency.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes.

We found people people’s privacy and dignity was respected and people experienced care and support that met their needs.

Lanhydrock care had suitable arrangements in place to protect people from the risks of unsafe equipment.

We saw, and were told, staff were supported with training, management supervision and appraisals. However, we did not see records of induction for four new staff.

We found people who used Lanhydrock Care were not protected from the risks of unsafe or inappropriate care and treatment as information was recorded in separate places and not consistently collated.

Staff and people who used the service told us they were clear about how to make a complaint should they need to.

We asked the agency for contact details for a sample of six of the agency's current clients and were able to carry out telephone interviews with five of them, or their relatives. Comments included "they do everything that I need" and "really impressed, always on time." We also spoke with the local district nurse after our inspection who informed us they "had no concerns" and "would use them as their first choice."

We checked people's care records but found no documentary evidence to support the process from assessment to care plans or the monitoring of identified changes. Risk assessments had not been timely reviewed with no arrangements for dealing with foreseeable emergencies.

Training records showed that staff had received relevant training. Management conducted observation checks which they linked with supervision. Records observed showed supervisions as having been completed or new appointment dates identified for 2013. We found that staff had not been appraised and the manager informed us that this was being addressed.

People who use the service and staff told us they knew how to raise a concern or complaint and felt confident in doing so. They said if they had any issues or concerns they were able to discuss "anything with the manager."

The quality of the service was monitored through regular checks and an annual service user survey. People who use the service were provided with the opportunity to give feedback and influence the way the service was run.