The inspection took place on 14 and 29 December 2017 and was announced.

Mulholland Care is registered with the Care Quality Commission (CQC) as a domiciliary care provider. It provides personal care to a range of older adults and younger adults living in their own houses and flats in the community. These included people living with dementia, a mental health illness or a learning disability.

At the time of inspection, there were 87 people receiving a service from the agency. Although the majority of people using the agency received a regulated activity, some received support visits only. CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

The agency provided an overall number of 840 care hours each week. The time of care visits ranged from a minimum of 15 minutes to a maximum of one and quarter hours, with the frequency of visits ranging from three times a week to 28 times a week. There were 38 full and part-time staff employed.

There was registered manager in post. 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.

At the last inspection, the service had an overall rating of good; safe, effective, caring and responsive were good and well led required improvement.

At this inspection, we found the service remained with an overall rating of good. The service had improved in the well led domain which was now good, along with the four other areas.

The registered manager and care workers provided people with a service and delivered care and support which took into account people’s individual choices and preferences. People were very happy with the service they received. Care workers treated people with respect, dignity and compassion at all times. People were encouraged to be as independent as possible.

Meaningful relationships had developed between staff, people and their relatives. Friends and family were involved in people’s care and spoke positively of the agency. People usually had a regular team of care workers, but on occasions received support from care workers they were unfamiliar with. People’s health needs were monitored and relevant professionals contacted when necessary.

People were kept safe by care workers who were safely recruited, well trained and received supervision. They enjoyed their jobs and felt valued by management.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Care workers had received training on the Mental Capacity Act 2005 and were aware of how it applied to their practice.

Each person had risk assessments and a care plan in place. However, these had been identified by the management team as requiring updating to include all the information needed. People and their families were involved in the planning of their care and these were regularly reviewed. When changes in care support were required, amendments were carried out in a timely way.

Care workers had been trained to give people their medicines safely and ensured medication administration records were kept up to date. Care workers supported people to eat a nutritious diet with food and drinks of their choice. In between care visits, care workers always made sure people had snacks and drinks available.

There had been a reorganisation of the management structure. Each member of the management team had a clear definition of their roles and responsibilities. People were confident any issues would be dealt with appropriately. There was a complaints policy and process

This inspection took place over three days on 3, 8 and 9 September 2015 and was announced. The provider was given short notice because the location provides a domiciliary care service and we needed to be sure that someone would be in.

The inspection team consisted of one inspector who was accompanied by a second inspector on one of the days.

Prior to this inspection, this service had an inspection carried out on 27 June 2013. This found the provider was fully compliant at this visit.

Mulholland Care Limited provides personal care and support to people living in their own homes in the towns of Barnstaple, Bideford and the surrounding areas. At the time of our inspection there were 109 people receiving a service. The length of visits ranged from 15 minutes to 24 hours a day and the frequency of visits ranged from one visit a week to a live in service.

There was a registered manager in post. 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.

Mulholland Care Limited had some quality assurance checks in place but not all of these were effective. Records were not always kept. The registered manager and provider had acknowledged this was an area for improvement and had put actions in place to address the issue.

People felt safe in their homes and with the staff that supported them. Staff were able to demonstrate a good understanding of what abuse meant and how to recognise and report it if they had concerns.

Staff received the training they required to do their jobs. They felt supported by management and were able to raise any concerns or suggest any changes to improve the service.

People’s needs and risks were assessed and care plans developed to meet these. People received personalised care which was specific to their individual needs.

People described how care staff were kind and caring towards them and they had developed meaningful relationships with them. People told us care staff went “above and beyond” what was expected of them and always asked if they needed anything else doing before they left. They paid attention to the ‘little things’ that mattered to people.

People received visits at the right time and staff stayed the right length of time. People generally had the same people giving care but were unhappy that they did not receive a staff rota to confirm who would be arriving. People were kept informed by the office if the care staff were running late.

Staff respected people’s privacy and dignity and maintained people’s independence as much as possible. Relatives felt involved in people’s care.

Staffing arrangements were flexible and adjusted when necessary. The service tried hard to match people and staff personalities. However, if they did not ‘get on’, people requested a change of care staff which was given.

Care staff worked in close partnerships with other health and social care professionals who were very positive about the good communication the service delivered.