We carried out this comprehensive inspection on 6, 7 and 9 March 2017. The inspection was announced a few days in advance so we could make arrangements to contact people who used the service to seek their permission to speak with them. At the last inspection, in March 2016, the service was rated Good. We brought forward the planned comprehensive inspection because we had received concerns about the service. These concerns were in relation to the care practice of some staff and the timing of some people’s visits. This included some missed visits, other visits were later than the agreed time and people were not always advised of changes to their times. There were also concerns that the service had given short notice to cancel care packages causing people distress because they were unsure if another provider could be found.

Penhellis Community Care is a Domiciliary Care Agency that provides care and support to adults of all ages, in their own homes. The service provides help with people’s personal care needs throughout Cornwall. 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 provide support with meals. These services were funded either privately, through Cornwall Council or NHS funding.

At the time of our inspection 513 people were receiving a personal care service. The care provision for 272 people, who lived in the west of the county, was managed from the registered office in Helston. The care provision for 241people, who lived in the middle and east of the county, was managed from an office in Roche, opened in June 2016. The provider advised us that they intended to register the Roche office as a separate location.

There was a registered manager in post who was responsible for the day-to-day running of the service. 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.

At this inspection we looked at the concerns raised with us. We found where people had raised concerns with the service about staff practice this had been dealt with appropriately. Records showed that investigations had taken place and disciplinary action had been carried out and some staff had been dismissed from the service.

We found the service had given notice to stop providing care to some people. This had been in specific geographical areas where the service had experienced staff shortages. Records showed the required four weeks notice had been given to the local authority. The quality manager explained that in some cases this message was not relayed to the person. We judged that the service had made these decisions because at the time there were not enough staff available to provide a safe service for people.

We had mixed responses from people in relation to the timing and reliability of their visits. Most people told us they received a reliable service, they knew the times of their visits and were kept informed of any changes. Comments included, “They’re not often late and they’ve never missed”, “They are generally on time”, “The carer arrives at 11.20am. She always phones when she’s on her way”, “I have nothing to complain about”, “A few visits have missed but they’re straight on the phone and get someone to come” and “In the last 18 months, they’ve been on time every day.”

Of the 54 people and 11 relatives we spoke with 14 people told us the service was not always reliable and they were not always informed of changes to times. However, the provider’s records did not confirm these missed visits and we found no evidence that anyone had come to harm as a result of a missed or late visit. People’s comments included, “They don’t always arrive on time and they never ri

Penhellis Community Care provides personal care to people who live in their own homes throughout Cornwall. The service’s registered office is in Helston where all care records are stored. An additional office in Liskeard provides support and management to staff in the east of the county.

At the time of our inspection on 7 and 8 March 2016 the service was providing care and support to approximately 650 predominantly older people. The service was previously inspected on 18 and 19 February when it was found to be fully compliant with the regulations.

The organisation was led by five directors, one of whom was the registered manager. 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 told us they felt safe and were well cared for by Penhellis Community Care. People’s comments included; “I do feel safe” and “The carers are very good.”

People who used the service were happy with the care they received but some people reported their staff did not consistently arrive on time. People told us that Penhellis Community Care headquarters would “usually” phone them if a care worker was going to be late which gave them reassurance that their visit would still continue. The registered manager was aware of these concerns and had taken appropriate action to resolve them where possible.

A call monitoring system was used to record staff arrival and departure times from each care visit. This information was monitored by office staff to ensure visits were not missed. In addition this data had been used to review the travel time required between consecutive care visits to ensure the care visit schedules were appropriate. Our analysis of call monitoring data, daily care records and staff visit schedules found care staff normally arrived on time and provided the planned care.

The service had robust and effective procedures in place to ensure that all planned care visits were provided. This included on-call management support, arrangements for additional staff to be available at short notice each weekend and a system for monitoring the provision of care visits in real time to ensure all visits were provided.

The service’s visit schedules were well organised and at the time of our inspection there were a sufficient number of staff available to provide people’s care visits in accordance with their preferences.

The registered manager and quality assurance manager were confident about the action to take if they had any safeguarding concerns and had liaised with the safeguarding teams as appropriate. Risk assessments clearly identified any risk and gave staff guidance on how to minimise the risk. They were designed to keep people and staff safe while allowing people to develop and maintain their independence.

The service’s systems for the induction of new members of staff were effective and fully complied with the requirements of the care certificate. Training was provided in accordance with the 15 fundamental standards. The service had commissioned a training academy to provide the induction and further training courses to their staff team. Staff said they were encouraged to attend training to develop their skills, and their career.

Staff received regular supervisions and annual performance appraisals. In addition ‘spot checks’ by managers were used regularly to confirm each member of staff was providing appropriate standards of care and support.

People were supported by stable and consistent staff teams who knew people well and had received training specific to their needs. People told us they were introduced to new staff before they supported them in their home. People confirmed they had consistent carers to support them and had built up positive rel

We spoke with 24 people who used the service or their relatives by telephone during the inspection. The majority of people that we spoke with were highly complementary of the care they received from Penhellis Community Care. Comments included, “the whole thing works as it should, I have been very impressed”, “I am more than happy, I would not want another agency” and “They understand my needs, they are reliable, helpful, caring and I am never made to feel a nuisance.”

We also sent a survey to 61 people who used this service, we received 18 responses. The survey asked, “Overall how do you rate the care you receive from Penhellis community care?” 69% of people said the service was “good” or “excellent” with the remainder indicating that the service was “satisfactory”.

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

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

People were cared for, or supported by, suitably qualified, skilled and experienced staff.

The provider had an effective system to regularly assess and monitor the quality of service that people receive and there was an effective complaints system available.

We carried out a themed inspection looking at domiciliary care services. We asked people to tell us what it was like to receive services from this home care agency as part of a targeted inspection programme of domiciliary care agencies.

We carried out a themed inspection looking at domiciliary care services. We asked people to tell us what it was like to receive services from this home care agency as part of a targeted inspection programme of domiciliary care agencies.

The inspection team was led by a CQC inspector joined by an Expert by Experience, who has experience of using or caring for someone who uses this type of service.

We used telephone interviews and home visits to people who used the service and to their main carers (a relative or friends).

We visited four people in their homes. They told us that they were very happy with the care and support they received. Everybody told us that staff were very caring and, “went that extra mile” to ensure everything was done properly and to their liking. Everybody we visited said they met their regular care worker and were always informed if the visit might be later than expected. We observed the staff member who accompanied us on our visits to be very polite and encouraged people to continue to be as independent as possible. All care was provided in a respectful and dignified manner.

One person told us over the telephone, they were very pleased that the same lady came every week unless she was on holiday. However six of the 18 people spoken with over the telephone told us that the number of different people who provided the care was high. One relative told us they felt the care provided was very good but the number of different staff who attended did not allow their relative to make a lasting relationship. They told us “the times of care are always fluid and my mum never seems to see the same person twice, they are all very nice caring young girls but surely for someone who has dementia continuity should be important”.

Everybody spoken to said they felt they could raise concerns with the agency and knew who to talk to. Some people spoken with over the telephone said they had not been asked to comment on the care they received. However during our visit to the office we saw completed surveys, from both clients and relatives with feedback on the service provided.

Penhellis Community Care provides personal care to people who live in their own homes throughout Cornwall. The service’s registered office is in Helston where all care records are stored. An additional office in Liskeard provides support and management to staff in the east of the county.

At the time of our inspection on 18 and 19 February the service was providing care and support to approximately 700 predominantly older people. When previously inspected the service was found to be fully compliant with the regulations.

The organisation was led by five directors, one of whom was the registered manager. 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.

Everyone told us they felt safe with their care staff and were treated with respect and kindness. People’s comments included; “I am pleased to have carers who care” and, “The care provided to me from Penhellis has made a very positive difference to my life” and, “they [staff] can’t do enough for me” and relatives told us, “they treat (the person) with a great deal of dignity and respect”.

Staff were well trained and effectively supported. The service’s Helston office was open seven days a week to provide people and staff with support when required. In addition the service’s on call management arrangements were appropriate and responsive to people’s needs.

Care plans were inconsistent and lacked the detailed information required to enable staff to respond to people’s individual care needs. We have made a recommendation about Penhellis Community Care’s care planning systems.

Care visit schedules and staff rosters were well organised and there were sufficient staff available to provide all planned care visits.

A call monitoring system was used to record staff arrival and departure times from each care visit. This information was monitored by office staff to ensure visits were not missed. In addition this data had been used to review the travel time required between consecutive care visits to ensure the care visit schedules were appropriate.

Our analysis of call monitoring data, daily care records and staff visit schedules found carer staff normally arrived on time and provided the planned care. People who used the service were happy with the care they received but some people reported their staff did not consistently arrive on time. People’s comments in relation to visit times included, “care workers were sometimes late” and, “the carers are rushed, no travel time, always asked to squeeze in extra clients due to sickness of carers”. The registered manager was aware of these concerns and had taken appropriate action to resolve them where possible.

Staff recruitment processes were robust and effective induction training was provided to new members of staff. Staff were well trained and effectively supported by managers. Staff told us, “The training is very good” and, “This is the best care company I have ever worked for as the training opportunities are excellent.”

The service had grown significantly since our last inspection. This growth had been well managed and effective quality assurance systems ensured the service continued to meet people’s care needs.