This inspection took place on 11 January 2018 and was unannounced. At the last inspection, in January 2016, the service was rated Good. At this inspection we found the service remained Good.

Pentowan domiciliary care service provides services to people in their own homes in the Newquay and surrounding areas. It supports Older People, People living with Physical Disability and Sensory Impairment. The service mainly provides personal care for people in short visits at key times of the day to help people safely maintain their independence to live in their homes. The services were funded either privately or through Cornwall Council or NHS funding. The service employed 50 staff including management.

At the time of the inspection one hundred and twenty people were using the service. People were supported by staff who knew how to recognise abuse and how to respond to concerns. The service held appropriate policies to support staff with current guidance. Training was provided to all staff with regular updates provided. The registered manager had a record which provided them with an overview of staff training needs.

People had a care plan that provided staff with direction and guidance about how to meet their individual needs and wishes. Care plans were regularly reviewed and any changes in people’s needs were communicated to staff. Assessments were carried out to identify any risks to the person using the service and to the staff supporting them. This included any environmental risks in people’s homes and any risks in relation to the care and support needs of the person. People told us they were involved in decisions about their care and were aware of their care plans.

The registered manager used effective systems to record and report on, accidents and incidents and take action when required. In order to learn from events the registered manager reviewed all incidents to make changes where necessary to manage risks more effectively. For example, where medicine errors had occurred the registered manager and senior staff worked with the staff member to provide additional support and training. This helped to ensure risks were reduced and staff competency met the expected level of the organisation.

Staff had been recruited safely, received on-going training relevant to their role and supported by the registered manager. They had the skills, knowledge and experience required to support people in their care.

Staffing levels were managed in a way to ensure staff were available to provide a consistent service to meet the needs of people who lived at home. Staff were knowledgeable about the people they cared for and responded appropriately as people's needs changed. For example, when people had been in hospital a new assessment was carried out before they returned home so the necessary services were available. Staff spoke positively about the people they supported and were motivated to provide an individualised service in line with people's needs and goals. Comments included, ”I’ve been doing this job for some time. It does change but the basics are that clients get the care they need when they need it” and “We [care staff] get the information we need if anything changes. It’s really important especially when they come from hospital because more often than not we need to do more.”

People confirmed there was a stable staff team and that care was provided by familiar faces. Staff told us that travel times were sufficient, so they were not rushed. People’s comments included, "They [the carers] are amazing and do absolutely anything I ask” and “Nothing is too much trouble, I never feel like I am a burden.”

People’s feedback about their experience of the service was positive. People said staff treated them respectfully and asked them how they wanted their care and support to be provided. People told us they had their care visits as planned. Staff arrived on time and stayed for the allotted time. Nobody reported any missed visits.

Staf

Pentowan Domiciliary Care Agency (DCA) provides support to people in their own homes in the Newquay, St Columb, Padstow, Camborne and Redruth areas of Cornwall. These included people living with dementia, older people, people with a physical disability and people with a learning disability. At the time of our inspection Pentowan DCA was providing support for up to one hundred and ninety people.

The service was previously inspected in March 2014 when it was found to comply with the requirements of regulations.

The registered person was in day to day control of the agency. There was no condition to employ a registered manager. 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 were systems in place to ensure the safe administration of medicines. However in one instance the list of medicines delivered from the pharmacist did not tally against the agencies own record of medicines for this person. When the registered person was made aware of this issue they acted immediately to ensure all medicines were up to date in each persons home where staff were responsible for administering medicines.

There were sufficient numbers of staff available to make sure people’s needs were met. Care workers had regular schedules of calls so that people received care from a consistent staff team wherever possible. Staff were visiting the office to collect their weekly rota. They told us, “It’s a good system to get the rotas in advance so we know what we are doing. Most of the calls are regular. It works well especially when we double up”. A person using the service told us, “They (staff) do get behind sometimes but we always get a call to tell us why and when they will be due to call”.

People confirmed care workers respected their privacy and dignity. Staff had a firm understanding of respecting people within their own home and providing them with choice and control. The agency had identified people’s needs and preferences in order to plan and deliver their care. Mechanisms were in place to review people’s packages of care and care plans to ensure the level of support was still meeting their care needs. Comments from people included, “Staff are very nice they are all excellent” and “They (staff) always make sure the door is closed and curtains are closed when they provide care for (name of person). All very respectful”.

Staff received training and were knowledgeable about their roles and responsibilities. They had the skills, knowledge and experience required to meet people’s care and support needs. Staff said, “They (agency) make sure we get all the training we need. Just done moving and handling which is focused on working in people’s homes. It gives us a true picture of the problems in moving equipment around and make sure it’s safe”. Some people using the service were living with dementia. Staff had access to training in dementia care which they said had helped them to understand the condition better. A person told us staff were very kind and patient when supporting their relative who was living with a dementia condition.

Staff told us they were supported by the managers and the on- call arrangements provided people and staff with appropriate support when the service was closed.

Systems were in place to protect people from abuse and harm and staff knew how to use the procedures. Staff understood the needs of the people they were supporting and had received training on safeguarding adults. People commented they felt safe with care workers entering their home. One person said, “(person’s name) has the same staff so we feel very safe. If there is a change the office always rings and lets us know”.

People were protected by recruitment procedures and new care workers had induction training which included shadowing more experienced care workers, until they were competent to work on their own. Care workers had core