We carried out this announced inspection between the 19 and 24 September 2018. At the last inspection, in February 2016, the service was rated Good overall but requires improvement in relation to our question ‘Is the service effective’ because staff were not receiving training updates. At this inspection we found improvements in access to training had been made and the service was now Good in all areas.

Proper Care (Cornwall) Limited provides personal care to people living in their own homes in the community. Services are provided to predominantly older people living in an around Helston in South West Cornwall. At the time of our inspection the service was providing support to approximately 70 people. The service generally provides short visits at key times of the day to support people with specific tasks to enable people to continue to live in their own homes. These services were funded either privately, through Cornwall Council or NHS funding.

People and their relative told us the service provided safe care. Their comments included, “I feel happy and safe with them [staff]” and “Yes I do [feel safe], they [staff] are very good.” Staff had received training in safeguarding adults and knew how to respond if they had any concern in relation to people’s safety. Staff were confident the registered manager would take any action necessary to ensure people’s safety.

Risk assessments had been completed and where risks had been identified staff were provided with guidance on how to manage and minimise these risks while providing support. Any accidents or incidents that occurred had been appropriately recorded and investigated by the registered manager to reduce the likelihood of similar events reoccurring. The service had purchased a lifting aid and staff had received training on how to assist people who were uninjured up from the floor following a fall. This meant people were protected from the risks associated with spending time on the floor while awaiting assistance from emergency services.

People told us they received a reliable service and no one reported having experienced missed care visits. Staff told us, “There are no missed visits. There is always someone to every visit.” We received mixed feedback from staff, in relation to the amount of time allocated to travel between care visits and identified that some staff visit schedules did not include appropriately amounts of travel time. We discussed these issues with the registered manager who accepted and recognised that travel time had not been consistently included in staff rotas. We have made a recommendation in relation to the services visit scheduling systems and the manager explained that changes were planed to address these issues.

People told us their care visits were normally provided on time and for the full duration and one person’s relative said, “One thing is we have been allocated a reasonable amount of time so we don’t feel under any pressure. The people are very caring and pleasant and they do try to understand my husband. They take the time and trouble to understand what he feels unsafe about.” Staff told us the issues with travel time did not impact on the support they provided and daily records showed staff normally arrived on time. We have made a recommendation in relation to the service’s current visit scheduling system.

Staff were sufficiently skilled to meet people’s needs. Following our previous inspection a new system had been introduced to ensure all training was regularly reviewed and updated. Staff told us, “They are very strict that all our training is up to date.” While health professionals said, “Staff appear to be well trained and are happy and actively striving to improve their education”. There were appropriate staff induction processes in place and all staff new to care received formal induction training in line with the requirements of the care certificate.

The service had robust recruitment practices, which meant staff were

The inspection took place on 3 February 2016 and was announced in accordance with our current methodology for inspecting domiciliary care services. Proper Care provides personal care to approximately 100 predominantly elderly people who live in their own homes in the West of Cornwall. The service was previously inspected on 7 and 14 May 2014 when it was found to be fully compliant with the regulations. There was a registered manager in post. 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.

Before the inspection we sent out a survey to a random selection of 50 people who used the service. Everyone who responded to our survey and all of the people who we spoke with during our inspection told us they felt safe with, and were well cared for by their staff from Proper Care. Comments received from people and their relatives included; “I definitely feel safe with my care staff”, “They are absolutely delightful” and, The staff are always lovely. [My relative] gets on really well with them.”

People told us they received a schedule of planned care visits each week which included details of the times of all visits and the names of the staff who would be visiting. People said this information was normally accurate, that staff arrived on time and stayed for the full planned care visit. People’s comments included; “Very, very occasionally they are late”, “They are never late they come when they say they will” and, “They are normally on time and will let me know if they are going to be late. Basically they are on time or I get a call.” We examined staff visit schedules and daily care records. We found staff were provided with appropriate amounts of travel time between consecutive care visits and provided care visits of the planned length. Staff told us, “We do get travel time”, “There is enough time during visits, you do not feel you have to rush people” and, “I definitely have enough time to talk. I can stay and have a cup of tea and a chat with people, I love all the stories people tell you.”

Proper Care had appropriate procedures in place to protect people from abuse and avoidable harm. Staff understood local safeguarding procedures and people’s care plans included detailed risk assessments. These assessments provided staff with detailed guidance on the actions they must take to protect people from each identified risk. The service’s recruitment procedures ware robust and necessary staff pre-employment checks had been completed.

The training needs of the staff team had not been met. Before our inspection the provider’s quality assurance systems had identified this area of concern. As a result the service’s training and induction systems had been reviewed. It was planned that in future all staff would receive appropriate regular training to help ensure they had the skills necessary to meet people’s care needs.

There were sufficient numbers of staff available to meet people’s assessed needs and care staff received regular supervision from managers and senior care staff. The service’s on call management arrangements were effective and staff told us, “I know I can phone up at any time and they will answer, I think they [managers] do an absolutely fantastic job.”

People told us, “I see the same staff regularly, I get on with them” and staff visit schedules showed people regularly received care from a consistent small staff team who they knew well. In addition, office staff knew people well and understood their care needs and individual preferences.

People’s care plans were detailed and informative. They provided staff with sufficient information to enable them to meet people’s care needs. Care plans were based on information gathered during assessmen

We contacted 26 people who used the service and relatives to seek their views of the care and support received. People told us they were happy with their care and the carers. Comments included: “They do a really good job” and “If I want anything extra they do help”.

We spoke with the registered manager, the deputy manager, the training manager, the community supervisor and four members of staff.

Care plans were detailed and informative. Risk assessments did not contain enough information to guide staff on how to manage identified risks.

We saw people were not protected from the risk of abuse because the provider had not taken steps to ensure staff were able to recognise and respond to potential abuse.

We looked at personnel files for four members of staff. Recruitment systems were robust and staffing levels were satisfactory.

Staff were supported well with regular supervision and meetings. We noted there was an open culture within the organisation.

Proper Care had a suitable quality assurance system in place.

We spoke to fifteen people who were received care from Proper Care (Cornwall) Ltd. Everyone we spoke to was very positive about the care they received and told us the staff do “a very good job” and one person said “I can’t speak too highly of them. Nothing is too much trouble for them”.

The care plans we looked at directed and informed staff as to how the care was to be provided on each visit and reminded carers to offer choices to people as well as prompting them to be respectful of peoples privacy and dignity during activities of personal care.

Some people told us they had specificially requested carers of one gender or another and this request had been accepted. We also saw examples of this documented in care plans and initial assessments. The agency told us that where there was difficulty accommodating a particular request they did not accept the care package.

The recruitment process was robust and training was both comprehensive and provided frequently.

During our routine inspection of this service we used the evidence gathered in relation to the five outcomes we inspected to answer our five key questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

Below is a summary of what we found. The summary is based on information gathered during conversations with people who used the service, relatives, staff and management of Proper Care (Cornwall) Ltd.

Is the service safe?

At the time of the inspection we found the service was safe. The 23 people who used the service that we spoke with all told us they felt “absolutely” safe with their care staff supplied by Proper Care (Cornwall) Ltd.

The Care staff we spoke with understood local safeguarding procedures and had received appropriate safeguarding and Mental Capacity Act training.

We found the providers Safeguarding policy had been updated and new procedures introduced for recording details of shopping trips completed by members of staff.

Is the service effective?

At the time of the inspection we found the service was effective. Everyone we spoke with was complimentary of the care provided by Proper Care (Cornwall) Ltd. People’s comments included “excellent”, “very good”, “absolutely wonderful” and “I’d give them 100%, I have had no problems with them at all”.

Staff demonstrated during our conversations with them a good understanding of the importance of gaining consent prior to providing care or support and people who used the service told us “they come in and chat, make sure I am OK then get started” and “the girls do things the way I ask”.

We saw that people’s care needs had been assessed in order to ensure that the service could meet their needs and we saw that detailed risk assessments had been completed.

The four care plans we inspected were up to date, highly detailed and provided staff with comprehensive information about each person’s care needs.

Is the service caring?

We found that the service was caring and that people who used the service valued the care and support provided by both office and care staff. People told us “Proper Care from the manager down are a really lovely group of people” and “they do listen and the service is always excellent”.

The five staff we spoke with reported that they enjoyed their work, their comments included “I love it” and “It’s a fabulous place to work”.

The daily records of care we inspected were detailed and included information about the care provided, the individuals mood, any changes to their condition and information about how the person had spent their day.

Is the service responsive?

At the time of the inspection we found the service was responsive, we found the service had appropriate complaints procedures and people who used the service told us told us “all the details (of how to make a complaint) are in the folder that has been provided by Proper Care” and “I phoned the office about one of the carers I wasn’t happy with and haven’t had her since.”

The service regularly received compliments and thank you cards from people who used the service and their relatives. We saw this information and details of any complaints received were shared with staff during informal rota collection meetings each Friday.

An annual survey of people who used the service had been completed in October 2013 when the majority of the 82 people who responded to the survey said the service was “Excellent” or “Very Good”.

Is the service well led?

At the time of our inspection Proper Care (Cornwall) Ltd was well lead and it’s manager was registered with the Care Quality Commission.

People who used the service told us “the manager is excellent, you only have to phone him. He listens and makes adjustments where needed. One phone call and it is sorted” while staff told us “it’s a fabulous place to work”, “if I had a problem I would call them (the office) and I am sure something would be done” and “out of hours, amazing service I always get through and always get the help I need”.

The service had appropriate quality assurance systems in place and accidents and incidents had been investigated appropriately.