Somerset Care (Taunton Deane) is a domiciliary care agency providing personal care and support to people living in their own homes. Not everyone using the service receives a regulated activity; 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.

At the time of the inspection 369 people were receiving the regulated activity ‘personal care’.

This inspection was announced and took place on 26 and 27 September 2018. The provider was given 48 hours' notice because the location provides a domiciliary care service to people in their own homes and we needed to be sure that someone would be at the office and able to assist us to arrange home visits.

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 2008 and associated Regulations about how the service is run.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Why the service is rated Good.

People told us they felt safe with the care provided and staff who visited them. One person said, “I have never felt anything other than safe. They[staff] are excellent and I look forward to their visits.”

There were sufficient staff to meet people’s needs. People confirmed they had a small team of care workers whom they had got to know. People’s comments on the timing of visits varied. Some people were happy that staff arrived at the agreed time and stayed the agreed length of time. Many commented on staff who stayed longer and did more than they expected. However, some people said they experienced staff arriving either earlier or later than planned. One person said they went to bed at 9pm and got up at 7am which they thought was too long in bed. The registered manager explained they tried to accommodate all time requests but they were open and honest with people at the start of the care package about any timings they could not achieve.

People were protected from harm because the provider had a robust recruitment process and staff received training in how to recognise and report abuse.

People’s medicines were managed safely and people told us they received support to take their medicines correctly and at the right time.

People were supported by staff who knew their needs and understood the importance of delivering effective care and support. Records showed all staff completed the organisations mandatory training and training relevant to the needs of the people. Staff received regular supervision and support from the management team. This was carried out either in one to one or team meetings. People told us that senior staff carried out ‘spot checks.’ This meant the senior staff arrived unannounced to check on staff and ask people what they thought about the team supporting them.

All new staff received an induction and initial training. Before working alone, they were able to shadow more experienced staff and meet the people they would be supporting. Staff told us the training provided was good and that they could also access training specific to people’s needs.

People were supported to have a balanced and nutritious diet. Some people required meals cooked for them and support to eat. At other times, staff supported some people to prepare their own meal and maintain their independence.

People were supported to have ma

This inspection took place on 11, 12 and 15 January 2016. The week commencing 25 January 2016 we spoke with people over the telephone. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we needed to be sure the registered manager would be available for the inspection. It also allowed us to arrange to visit people receiving a service in their own homes.

Somerset Care Community (Taunton Deane) provides personal care for people living in their own homes in the Taunton, Bridgwater and Chard areas. At the time of this inspection they were providing personal care for 509 people. They also provided a domestic service to people in their own homes. This was the first inspection since the service was reorganised following the Chard and Taunton office merger.

There is 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 2008 and associated Regulations about how the service is run.

People who received personal care from Somerset Care Community (Taunton Deane) told us they were happy with the care and support provided. They said the management and staff were open and approachable and cared about their personal preferences and kept them involved in decision making around their care. One person said, “Since I changed to Somerset Care I have been very happy with the support I receive.” Another person said, “They [staff] are always very cheerful and nothing is too much for them.”

Some people who used the service and care workers said office staff did not allocate sufficient time for care workers to travel between visits. One person said, “The staff are very well organised, but the company is not organised, they don’t recognise the distance the staff travel.” Some staff spoken with also said planners did not recognise the time it took to travel between calls. These people felt this was the reason some calls were later than planned. The registered manager confirmed planners carried out care duties every six months and covered for staff sickness so they would have an idea of the time it took staff to travel. One staff member said, “Travel time can vary a lot in this area as traffic congestion can change in a second and then it puts everything out, so it is difficult to plan for that.”

People were supported by sufficient numbers of staff who had a clear knowledge and understanding of their personal needs, likes and dislikes. We observed staff took time to talk with people during our home visits. Most people said they had a consistent team of care workers who visited. They said they were usually on time and very few people said they had experienced missed calls. However some people said they were not informed when a care worker was changed or if they were going to be late. The registered manager confirmed they would only take new people on if they could meet their needs. If they were unable to meet their needs they would signpost them to another agency or health care professionals.

People told us they received care from care workers who were knowledgeable about their needs and were appropriately trained to meet them. Care workers had access to training specific to their roles and the needs of people. For example they could ask the training team to provide specific training in the person’s home if they had new equipment. They understood people’s needs and were able to explain to us how they would care for each person they visited.

People’s care needs were recorded and reviewed regularly with senior staff and the person receiving the care or a relevant representative. All care plans included written consent to care. Care workers had comprehensive information and guidance in care plans to deliver consistent care the way people preferred. Daily

Our inspection team was made up of an inspector who spent three days at the agency and visiting people in their own home. A pharmacy inspector visited the office on 26 June 2014 and we used an expert by experience to contact people using the service by phone to hear their experience. We considered our inspection findings to answer questions we always ask:

Is the service safe?

Is the service caring?

Is the service effective?

Is the service responsive?

Is the service well led?

This is a summary of what we found.

We gathered the views of people who used the service by visiting them in their home and by telephoning them. We contacted 42 people and were able to speak with 27 people using the service and three relatives.

In addition to speaking with people who used the service and/or their representatives, we met or spoke with 34 members of staff, individually or in small groups. We also reviewed a range of relevant documentation.

Is the service safe?

People who used the service told us they felt safe with the staff that provided care and support for them. Comments included, “Staff are very considerate. They recognise when I get breathless and never rush me”; “I have confidence in the staff. They are never abusive. I trust them”; and “I am treated very well by the staff”.

Care plans and risk assessments were available in eight of the nine people's homes we reviewed for staff to follow, so people received the care they needed. However we found people were not always protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not always maintained.

Equipment was available where necessary, for example hoists, to aid people’s safe moving and handling.

We found systems and processes were in place to safeguard people from harm and abuse. This was because staff had received training to provide them with the knowledge to identify abuse and where to report abuse, so appropriate action could be taken. All staff spoken with were aware of the processes for raising safeguarding alerts.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

There was monitoring of events and incidents and measures were put in place to minimise a repeat of any issues. This included, changes to health care needs and some medication incidents.

Is the service effective?

People and their families described how they were involved in the assessment and care planning of their care needs, so they received care that met their needs and supported their rights. When staff had regular rotas it enabled continuity of care and ensured they knew people well.

The service worked with a local authority independent living team providing care, support and rehabilitation for up to six weeks. External professionals working with the service told us this service “worked incredible well” and that they were happy with the joint working which delivered an effective and responsive service.

Staff had completed comprehensive training before they started work to ensure care and support was delivered safely and respectfully and in accordance with the registered provider’s policies and procedures.

There were effective recruitment and selection processes in place.

Is the service caring?

People told us care staff respected their choices and maintained their dignity. Comments from people using the service included, “The staff are very good indeed. Very friendly and polite, always respectful. That (respect) couldn’t be better”; and “The staff are lovely. They stick to my routine and give me choices. They are mindful of my privacy and dignity”. One person told us they felt more in control and able to stay living at home because of the agency support.

During our visits to people’s homes we saw staff interacted positively and gave encouragement when supporting people. Staff were polite, friendly and knowledgeable.

Is the service responsive?

The service was not always responsive to people needs as preferences relating to the timing of visits and continuity of staff were not always met, which caused frustration and anxiety for some.

The service was generally responsive to people’s complaints. The majority of complaints were responded to in a timely way and most were resolved satisfactorily.

Is the service well-led?

The service worked with other agencies and services to make sure people received their care in a joined up way.

The service had quality assurance processes in place to monitor the quality of the service provided. We saw steady improvements were being made, especially with missed visits. We also saw that unallocated visits were also being addressed and had fallen to 10% in June from 15% in April 2014, which meant better continuity for both people using the service and care staff.

People who used the service and their representatives and staff confirmed they had regular monitoring visits to check the quality of the service and that the care provided continued to meet their needs.

Staff we spoke with told us they felt supported by the management of the service. Staff were clear about their roles and responsibilities. Discussions at team meetings included issues of best practice, improved ways of working and knowledge sharing, which aimed to improve the service provided.