South Western Care Services in a domiciliary care service that supports approximately 50 predominantly older people living in their own homes. The service is based in Helston in the South of Cornwall and supports people living in the surrounding rural areas including the Lizard peninsula. The provider also operates a day care centre at the same address as the registered care service and many of the people who use the day centre are supported at home by the domiciliary care agency.

The focused inspection took place on the 1 and 2 November 2018. This inspection was done to check the provider had taken the action necessary to achieve compliance with the warning notice issued following our comprehensive inspection of June 2018. The team inspected the service against two of the five questions we ask about services: Is the service well led? and Is the service safe? The inspection was announced because we wanted to speak with people about the quality of support they received before completing the site visit.

Not everyone using South Western Care Services 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.

The service is led directly by the provider who is based in the service offices full time and is not required to have a registered manager. The provider is legally responsible for ensuring the service is meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

In response to the findings of our previous inspection the provider had returned care packages, in outlying areas, to commissioners for allocation to other service providers. This had allowed the service visit schedules to be redesigned and a new digital visit scheduling system had been introduced. This system used on-line route planning software to calculate the distance and time necessary to travel between consecutive care visits. At this inspection staff told us their rotas were now achievable and their comments included, “I feel the rotas have changed a lot. They have really looked in to sorting out the rounds”, “It does feel like it has improved. We used to have to rush. It now has about the right amount of travel time on the rota” and “Travel time is fine. No issues there, that has been sorted. Visit times have got better as well as you don’t have to rush around.” We reviewed the service visit schedules and individual staff rotas and found they now included appropriate travel time between care visits.

Most people we spoke with said they now received their visits on time and for the planned duration. They told us, "They are always on time, they are very good" and "The timing is good and we get to see the same carers." We completed a detailed analysis of 961 care visits completed in October 2018. We found that over 72% had been provided on time and that visits were normally of the planned duration.

Staff said the inclusion of travel time on their rotas meant they were now able to meet people’s needs and to provide their visits on time. Staff comments included, “You can get to visits on time and you don’t feel that pressure to do visits quickly. I think people are happy about the change” and “I feel it is a lot better out there. I have enough time with clients and you know you have the time you need to get to the next person.”

The provider had introduced a bonus pay system to encourage staff to accurately record details of each visit they provided using the call monitoring system. This had led to significant improvements in the use of this system and managers now monitored the system in real time to ensure staff safety and check that all planned visits were provided. We found no evidence that care visits had been missed since our last inspection and staff told us, “Missed visits do not happen often.”

South Western Care Services in a domiciliary care service that provides support to 60 predominantly older people living in their own homes in the South of Cornwall, from it’s office in Helston. The provider also operates a day care centre from the same address and many of the people who use the daycentre are supported at home by the domiciliary care agency.

The inspection took place between the 04 and 06 June 2018 and was announced. This was because we needed to ensure staff would be available in the office during the inspection visit. Not everyone using South Western Care Services 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.

The service is not required to have a registered manager as the register provider had direct oversite of the service’s performance and is based in the service’s office on a full-time basis. The provider was legally responsible for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The provider was supported by a team of office based managers and staff who had well defined roles and responsibilities.

This was the first time the service had been inspected at its current address following changes to its registration. The service had previously operated from a different address where it was registered as Southwestern Care Services Ltd. We had previously completed a responsive inspection of Southwestern Care Services Ltd in March 2017 and found the service to be good in both key questions inspected. A comprehensive inspection of Southwestern Care Services Ltd had been completed in August 2016 and had found the service to be good over all but requires improvement in relation to our question ‘Is the service responsive’.

Prior to this inspection we received information of concern that indicated people’s needs were not being met as care visits were not being provided on time and for the full duration. We looked at the concerns raised as part of our inspection.

The service’s visit schedules, call monitoring data and people’s daily care records confirmed visits were regularly not provided on time or for the correct duration. For example, one person was due to receive an evening visits at 9:30pm. However in one week this visit had only twice been provided within 30 minutes of the planned start time. The earliest visit had started at 8:40pm while staff did not arrive until 10:25pm for the latest visit. Eighteen of the 20 people we spoke with raised concerns about the variability of the timing of care visits, with some people reporting this made them feel unsafe. Comments received from people and their relative’s included, “No [I don’t feel safe] because I never know when they are coming”, don’t know when they are coming. I have to wait for them to help me get up and go to the toilet. It can be any time between 7am and 9am and sometimes I am bursting (for the toilet). It’s awful, waiting” and “No they are never on time. Sometimes they don’t come to put [My relative] to bed until 11.30pm, it’s too late, I am exhausted by then.”

Our analysis also found that care visits were regularly shorter than planned. For example, one person who was scheduled to receive 15 hours of support during three weeks was only provided with eight hours and fifteen minutes of care. People confirmed that care visits were regularly shorter than planned and told us, “They are meant to be here for half an hour but I get 20 minutes at most” and “Sometimes I just get about 10 minutes. They have barely got the chance to say hello.” Staff said, “I don’t think people are always getting the service they are paying for. That is mainly down to staff rushing and not staying for the time they should.”

The service operated in a rural area and staff regularly had to travel signi