We carried out this announced inspection on the 8 and 9 January 2019. At the last inspection in June 2016, the service was rated Good in all areas. At this inspection we again found the service was Good.

Tamarisk Care Agency is a domiciliary care agency. It provides personal care to predominantly older people living in their own homes in Hayle, West of Cornwall. At the time of our inspection the service was providing support to approximately 35 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. Most people who used the service had privately commissioned this support.

People and their relatives were complementary of the service which they were happy to recommend. Their comments included, "The girls I have are absolutely lovely", "Everybody is really cheerful, they make my day", "I cannot recommend them enough" and "They are the best care agency in Hayle."

We found people were supported by carers who they knew well and got on with. Rotas included appropriate amounts of travel time for staff between consecutive care visits. Daily care records showed the service was reliable with staff normally arriving on time and providing visits of the full duration. People told us, "They are so reliable, you just know they are going to be there”, "They are very punctual, always on time" and “The patience the staff have is brilliant, they never rush my relative." While staff commented, “The rota is worked out really well, it works really smoothly” and “The visits are long enough, if you are over running regularly you mention it to the office and they will extend the visit [on the rota].”

People told us they felt safe while receiving support. Staff had completed safeguarding training and understood their role in ensuring people were protected from abuse and avoidable harm. Risks had been assessed as part of the care planning process and staff understood how to protect people from identified risks. Any accidents that occurred were fully investigated by the registered manager to identify any learning and how similar incidents could be prevented.

Staff were sufficiently skilled to meet people’s needs and there were systems in place to update training. All staff initially completed training in a variety of topics considered mandatory by the service and shadowed the deputy manager and senior carers until they felt confident to provide support independently. Staff new to the care sector had been supported to complete the care certificate. This was a nationally recognised induction training designed to ensure new staff have an understanding of current good practice. Staff told us, “The induction was really good. I went out with a mentor until I felt confident to go out on my own”, “The training is pretty good” and “All my training is up to date.”

The service’s recruitment practices were safe. All necessary pre-employment checks had been completed to ensure new staff were suitable for employment in the care sector.

Assessments of people’s needs were completed by the deputy manager before the initial care visit to ensure the service was able to meet people needs. Care plans were developed from information provided by people and their relatives during the assessments process. These documents were sufficiently detailed and provided staff with the guidance they needed to know to meet people’s needs. Staff told us, “The care plans are set out really well and we know what to do” and “The care plans are very good, very informative. Every little detail is in them.”

The registered manager had a good understanding of Mental Capacity Act 2005(MCA). There were systems in place to support people to make decisions independently and where this was not possible the service had consistently acted in people’s best interests.

The service was led by a registered manager who was based in the service full time. The manager was supported b

The service provides personal care to approximately 35 people who live in their own homes in and around Hayle in Cornwall. At the time of our inspection the service employed 14 care staff and was operating a waiting list of people who wished to receive a service. This was because it was oversubscribed.

Everyone we spoke with told us they felt safe while receiving care and support. People said, “Oh yes, I am safe I look forward to them coming” while staff commented, “People are safe in my care, that comes first with me.”

People and their relative told us, “They have never let me down” and, “They have never missed a visit and I do not suppose they would as they seem well organised.” During our review of daily care records we found no evidence that planned care visits had been missed.

Staff visits schedules included appropriate travel time and daily care records showed that people’s care visits were normally provided on time and for the correct visit length. People told us, “They are generally on time” and relatives said, “They are all very patient, there is never any rushing.”

Further comments included , “I know all the girls.” We found care was provided by consistent, small groups of staff who they saw regularly and whose company they enjoyed. People knew which staff were due to provide their next care visit and staff told us, “Generally I see the same people week in week out.” Our analysis of staff visit schedules found there were sufficient staff available to provide all planned care visits.

Staff consistently respected people’s choices and decisions. People told us, “They do what I want them to do” and staff described how they followed people’s directions and ensured their dignity was protected while care and support was provided.

The service’s systems for managing staff training needs were somewhat disorganised and staff training had not been regularly refreshed. In addition induction training for new members of staff had not been provided in accordance with current best practice. Prior to our inspection the registered manager had identified that improvements were necessary in relation to staff training and induction. All staff had recently received additional safeguarding training further addition training coursed had been arranged to update staff skills.

People’s care plans were sufficiently detailed to enable staff to meet their specific needs. These documents had been developed by combining information, provided by the commissioners of care with information gathered during assessments of care need and initial staff experiences of providing support. People told us their care plans were accurate and had been regularly reviewed. Staff told us, “The care plans are fine, there is enough information in them.”

The service was well led by the register manager. There was a clear management structure and staff told us they were well motivated and well supported. Staff said managers acted to ensure they were not unnecessarily disturbed while not at work and that the service on call manager system worked well.

Records were well organised and the service’s policies and procedures had been updated regularly to ensure they accurately reflected current practices. Quality assurance systems ensured people’s feedback was valued and acted upon. Responses to recently completed surveys had been consistently positive.

We spoke with eight people that used the service and five members of staff. People were complimentary of the staff and of the service. Comments included; the staff were “wonderful” and they “don’t rush me”. Staff told us they “love” their job and “feel supported”.

People told us they were “pleased with the service” and the care met their needs. Care plans were written in plain English that was easy for the staff and people that used the service to read.

The recruitment process did not ensure people were protected from harm. Staff had not received effective training or formal supervisions

The manager had sought the opinions from the people that used the service to monitor the quality of care provided.

We spoke with ten people who used the service or their relatives by telephone during the inspection. The people we spoke with were complementary of the care and support they had received from Tamarisk Care. Comments included “very good”, “Tremendous, they make me feel human again the mornings”, “I wouldn’t want anybody else” and “oh heavens yes, they do a very god job”.

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

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

People were cared for, or supported by, suitably qualified, skilled and experienced staff who were supported to deliver care and treatment safely and to an appropriate standard.

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