This inspection took place on the 11 and 17 April 2018 and was unannounced.

Our last inspection of the service was carried out on 19 January 2016. At that inspection we rated the service as Good. At this inspection in we found the service Requires Improvement.

This service is a domiciliary care agency. It provided personal care to people living in their own homes in the community. It provided a service to people living with Dementia, Mental Health, Older People, Physical Disability, Sensory Impairment and Adults with Learning Disabilities. The service mainly provided 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. There was one 24 hour package of care and people with learning disabilities are supported with life skills including accessing community events. These services were funded either privately or through Cornwall Council.

Taylors of Grampound Limited is registered to carry out the regulated activity of personal care. The agency’s office is located on the outskirts of Grampound Road and is accessible for people using the service and staff.

The service covers two geographic areas in Cornwall including the south and central region. At the time of our inspection 136 people were receiving support from the service from a staff team of 56.

There was no registered manager in post at the time of our inspection. 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. The registered manager had deregistered with the commission in March 2016. There followed a significant period, where the service had not taken action to meet the condition of registration to have a registered manager in post. However, immediately following this inspection we were informed a suitable candidate had been recruited and an application to the commission was underway.

However at the time of the inspection there was recruitment taking place for the post of a manager to be registered with the commission. The service has a condition to have a registered manager in post as part of their registration requirements. This registered provider was failing to comply with the conditions of their registration under Section 33 of the Health and Social Care Act 2008.

The service had systems in place to record safeguarding concerns, accidents and incidents and take necessary action as required. Staff had received safeguarding training and understood their responsibilities to report unsafe care or abusive practices.

Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. These had been kept under review and were relevant to the care being provided. The information was person centred and where necessary alternative communication methods were used to support people. This included, pictorial and large print formats.

Staff had been recruited safely, appropriately trained and supported. They had the skills, knowledge and experience required to support people with their care and social needs.

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. One person said, “It seems to be a lot better now staff are not as rushed as they used to be.”

People had a care plan that provided staff with direction and guidance about how to meet their individual needs and wishes. These care plans were regularly reviewed and any changes in people’s needs were communicated to staff. Assessments were carried out to identif

Taylors of Grampound Domiciliary Care Agency provides support to people in their own homes in a large geographic area of Cornwall. The service has geographic divisions North and South. These included people living with dementia, older people, people with a physical disability and complex needs. There is a separate division of Taylors of Grampound called Bespoke staffing solutions. This is a service specifically designed to support people with learning disabilities and other complex needs associated with learning disabilities. At the time of our inspection Taylors of Grampound was providing support for approximately 160 people. There were approximately 100 staff including care support workers and office staff.

The service was previously inspected in June 2014 when the service was found to comply with the requirements of 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 2008 and associated Regulations about how the service is run.

The agencies policies and procedures required updating to reflect current legislation and for contact details for external agencies were accurate for people to use. We have made a recommendations about this.

There were sufficient numbers of care workers available to make sure people’s needs were met. Care workers had permanent regular schedules of calls so that people received care from a consistent team. Staff received regular rotas informing them who would be visiting so that visits were planned and organised. Any last minute changes were relayed to staff either by telephone or e-mail.

Systems were in place to protect people from abuse and harm and care workers knew how to use them. Care workers 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 told us, “I have never experienced any verbal or physical abuse”.

Staff understood the principles 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, “ I feel they are all perfectly skilled” and “ I feel that the carers are fully trained and experienced to do the job they do. My (relative) has fallen several times but this has not been through negligence, they are very good with him, I cannot fault them. We do feel safe with the carers”.

People were protected by recruitment procedures and new care workers received induction training which reflected the requirements of the Care Certificate which followed a set of induction standards reflecting good practice in the care sector.

Staff had good access to training and were knowledgeable about their roles and responsibilities. There was a designated training manager. Staff also had access to a fully equipped training room which enabled staff to gain experience to use equipment safely. Care workers had core training and more specialist training, so they had the skills and knowledge to meet people’s needs. Staff said, “The training is very good and we always get reminders when things are due” and “The good thing is that we have a fully equipped training room. Not always like that when you go to people’s homes but it helps us to get to know how to use it”. People using the service had a range of needs including those living with dementia or learning disabilities. Staff had access to training in dementia care which they said had helped them to understand the condition better. Staff supporting people

We contacted 20 people who used the service to seek their views. Comments made regarding the carers and the care they provided included: “very good” and “couldn’t ask for better.” Most people said the carers came on time.

We saw that care plans and risk assessments had been updated to ensure care staff were aware of any changes to a person’s needs.

People were able to request a copy of the rota, to enable them to know which carer would be visiting them throughout the week.

Quality assurance monitoring was completed by the “Area Manager” twice a year. The results of the questionnaires were being analysed and people had been informed that the findings would be sent to them in April 2013.

People we spoke with confirmed they had recently received the complaints policy and procedure ensuring people were aware of how to report any issues or concerns they may have had

We carried out a themed inspection looking at domiciliary care services. We asked people to tell us what it was like to receive services from this home care agency as part of a targeted inspection programme of domiciliary care agencies with particular regard to how people's dignity was upheld and how they can make choices about their care. The inspection team was led by a CQC inspector joined by an Expert by Experience, who had experience of using or caring for someone who uses this type of service.

We used telephone interviews and home visits to people who used the service and to their main carers (a relative or friend). We visited four people and spoke to sixteen people over the telephone. Overall people told us the care staff provided a good level of care which protected their dignity and promoted their independence, comments included, “I like all the carers and they chat nicely”, and “they are my eyes, my carers are both male and female and all are nice to me, they have patience and help me”.

However, other comments included “generally time keeping is okay, but the odd carer rushes”, and “at dinner time we have to work around Taylors”. Two people told us, at times, staff do not always stay for the allocated time, and as a result of this rush personal care.

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 Taylors of Grampound.

Is the service safe?

At the time of the inspection we found the service was safe. The 20 people who used the service that we spoke with all told us they felt “absolutely” safe with their care staff provided by Taylors of Grampound.

The care staff we spoke with understood local safeguarding procedures and had received appropriate safeguarding training and were due to receive further Mental Capacity Act training.

We found the providers safeguarding policy was appropriate and had been shared with the staff team.

Is the service effective?

At the time of the inspection we found the service was effective. Everyone we spoke with were complimentary of the care provided by Taylors of Grampound. 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 seven care plans we inspected were up to date, detailed and provided staff with comprehensive information about each person’s care needs.

Is the service caring?

At the time of the inspection 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 “they do listen and the service is always excellent”.

The 12 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 individual’s 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 they would raise any concerns without hesitation to staff. One person who used the service told us “The office staff (managers) are good when you phone, they listen and make changes where needed.”

The service regularly received compliments and thank you cards from people who used the service and their relatives. This showed that people were satisfied with the support they received.

An annual survey of people who used the service was in the process of being completed. From the questionnaires that had been returned to Taylors of Grampound, We saw the majority of people who responded to the survey said the service was “Excellent” or “Very Good”.

Is the service well led?

At the time of the inspection we found that the service was well lead and it’s manager was registered with the Care Quality Commission.

People who used the service told us “the head of care is excellent; you only have to phone her. She listens and makes changes where needed” while staff told us “it’s a good 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.