The inspection was announced and was carried out on 13 and 14 November 2017 by 3 inspectors supported by an expert by experience. This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to older adults.

At the time of our inspection there was a registered manager at the service. 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 were being protected against risks but the risk assessments we saw on people’s files failed to mitigate the potential hazards. The risk assessments we saw were not robust and merely described potential harm to people. We made a recommendation about this.

People’s needs and choices had been assessed when they started using the service, but changes to their needs had not consistently been identified or planned for. This meant that people were at risk of not receiving the care, treatment and support they needed. We made a recommendation about this.

Care plans did not always fully reflect people’s preferences. There was insufficient information recorded for staff to know how the person preferred to be supported, or their likes or dislikes. We made a recommendation about this. There was a system in place to review care plans, and reviews took place every 6 months. People and their relatives were involved in the reviews. The service took people’s communication needs into account when planning for and providing support. People’s complaints and concerns were responded to appropriately.

People were protected against potential abuse. The service had safeguarding and whistleblowing policies in place and staff we spoke to told us these were clear and easily accessible in the office. There were sufficient numbers of staff on duty to ensure the needs of people were being met. Recruitment systems were robust and made sure that the right staff were recruited to support people to stay safe. People were protected by the prevention and control of infection where possible. Staff were aware of the importance of using Personal Protective Equipment (PPE) when supporting people. Staff received infection control training. People received their medicines safely. The service had a medication policy which gave guidance to staff on how to support people with their medicines. Accidents, incidents and near misses were reported to management in line with the provider’s policy and procedure.

Staff were trained and competency checked by the registered manager. Staff at Terrablu worked with other organisations and professionals to deliver effective care. People had access to health and social care professionals. Records confirmed people had access to a GP, dentist and an optician and could attend appointments when required.

People’s rights had been protected and staff were acting in accordance with the Mental Capacity Act 2005. Staff demonstrated a good understanding of the MCA.

Staff were seen to be kind and compassionate towards people. Staff were encouraged to develop positive, caring relationships with the people they support. Staff told us they were able to spend time with people to get to know them, and wherever possible were matched with people in order to develop close working relationships. People’s dignity and independence was respected at all times.

People and staff spoke positively about the management of the service. Discussions with staff and people showed there was an open and inclusive culture at the service.

The service took steps to promote equality and inclusion within its workforce. The registered manager kept up-to-date with best practice and guidance in order to ensure she was able to lead the service effectively.

The registered ma

The inspection was announced and was carried out on 28 October 2015 by an inspector, supported by an expert by experience. TerraBlu Home Care is a domiciliary care agency that supports and cares for people who want to remain in the comfort of their own home. They provide support for older people and people living with disabilities in Tunbridge Wells, Tonbridge and the surrounding areas.

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.

Staff were trained in how to protect people from abuse and harm. They knew how to recognise signs of abuse and how to report any concerns.

Risk assessments were centred on the needs of the individual. They included clear measures to reduce identified risks and guidance for staff to follow to make sure people were protected from harm. Accidents and incidents were recorded and monitored to identify how risks of recurrence could be reduced.

There were enough qualified, skilled and experienced staff to meet people's needs. Staffing levels were calculated according to people’s changing needs. The provider followed safe recruitment practices.

Each person’s needs and personal preferences had been assessed before support was provided and were regularly reviewed. This ensured that the staff could provide care in a way that met people’s particular needs and wishes.

Staff knew each person well and understood how to meet their support needs. People told us, “My care worker understands me well, she knows how I like things to be done and she does it well.”

Staff had completed the training they needed to care for people in a safe way. They had the opportunity to receive further training specific to the needs of the people they supported. All members of care staff received regular one to one supervision sessions and were scheduled for an annual appraisal to ensure they were supporting people based on their needs.

All care staff and management were knowledgeable in the principles of the Mental Capacity Act 2005 (MCA) and the requirements of the legislation.

Staff sought and obtained people’s consent before they provided support. People told us that staff communicated effectively with them, responded to their needs promptly and treated them with kindness and respect. People were satisfied with how their support was delivered.

Clear information about the service, the management, the facilities, and how to complain was provided to people. Information was available in a format that met people’s needs.

People’s privacy was respected and people were supported in a way that respected their dignity and independence.

People were referred to health care professionals when needed and in a timely way. Personal records included people’s individual care plans, likes and dislikes and preferred activities. The staff promoted people’s independence and encouraged them to do as much as possible for themselves.

People’s individual assessments and care plans were reviewed regularly with their participation. People’s care plans were updated when their needs changed to make sure they received the support they needed.

The provider took account of people’s comments and suggestions. People’s views were sought and acted upon. The provider sought and obtained their feedback on the quality of the service. The results were analysed and action was taken in response to people’s views.

Staff told us they felt valued under the manager’s leadership. The manager notified the Care Quality Commission of any significant events that affected people or the service. Quality assurance audits were carried out to identify how the service could improve and remedial action was taken when necessary.

We visited the office and spoke with the registered manager, the managing director and two members of staff. We later spoke by telephone with the 13 people who used the service and another five staff.

People felt they were able to make their own decisions and choices regarding their day to day care and support. People confirmed that they had given their consent and been involved in discussions about their care, sometimes with a family member, when the service had first started.

People said they were satisfied with the care and support they received. One person said, “As an agency I would give them top marks”. Another person said, “I am quite satisfied at the moment”. People knew about their care plans or said they had discussed their care and support with staff.

People felt they received safe and coordinated care and support where more than one provider was involved.

People were complimentary about the staff and felt the service recruited the right calibre staff to meet their needs. One person said, “They vet them”. Another person said, “They are very fussy who they have, they want to make sure they get the right people”.

The majority of people said they had been asked for their views and feedback on the service provided. People told us they felt confident that any concerns would be addressed. There were systems in place to monitor the quality of the service.

One inspector visited the service and spent time in the office and spoke with the registered manager, registered provider and the care coordinator. We spoke with four people who used the service and four members of care staff during telephone conversations following our visit.

People purchased the service privately and were protected by a contract that clearly stated all the terms and conditions.

There were appropriate processes in place that monitored the quality of the service provided.

People we spoke with were overall happy with the service provided. People felt that care staff treated them with dignity and respect and listened to what they had to say.

The majority of people felt that they were visited by regular members of care staff at times that suited them. One person however felt that there were some ongoing problems with times and continuity of care staff that the agency had not yet managed to fully resolve, although they did tell us that the agency was, “Trying to sort this out for them”.

People were visited by care staff who were appropriately trained and supervised in order that their individual care needs could be met.

Each person had an individualised plan of care that gave care staff the information they needed.

Senior staff and care staff were aware of the importance of safeguarding people from the risk of abuse. The policy however did not link with local authority protocols.