Torcare Domiciliary Service provides personal care to people living in their own homes. It currently provides a service to older adults who need support with their personal care. The service supports people within the localities of Torpoint and surrounding villages. The service is owned by Torcare Limited, who also have three care homes nearby.

The inspection was announced and started on 10 December 2018 and ended on 19 December 2018. The provider was given 48 hours' notice because the location provides a domiciliary care service and we needed to be sure that someone would be available in the office. It also allowed us to arrange to visit people receiving a service in their own homes.

Not everyone using Torcare Domiciliary Service received 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 there were 13 people receiving personal care.

There was a new manager in post who had submitted their application to become registered with the Commission. 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 in December 2017 the service was rated requires improvement, because people’s medicines were not always managed safely and the provider did not have effective systems in place to monitor the quality and safety of the service. The provider submitted an action plan to the Commission detailing how they would make changes. At this inspection we checked to see if action had been taken, and found that improvements had been made. Therefore, the service has been rated Good overall.

People’s medicines were now managed safely and they had detailed care plans in place.

People told us they felt safe when staff were in their homes. People were protected from abuse because staff knew what to action to take if they were concerned about a person’s safety.

Overall, people were supported by staff who had been recruited safely to help ensure they were suitable to work with vulnerable adults. People told us there were enough staff to meet their needs, but the new manager was aware that some people had experienced some late and missed visits. They had therefore made this area a priority to make the necessary improvements.

In the event of adverse weather or significant staff sickness, the provider had an emergency staffing contingency plan which helped ensure people still received support, in such circumstances.

People’s risks associated with their health and social care were documented and known by staff, and environmental risks were assessed to help keep staff safe when working in people’s own homes.

People were protected by infection control practices.

People and their relatives told us their needs were met by staff who had received suitable training. When new staff joined the organisation, staff received an induction to help ensure they got to know each person, and were introduced to relevant policy and procedures. The providers induction followed the principles of the Care Certificate. The Care Certificate is a national induction training programme introduced to support all staff new to care to obtain a basic level of understanding of good care standards. Staff received supervision of their practice to help monitor and ensure ongoing high standards.

The provider had considered the Accessible Information Standard (AIS) in the delivery of the service. The AIS aims to make sure that people who have a disability, impairment or sensory loss get information that they can access and understand. For example, people’s individ

Torcare Domiciliary Service is a domiciliary care service that provides care and support to adults in their own homes. Torcare also owns three care homes in East Cornwall, providing residential and nursing care to older people.

The service provides help with people’s personal care needs in Torpoint and surrounding areas. The service supports some people who may require support with personal care needs at specific times of the day and/or night. At the time of the inspection 24 people were receiving support with their personal care needs.

There was a manager in place who also had responsibility for a residential home owned by the same company. They had been in post for three weeks and were in the process of registering with the Commission. 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.

Medicines were not always managed safely. The level of support people required to take their medicines safely was not always recorded in their care plan. Staff had not all received the correct training to provide the level of support some people required to take their medicines. This meant they might not be following best practice when providing this support. Medicines administration records (MARs) were not always completed fully which meant it was not always clear whether people had had their medicines or not.

People did not always have risk assessments in place to guide staff how to reduce risks to them or how to identify that their specific health risks may be affecting them.

The provider had not ensured records relating to people’s care were monitored effectively to help ensure they covered all of people’s up to date needs.

People and their relatives spoke highly of the staff and the support provided; and told us staff had the knowledge and skills to meet their needs. Comments included, “The staff are very good, exceptional.” People were supported by staff who treated them with care and compassion. Comments included, “The staff are lovely. I wouldn’t be without them.”

There were sufficient numbers of suitably qualified staff to meet the needs of people who used the service. People reported receiving care from a consistent staff team who had got to them know well and helped them maintain their independence.

People had care plans in place which gave staff guidance about the support they needed and their preferred routines. People told us they were able to make choices about how their care was delivered and knew how to raise a concern or a complaint.

People told us they felt safe using the service. Staff were recruited safely and had received training in how to recognise and report abuse. They confirmed they were confident any allegations would be taken seriously and investigated to help ensure people were protected.

Staff knowledge and skills were regularly updated to help ensure they remained aware of best practice. The manager and staff had received training about the Mental Capacity Act 2005 and knew what action to take if they suspected someone was losing their capacity to make their own decisions.

There was a positive culture within the service. The provider had clear visions, values and enthusiasm about how they wished the service to be provided and these values were shared by the whole staff team. People were consulted regularly for their views of the service and given opportunity to suggest improvements. Information was used to aid learning and drive improvement across the service. People and their relatives told us the management team were approachable.

We found breaches of the regulations. You can see what action we told the provider to take at the back of the full version of the report.

The inspection took place on 28 August 2015 and 28 September 2015 and was announced.

Torcare Domiciliary Service provides domiciliary care services to adults within East Cornwall. On the days of the inspection Torcare Domiciliary Service was providing support to 30 people including those with physical disabilities, sensory impairments, mental health needs and people living with dementia. Torcare Domiciliary Service is owned and operated by Torcare Limited. Torcare Limited also owns three care homes in East Cornwall, providing residential and nursing care to older people.

The service had 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 were supported by a small staff team which helped to provide continuity of people’s care and assisted in the development of positive relationships. Staff had been recruited safely, which meant they were suitable to work with vulnerable people. The registered manager and staff had a good understanding about safeguarding procedures and were able to tell us what action they should take if they felt some one was being abused, mistreated or neglected. When staff had reported concerns they had been supported by the registered manager.

People told us care staff were kind and caring. People also told us staff were respectful of their privacy and dignity. People felt safe when staff entered their home. Staff arrived on time and when they were going to be late, people were informed of this. Staff felt there were enough staff to meet people’s needs and had adequate travelling time. Staff were protected from risks associated with lone working. People were protected from the spread of infection because staff followed infection control procedures.

People were supported by staff trained to meet their needs. All staff were trained to meet people’s needs and had regular supervision to focus on their development. New staff received a detailed induction as well as training and supervision. Staff told us they were well supported and there were adequate opportunities to obtain further training and qualifications. The registered manager carried out pre-assessments to help ensure staff had the right skills and experience to meet people’s needs prior to people using the service.

People had care plans and risk assessments in place. This provided guidance and direction to staff about how to safely meet a person’s needs. For example how people wanted to be supported with their personal care or with mobility. Staff were aware of the importance of obtaining people’s consent prior to carrying out care and support. People’s consent and mental capacity was demonstrated in care plans to help make sure people who did not have the mental capacity to make decision for themselves, had their legal rights protected.

People who required support with their medicine received them safely. People had care plans in place and staff received training. People were encouraged to eat and drink. When staff were concerned about whether a person was not eating and drinking enough, they reported any concerns to the registered manager. Staff were observant of the deterioration in someone’s health and wellbeing and took the necessary action, for example contacting the person’s GP or a district nurse. The registered manager and staff were pro-active in making sure people received the support they required from external health professionals. This was achieved with the person’s consent. The registered manager worked positively with external health and social care professionals as required.

People’s feedback was obtained, valued and used to facilitate change and make improvements to the running of the service. People did not have any complaints, but if they did, they told us they felt able to complain and that their complaints would be investigated and resolved.

There was clear governance and leadership in place. The registered manager felt supported by the provider. There were effective systems in place to help monitor the ongoing quality of the service. The registered manager had notified the Commission in line with legal requirements.