This inspection was carried out between 21 November 2017 and 27 November 2017.

Town and Country homecare 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 and younger disabled adults. Not everyone using Town and Country homecare receives 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.

There was a manager in post who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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.

Following the last inspection, on 21 September 2016, we asked the provider to complete an action plan to show what they would do and by when to improve all the key questions to at least good. At our previous inspection we found breaches of regulation relating to the management of risks, the management of medicines and personalised care. We carried out this inspection to check on the improvements the registered provider told us they had made.

The registered provider had not consistently followed the principles of the Mental Capacity Act 2015 (MCA). Some MCA assessments had been completed that were not in relation to a specific decision that the person needed to make. The registered provider made the necessary improvements and provided us with evidence of this immediately following the inspection. We made a recommendation that the registered manager continues to review the implementation of the Mental Capacity Act 2015 principles in the service to ensure they are followed consistently.

The service was not yet using the Care Certificate for staff that were new into care roles. We made a recommendation that the registered provider seek further advice on using the Care certificate or a similar qualification to ensure staff receive an appropriate induction.

People were safeguarded from harm and abuse. The registered provider worked proactively with the local safeguarding team to respond to allegations of abuse. They ensured that lessons were learned when things went wrong. Staff knew what action they needed to take to reduce risks and to provide safe care and support. Improvements had been made to risk assessments to ensure staff were provided with detailed guidance about the action they were required to take to keep people safe. The premises were well maintained and equipment had been checked regularly to ensure it was suitable and safe. The registered provider ensured that the risk of infection in the service was assessed and managed.

There were sufficient numbers of skilled and competent staff working in the service to meet people’s needs. The registered provider ensured that staff were safe and suitable to work with people. Staff received appropriate training and support and were enabled to develop their knowledge and skills through qualifications. Staff had positive relationships with the people they cared for. They understood the individual ways that each person communicated and provided appropriate support to enable their views to be heard.

People received safe support to manage their medicines. People were supported to stay healthy and staff enabled them to access healthcare professionals as needed. People had a balanced diet and enough to eat and drink. The registered provider ensured that care was planned in line with best practice guidance. They worked effectively with partner agencies to deliver safe and effective care.

People and their relatives told us that the staff provided a responsive and reliable service. Improvements had been made to ensure that

The inspection took place on 21, 22 and 23 September 2016, and was an announced inspection. The registered manager was given 48 hours’ notice of the inspection.

Town & Country Homecare Limited provides care and support to people in their own homes. The service is provided to mainly older people and some younger adults. At the time of the inspection there were approximately 107 people receiving support with their personal care. The service undertakes visits to provide care and support to people in Tenterden, Cranbrook, Rye and surrounding villages. It also provides staff to cover wake night and sleep in duties within people’s homes and a sitting service.

The service is run by a registered manager who was registered with the Commission in September 2015. 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 told us they received their medicines when they should and felt their medicines were handled safely. However there were shortfalls in some medicine records and a lack of guidance about some areas of medicine management.

Risks associated with people’s care had been identified, but there was not always sufficient guidance in place for staff, to ensure people remained safe.

People were involved in the initial assessment and the planning of their care and support and some had chosen to involve their relatives as well. However care plans varied in the level of detail and some required further information to ensure people received care and support consistently and according to their wishes. People told us their independence was encouraged wherever possible, but this was not always supported by the care plan.

There were audits and systems in place to monitor that the service ran efficiently. These had been effective in identifying most of the shortfalls highlighted during the inspection, but not all.

People felt safe using the service and when staff were in their homes. The service had safeguarding procedures in place. Staff demonstrated an understanding of what constituted abuse and how to report any concerns in order to keep people safe.

People had their needs met by sufficient numbers of staff. The majority of people’s visits were allocated permanently to staff schedules and these were only changed when staff were on leave. People received a service from a team of regular staff. New staff underwent an induction programme, which included relevant training and shadowing experienced staff, until they were competent to work on their own. Staff received training appropriate to their role and more than half of the staff team had gained qualifications in health and social care.

People told us their consent was gained at each visit. People were supported to make their own decisions and choices. No one was subject to an order of the Court of Protection although people had made Lasting Power of Attorney arrangements and some people had a Do Not Attempt Resuscitation (DNAR) in place. Some people chose to be supported by family members when making decisions. The Mental Capacity Act provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. When people are assessed as not having the capacity to make a decision, a best interest decision is made involving people who know the person well and other professionals, where relevant. The registered manager understood this process and had recently made improvements to ensure all legal arrangements and best interest decision making would be recorded.

People were supported to maintain good health and they told us how observant staff were in spotting any concerns with their health and taking appropriate action.

People felt staff were very caring. People said t

On 11 December 2013 we inspected Town & Country Homecare Limited and found non-compliance in the area relating to care and welfare of people who used services. This was a follow up inspection to check compliance against that area.

During this inspection we spoke with eight people who used the service, two relatives and two members of the management team.

People told us they continued to be satisfied with the care and support they received. People’s comments included, “They are marvellous, I’m very happy with it” and “It’s very good”. We found that care plans were being updated to include information about people’s wishes and preferences and the steps staff should take to ensure people remained safe.

We visited the office and spoke with the registered manager, two members of the management team and two staff. We later spoke by telephone with the 23 people who used the service, six relatives 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.

Most people said they were satisfied with the care and support they received. One person said, “I think Town and Country are excellent”. Another person said, “They are efficient, very good and we laugh a lot together”. One person we spoke with was not happy with the service they received and this was fed back to the manager. We found that care plans contained information about the tasks staff needed to undertake, but lacked detail about people’s wishes, preferences and abilities to ensure care and support was delivered to promote their independence. People knew about their care plan or confirmed that staff had talked about the care and support they required. Care was delivered generally by a regular team of care workers to ensure people had continuity.

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, “The girls we have are pleasant, helpful and understanding”. Another person said, “They are varied, but good”.

People said they had been asked for their views and feedback on the service provided. One person said, “They visit every six months and go through it all, the care plan and whether the staff wear their gloves etc.” People told us they felt confident that any concerns would be addressed. There were systems in place to monitor the quality of the service.

Care records showed that people or their representatives had been involved in planning their care and support. When people’s needs changed, we found that records had been updated to reflect this.

People and carers told us that they felt treated with respect and had been included in their care planning. One told us that "they do put their customers as the priority".

We saw that the provider had suitable safeguarding procedures in place and that these had been used when needed. We saw that staff had been trained in safeguarding and this was confirmed to us by staff we spoke to.

We saw that staff had received training appropriate to their roles, including specialist training such as dementia, and that this was updated as necessary.

We saw the provider had quality assurance systems in place to assess and monitor the quality of service people received.