Comfort Care (Truro) Ltd

People’s experience of using this service:

• People, and their relatives, were highly complimentary about the way in which care was delivered. They told us staff were caring and friendly in their approach. Comments included; “They are all very cheerful, they put my mind at rest. They are just a nice crowd”, “It just takes the pressure off me a bit, somebody coming in that he can chat to. I let them get on with it” and “I think I’m comforted by the fact she is visited by very caring people who will keep me updated.”

• People received care visits from small groups of care workers who they had formed trusting relationships with. Although people were not given information in advance about who would be visiting most said they were not concerned about this. However, some relatives thought the provision of rotas would improve the service.

• Staff also mentioned rotas as an area for improvement. While they considered the organisation to be well managed they said rotas were not provided far enough in advance.

• Everyone told us they liked and respected the registered manager. People and staff told us the registered manager was open, caring, trustworthy and approachable. When things went wrong they responded quickly and took action to make sure lessons were learned.

• Care plans were informative, accurate and regularly reviewed to help ensure they reflected people’s needs. Monitoring systems to highlight when people’s health was at risk of deteriorating were not always implemented. We have made a recommendation about this in the report.

Rating at last inspection: At our last comprehensive inspection in September 2016 we rated the service as Good overall and Requires Improvement in Safe. We carried out a focused inspection in February 2017 when we found improvements had been made and the rating for Safe was improved to Good. (Reports published 7 October 2016 & 22 March 2017)

Why we inspected: This was a scheduled inspection and was planned based on the previous rating.

Follow up: We will continue to monitor the service and plan to inspect it in line with our re-inspection schedule. If we receive any information of concern we may bring our inspection forward.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The service was last inspected in September 2016 when a breach of legal requirements was found. This was because arrangements for assessing the risks to the health and safety of people who were supported to manage their medicines were not robust.

Following the last inspection the service sent us an action plan detailing how they would address the breach of regulations. We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Comfort Care (Truro) Ltd on our website at www.cqc.org.uk.

The service is required to have a registered manager and at the time of our inspection a registered manager was 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 and associated Regulations about how the service is run.

The service had overhauled their system for assessing people’s needs and had ensured that robust risk assessments were completed and followed by staff. For example, identified risks regarding a person’s capacity to safely self-administer their medicines had been reassessed with professional input from a GP, pharmacist and social worker and a safer system for supporting the person to safely take their medicines was put in place.

People told us they were happy with the care they received and believed the agency were, “Excellent” and comments included, “I really could not fault the service at all. They are very caring and I consider myself safe under their care” and “I have been lucky to have been with this agency for quite a long time now. I trust them implicitly.”

There were sufficient numbers of suitably qualified staff employed to meet people's needs in a timely manner.

Staff completed a thorough recruitment process to ensure they had the appropriate skills and knowledge for their role. Staff had received safeguarding training and knew how to recognise and report the signs of abuse. They were confident any concerns would be dealt with. Incidents and accidents were recorded and investigated appropriately.

Comfort Care (Truro) Ltd is a domiciliary care agency that provides care and support to adults, of all ages, in their own homes. The service provides help to people with physical disabilities and dementia care needs in Truro and surrounding areas. The service mainly provides personal care for people in short visits at key times of the day to help people get up in the morning, go to bed at night and support with meals.

At the time of our inspection 20 people were receiving a personal care service. The services were funded either privately or through Cornwall Council or NHS funding.

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.

People who used the service, families and health and social care professionals told us they felt the service was safe. Comments included, “They are good. We have nothing but praise for them” and “Nothing is too much trouble”. However, we found that needs assessments completed by the service had not consistently identified or risk assessed particular risks to people’s welfare. In particular this was identified regarding a person’s medication administration. The service had not provided written guidance for staff about how to manage risk in relation to supporting a person with complex care needs. This meant there was a lack of knowledge about how best staff could mitigate the risk to the person.

People told us staff always treated them respectfully and asked them how they wanted their care and support to be provided. People and their relatives spoke well of staff, commenting, “The staff are lovely. I’m more than happy with them” and, “Nothing is too much trouble for them.”

People told us they normally had a team of regular, reliable staff, and they knew the approximate times of their visits and were kept informed of any changes. Wherever possible the service had worked to find suitable and agreed times for people. No one reported ever having had any missed visits. People told us, “We usually know which staff will be coming to us. If there are any changes the office rings to let us know,” and “I have regular carers.”

Staff were knowledgeable about the people they cared for and knew how to recognise if people’s needs changed. Staff were aware of people’s preferences and interests, as well as their health and support needs, which enabled them to provide a personalised service.

Care plans provided staff with direction and guidance about how to meet people’s individual needs and wishes. Regular reviews of care plans took place. Changes in people’s needs were communicated to staff in daily records and directly to staff by the registered manager.

Staff were recruited safely, which meant checks had been made to ensure they were suitable to work with vulnerable people. New staff received an induction, which incorporated the care certificate. Staff received appropriate training and supervision. There were sufficient numbers of suitably qualified staff available to meet the needs of people who used the service.

Staff had received training in how to recognise and report abuse. All were clear about how to report any concerns and were confident that any allegations made would be fully investigated to help ensure people were protected.

Management had an understanding of the Mental Capacity Act 2005 and how to make sure people who did not have the mental capacity to make particular decisions for themselves, had their legal rights protected. However, we found one instance where the service had not ensured the correct procedures for assessing a person’s capacity had been followed. Following the inspection the service took immediate action to remedy this.

There was a positive culture within the staff team and staff spoke positively about their work. Staff were complimentary about the management team and how they were supported to carry out their work. The registered manager and nominated individual were also passionate about their roles and were clearly committed to providing a good service for people. Staff told us, “It’s quite a small company and everyone looks out for each other”; “I love my job” and “There is a genuine desire to do the best for the people we support.”

There were effective quality assurance systems in place to help ensure any areas for improvement were identified and action taken to continuously improve the quality of the service provided. People told us they were regularly asked for their views about the quality of the service they received.

There was a complaints procedure in place and the provider had responded appropriately to complaints.

We identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see the action we told the provider to take at the back of the full version of the report.

People's privacy, dignity and independence were respected and care 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.

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