This review of compliance took place over two days. On 28 November 2011 we visited the offices of Trenovissick Domiciliary Care Agency to look at records and we talked to the manager and other members of the management team. On 1 December 2011 we visited four people who receive a care service in their homes. In addition we spoke to six people on the telephone and three relatives. We also talked to two care workers. People praised the care workers for their caring manner. Comments included, 'I am very lucky indeed. I am well looked after', 'The care workers are always very pleasant ' I like all of them', and 'Exceptional!'
All of the people we spoke to told us that their regular care workers always treated them with respect and kindness. One person said they had the same team of care workers for several years. The care workers knew her well, never missed a visit and always arrived on time. 'We have a bit of fun ' they always do an excellent job!'
The agency sent out a weekly timetable to every person to let them know the names of the carers who would be visiting the following week, and the date and time of each visit planned. People told us they appreciated the timetables as it meant they knew who would be visiting them.
Most people said they had never had any problems but said they would ring the agency office if they needed to. However one person told us they had complained to the agency four times because of care workers arriving late. She praised the care workers but said they were always rushed because the agency did not allocate any travel time between visits. She said that a number of care workers had said they had given in their notice in recent months because of the pressure they were under to get to each person on time and complete all of the tasks in the time allocated.
The relative of another person who received a service from the agency told us 'The carers are variable, with some excellent. They appear rushed'. The person said that time was not allowed between jobs for travel, and they complained that additional visits were frequently inserted into the care workers schedules without actual slots existing. The relative said their mother had recently seen a decline in the morale and initiative of the care workers.
We talked to the manager and a senior manager about the way the agency allocated travel time between visits. The managers told us they were considering allocating some travel time between visits in future.
We looked at four care plan documents held in the agency office and we also looked at the care plans of the four people we visited in their homes. We found that many of the care plans provided a short list of the tasks each person needed assistance with but did not give a full explanation of how the person wanted the tasks to be carried out. Two care plans we looked at had recently been reviewed and provided very good detail about each task, and were clear and easy to follow. The manager told us they were planning to draw up all care plans in future with a similar level of detail.
We looked at the way the agency helped people to take their medication. We found that the agency had incorrectly assessed some people as requiring prompting only, even though people relied on the care workers to administer their medicines. Records of medicines administered were poor, and some of the records had many unexplained gaps. Care workers had received training on the safe administration of medicines, but, despite the training, they had failed to alert the agency office when they visited people and found incomplete records of administration. This means there was a risk that people may experience medication errors or omissions.
The manager had received training by the local authority on safeguarding adults, and all new staff had received training on this topic during their induction period. The manager had a good awareness of local safeguarding reporting procedures.
The manager told us that the agency had policies and procedures and good recording systems in place to protect people from financial abuse. However, two people we visited had received assistance from care workers with shopping tasks but no financial recording sheets had been completed by the care workers each time they handled cash. This means that the care workers could not provide evidence that the transactions had been completed correctly and people had received their shopping and change correctly.
We looked at the way the agency recruited and trained new staff. We found they had taken up all required checks before new staff began working. We were given details of training the staff had received and we found the agency had provided training on a wide range of topics relevant to the needs of the people who received a care service.
The agency had a range of procedures in place to check the quality of the services provided. These included questionnaires sent to people to find out what they thought about the services provided by the agency.