We inspected Betamindes on 5, 6 and 7 October 2016. As this was a domiciliary care agency service, we contacted the registered manager 48 hours’ before the inspection. This was so that we could ensure that staff were available at the office. At the last inspection in October 2013 we found the service met all the regulations we looked at.

Betamindes is a domiciliary care agency which is registered to provide personal care to adults who live in their own homes. The registered manager is also the owner and director of the company, along with another owner/director. At the time of the inspection, there were 50 adults in receipt of personal care.

There was a registered manager in place. 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.

We found that people were very positive and complimentary about the service they received. People using the service told us they felt safe and the relatives we spoke with also agreed people were safe. We found that people were protected from the risk of harm and abuse. All staff spoken with had a good understanding of safeguarding, the signs of abuse, and how to report it. Although two staff were unsure where they could report concerns to outside of their organisation. We found that the service had a safeguarding policy in place we saw that the registered manager had reported safeguarding concerns appropriately as per local procedures.

There were sufficient staff to meet the needs of people receiving a service. The service was recruiting new staff. People told us that staff always arrived on time and calls were not missed

People’s medicines were administered safely. However we found that staff’s competency to administer medication was not always recorded robustly. The service had implemented a new staff coordinator role and her focus was on the development of training and induction. Staff told us that they had undergone an induction and shadowed experience staff when they started work at the service. Staff also undertook refresher training in subjects that the service identified as mandatory as well as in others topics such as health conditions.

We found that staff had some awareness of the Mental Capacity Act 2005 (MCA). Staff sought consent from people prior to undertaking any care. The service took people’s mental capacity in account when making decisions about their care and treatment. However we found that the records which demonstrated that mental capacity assessments and best interest decisions had been carried out were not always robust enough.

Staff were kind, caring and compassionate. People told us that staff treated them with dignity and respect. We found that staff had developed effective caring relationships with people.

Care plans were in place. They provided sufficient details and were regularly reviewed and updated. The care plans and risk assessments provided sufficient information to enable staff to meet their care needs. Some were detailed and included people’s preferences and choices, whilst others would benefit form more person canted information. We found that people were supported to maintain as much independence as possible. People told us that the service was very flexible and accommodated any changes to people’s needs.

People had access to the complaints procedure and told us that they knew how to make a complaint should they need to. We found that the management team had regular contact with people and dealt with any issues and concerns as they arose.

People using the service and staff told us that the service was well led. People found that the registered manager and management team were very approachable and responsive. The registered manager had already identified areas for

When we visited Betamindes Limited we spent time in the office base looking at records and other documentation. We talked to the manager, interviewed staff and met people who used the service and a relative. One person who used the service allowed us to visit them in their own home. We asked the manager to provide us with a list of the current people who used the service at Betamindes Limited and we chose four people from this list so that we could contact them or their relatives to ask about the service provided by Betamindes Limited.

When we asked people about the care they received from Betamindes Limited they told us “The staff are extremely good. They do what I want and they know what I want. They never miss anything and if I need any extra it can be arranged. I would be very upset if for any reason I lost the service”.

We looked at the arrangements for the management of medicines and found that these were appropriate for the level and type of care being provided by Betamindes Limited. Because the people who used the service lived in their own homes, we checked that Betamindes cooperated with other agencies which might be visiting the same people and found that this was the case.

We checked that there were sufficient numbers of staff employed at the Betamindes Limited so as to ensure adequate levels of care. We found that the provider was able to cover staff absences from the existing staff team and so usually managed to preserve continuity of care for people from the same staff member.

We looked at the records kept by the provider and found that that care records were updated. However Betamindes was not able to provide us with other records which we required them to produce.

We spoke to four people who use the service. They told us that the home carers from Betamindes were “Very good – they will do anything you ask them to”. People told us that staff from Betamindes generally made their visits promptly and that the visits lasted for the length of time agreed with them. One person told us that carers sometimes spent longer at their home than was scheduled and that this added a "social" perspective to the service.

We also talked to two relatives of people who use the service. They told us that the service provided by Betamindes was reliable and that they would “never let you down”. People complimented the staff on their maturity and ability to communicate “They don’t talk down to my father – they talk to him”. The positive relationship between Betamindes home carers and people who used the service was described to us on several occasions “They all communicate”.

All the people we spoke to found Betamindes to be approachable “You can walk in to the Office and talk to them at any time”. People who use the service, their relatives and the staff all had positive relationships with the Agency and expressed confidence in its management “Dawne (Manager/Director) is always very willing to talk or to chat things through”. “If something needs changing I have a quick word with Dawne.” “Dawne, Ian (Director) and Elaine always answer the phone very quickly and activate what you want.”

We spoke to a carer for a person who uses the service. They told us that the provider carried out a full assessment and that they decided together what the package of care would be.

We spoke to someone else who said that their relative had responded well to the care and this was because of the good relationship they had with the care workers.

We were told that the service has “jolly good carers”. The same person told us that the provider had “a good reputation”, that the care workers were “fantastic” and that “the service couldn’t be faulted”. We were also told that the care workers usually turned up on time and that when there were unavoidable delays the client was contacted. Another person told us they had not received a late visit all year.

We were told by another person that they were “delighted with them” and that the staff were pleasant and more personal than another provider that they named. This person also told us that the provider was responsive to changes in their needs. We were told by someone else that they had been available to provide care at short notice.

We asked three people whether they would be confident to raise issues of safety with the provider. They all said they would and two of the people said they knew they would get a good response.

We spoke to a carer for a person who uses the service. They told us that the provider had visited to discuss the service that was provided and to check that everything was alright.