This inspection was completed on 27, 28 and 29 November 2017 and was announced.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.

The provider was given 48 hours’ notice because the service provides a domiciliary care service; we needed to ensure we would be able to meet with people where they were receiving the service. At the time of the inspection, the service was supporting 159 people in their own homes.

Not everyone using DoCare receives a regulated activity; CQC only inspects the service being received by people provided with the regulated activity of ‘personal care’; help with tasks related to personal hygiene. Where they do we also take into account any wider social care provided.

There was a registered manager in post at the service; 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The previous inspection was completed in March 2016 and there was one breach of regulation at that time. Following the last inspection we asked the provider to complete an action plan to show what they would do to improve the key question Safe and to meet the requirements of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we found the provider had made the required improvements to meet the requirements of this regulation. A new office based on call system had been introduced from 06.00am until 23.00pm and at weekends to monitor and manage visits. There had been three missed calls in approximately 5500 visits in this timeframe. A contingency plan was in place and people were assessed by risk in an emergency situation.

The service was safe. A new management team had been introduced to manage care calls. This was being staffed from 06.00am until 23.00pm. Risk assessments were implemented and reflected the current level of risk to people. There were sufficient staffing levels to ensure safe care and treatment. People’s medicines were being managed safely. People told us they felt safe.

People were receiving effective care and support. Staff received training which was relevant to their role. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and procedures in the service supported this practice. The service was adhering to the principles of the Mental Capacity Act 2005 (MCA).Staff supervisions and appraisals were being completed. People were supported to access health professionals. People could choose what they liked to eat and drink.

Staff told us there was an open culture and the environment was an enjoyable place to work. Staff were extremely passionate about their job roles and felt integral to the process of providing effective care to people. There was positive feedback from relatives regarding the management.

The service was caring. We observed staff supporting people in a caring and patient way. Staff knew the people they supported well and were able to describe what they liked to do and how they liked to be supported. People were supported sensitively with an emphasis on promoting their rights to privacy, dignity, choice and independence.

The service was responsive to people’s needs. Care plans were person centred to provide consistent, high quality care and support. Daily records and visit notes were detailed and contained sufficient information for staff to read and support people effectively.

The service was well led. Quality assurance checks and audits were occurring regularly and identified actions to improve the service. People, staff and relatives spoke positively about the registered manager.

This inspection took place on 8, 9 and 10 March 2016. We last carried out a comprehensive inspection of this service on 10 January 2013 and found no breaches of legal requirements at that time. However, we also visited the service on 15 July 2013 to follow up on concerns shared with us. At that inspection we found the provider had not ensured there were sufficient staff to provide the service. We then inspected on 11 September 2014 in response to further concerns shared with us regarding keeping people safe. At that inspection we found the provider had taken action to address these concerns.

DoCare Limited provides personal care to adults in their own homes. At the time of our inspection around 130 people were using the service in Gloucestershire and South Gloucestershire.

There was a registered manager at the service. 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 did not always receive a service that was safe. This was because some care calls had been missed and staff were sometimes late for calls. The management of medicines requires improvement as administration sheets were not always completed. Staff understood their role and responsibilities to keep them safe from harm. Risks were assessed and individual plans put in place to protect people from harm. The provider carried out pre-employment checks on care staff before they worked with people to assess their suitability to provide care to vulnerable people.

The service provided was effective. People were cared for by staff who had received the training to meet their needs. Care staff were well supported by managers and senior staff. People were supported to maintain their independence. Staff understood their roles and responsibilities in supporting people to make their own choices and decisions.

People received a service that was caring. Staff treated people with dignity and respect. Equality and diversity was seen as important by staff. People were involved in planning their care and support. People were not given notice of which staff would be providing care and support.

The service was responsive to people’s needs. Care planning was person centred and people received individualised support. The provider encouraged people to provide feedback on the service received. Concerns and complaints were investigated and responded to appropriately. The provider had worked hard to ensure an effective transition to new care providers.

The service was well-led. The provider had identified and taken some action regarding late or missed care calls. The registered manager and senior staff were well-liked and respected. Staff understood their roles and responsibilities. The quality of service people received was continually monitored and any areas needing improvement identified and addressed.

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

The inspection of the DoCare service was completed as a result of information given to the CQC by a whistleblower. Allegations from a whistle blower were that the service was short staffed in the Stroud and Gloucester team and that people who had been assessed as needing assistance from two carers were sent one carer due to the service being short staffed.

During our inspection we checked the records of three people who needed two carers. We also spoke with them about their experience of the service and asked if staffing levels were good. It was clear that these allegations were accurate.

We spoke with staff who worked in the Stroud and Gloucester team and they confirmed that staffing levels were lower in their team. They told us "Staffing is ok but when people take annual leave or sickness it is hard to cover their runs” and “On occasions when the team is short staffed I have covered double up calls on my own which I do not like doing” and “I love my job but it gets me down as we work under pressure” and “I have carried out double up calls on my own due to staffing issues but people seem happy with this”.

We spoke with four staff and they told us that they had received training in safeguarding vulnerable adults. They told us that safeguarding topics were also discussed during staff meetings and during individual supervision.

People's personal records including medical records were accurate and fit for purpose. People were provided with detailed care plan files that contained information about their health and well being and how to raise concerns if they thought they were being abused.

People told us the area managers and team leaders completed a comprehensive assessment of their needs to find out what support they needed prior to receiving care from the agency. Comments included "The area manager visited me with the staff to discuss what I needed help with".

We spoke with three people during our visit they told us "The carers have great personalites are joyful and caring” another person told us “The staff work very hard sometimes they may be late”.

The complaints policy had a stage three process where if people were still unhappy with the response from the provider it would be referred to the area manager or director if complaints were to be escalated. We found the policy did not contain the correct information and contact details it stated if complainants were unhappy with the director’s response they had the right to refer complaints to the Care Quality Commission.

People we spoke with made a number of comments about the quality of the care they receive. They included; "without their care I couldn't manage on my own", "they are very flexible never had any problem changing anything", "very satisfied with the care no complaints whatsoever", "care workers always very polite,very friendly".

Some the comments received by the agency:

"DoCare have been wonderful with the care package and go the extra mile".

"Very caring. Always asking if there is anything else I need".

"Professional care service", "I appreciate their punctuality".

"Your professionalism,care,good humour and general caring attitude made life so much easier".

What is good about the service people said; "Reliability,their helpfulness,their friendliness", "Punctuality of the care workers", "Patient,understanding and very caring", "Professional,caring and friendly".

Care workers we spoke with made a number of positive comment about the agency. They felt the agency cares for staff and are very supportive. There are good opportunities for training; "only have to ask". Team meetings are held on a regular basis with staff feeling that managers are very accessible.

We undertook this responsive inspection because the provider had notified us about safeguarding concerns of people who used the service which involved staff employed by DoCare.

The purpose of the inspection was to check what actions the agency had taken in respect of the concerns and to ensure people were safe and the appropriate checks were undertaken of staff.

Our inspection of July 2014 found that not all aspects of the service were safe in respect of staffing. We took the opportunity during this inspection to check if the agency had achieved compliance with the regulation.

This inspection was carried out by one inspector. During the inspection we spoke with the general manager, one area manager, seven care staff and we spoke with ten people that used the service.

We used the information we collected during this inspection, to answer one of the five questions which now form the basis of our inspections. Is the service safe?

Is the service safe?

During this inspection, we found that improvements had been made in relation to staffing. We were told since the last inspection the registered manager had introduced a weekly system to monitor the levels of staff in each team. We saw evidence the system calculated the total number of staff available to cover in each team against the number of care hours they had to cover. We were told this had helped the agency to cover annual leave, sickness and plan peoples visits in advance.

We spoke with ten people during our inspection they told us “I have not experienced any missed calls or lateness” and “I have the same regular staff who are very caring” and “no concerns with staffing, the staff are great” and “I have no complaints I have two carers each visit and they arrive together always on time”.

Appropriate checks were undertaken before staff began work. We were told recruitment checks were based upon protecting and safeguarding people. During the inspection we looked at ten staff files and saw evidence that applications forms, interviews, employment history and pre-employment checks were carried out before employment commenced.