DomCare is a domiciliary care agency registered to provide personal care to people living in their own home. At the time of our inspection visit the service provided a service to 250 people and employed approximately 90 care staff.

At the last inspection of the service in October 2015, the service was rated as good overall, with requires improvement in Well Led. At this inspection we found some improvements had been made in Well Led but further improvement was required. The overall rating remained Good.

The office visit took place on 25 October 2017 and was announced. We told the provider 48 hours before the visit we were coming so they could arrange to be there and arrange for staff to be available to talk with us about the service.

A requirement of the provider’s registration is that they have a registered manager. 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. There was a registered manager for the service at the time of our inspection.

There were enough staff to provide the care and support people required. People told us staff were friendly and caring and had the right skills to provide the care they required. Staff received an induction when they started working for the service and had their training updated to support them in meeting people’s needs effectively. The procedure for recording and monitoring staff training needed improvement.

People felt safe using the service and there were processes to minimise risks to people’s safety. These included procedures to manage risks identified with people’s care. Staff understood how to protect people from abuse and people who required support to take medicines received these as prescribed. The provider conducted pre-employment checks prior to staff starting work, to ensure their suitability to support people who used the service.

The managers and staff followed the principles of the Mental Capacity Act (MCA). Staff respected decisions people made about their care and gained people’s consent before they provided personal care.

Most people were visited by care staff who they knew and who understood their needs and preferences. People said staff usually arrived around the time expected and stayed long enough to provide the care they required. Care plans provided guidance for staff about people’s care needs and instructions of what they needed to do on each visit.

Staff felt supported to do their work effectively and said the managers were approachable and available. There was an ‘out of hours’ on call system, which ensured management support and advice was always available for staff.

People and staff said they could raise any concerns or issues with the management team, knowing they would be listened to. Although some people said they had experienced difficulty contacting the office phone number. People knew how to complain and information about making a complaint was available for people.

The provider’s quality monitoring system included asking people for their views about the quality of the service. This was through telephone conversations, visits to people to review their care and satisfaction questionnaires. The management team checked people received the care they needed by observing staff during visits to people and through feedback from people and staff.

There was a programme of other checks and audits which the provider used to monitor and improve the service. We found these were not always implemented consistently or were sufficiently robust to ensure people always received safe, effective care.

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DomCare is a domiciliary care agency which provides personal care support to people in their own homes. At the time of our visit the agency supported 267 people with personal care and employed 100 care workers.

We visited the offices of DomCare on 26 October 2015. We told the provider before the visit we were coming so they could arrange for staff to be available to talk with us about the service.

The service has a registered manager. 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 and their relatives told us they felt safe using the service and care workers understood how to protect people from abuse. There were processes to minimise risks associated with people’s care to keep them safe. This included the completion of risk assessments and checks on care workers to ensure their suitability to work with people who used the service. There were enough suitably trained care workers to deliver care and support to people.

Most people had regular care workers who usually arrived on time and stayed the agreed length of time. People told us care workers did everything they needed before leaving, but some people said care workers rushed to finish and move on to the next person. Care workers received an induction and a programme of training to support them in meeting people’s needs effectively. People told us care workers were kind and caring and had the right skills and experience to provide the care and support they required.

The managers understood the principles of the Mental Capacity Act (MCA), and care workers respected people’s decisions and gained people’s consent before they provided personal care. People who required support had enough to eat and drink during the day and were assisted to arrange health appointments if required.

Care plans and risk assessments contained information for care workers to help them provide the care people required. Most people knew how to complain and information about making a complaint was available for people. People said they knew how to raise complaints and knew who to contact if they had any concerns. Most care workers were confident they could raise any concerns with the managers, knowing they would be listened to and acted upon.

There were some processes to monitor the quality of the service provided and understand the experiences of people who used the service. This was through communication with people and staff, spot checks on care workers and a programme of other checks and audits. These systems were not consistently implemented.

We visited DomCare on 7 August 2013. At the time of our visit the agency was providing support to approximately 250 people in their own homes and employed around 100 care workers. On the day of our visit we spoke with the provider, registered manager, two members of the management team and two care workers. Following our visit we spoke with 26 people who used the service or their relatives over the phone. We also sent surveys to 60 people. We had 15 surveys returned to us.

We found people had different experiences of using the service. Some people said the agency was very good. Others told us they were dissatisfied with the service and things could be improved.

Most of the people we spoke with said they had been consulted about the care provided. The majority of people said their views and opinions had been listened to although three people we spoke with did not think this happened. One person told us,"The manager went through the care plan and I was happy with it. She told me all the things they could offer me."

We reviewed the care and support being provided for four people. The care files we looked at in the office contained detailed information about the care and support each person needed. We found staff had enough information about what they needed to do to support people safely.

People we spoke with described varying experiences of the quality of service they received. People told us the service was not always consistent. Some people said they did not have regular carer’s and carers were not always turning up around the expected time. Some people had no delays on visits; some short delays and others long delays. Some people told us care workers took their time and did everything they needed; others told us workers rushed in and out. People said they would like more consistency in the staff visiting them as they preferred to have regular carers who they could get to know.

During our visit we looked at a sample of work schedules and staff timesheets to see how calls were scheduled to people. We found that some care workers had calls scheduled to different people at the same time. This meant calls could not be carried out at the time allocated to people.

We asked people if staff seemed competent and properly trained to provide the support they needed. We were told, “Staff sometimes use a hoist. X seems perfectly happy when they do this. They tell her what they are doing, reassuring her all the time. They told me they have regular training to make sure they know how to use this.” Another said, “I am not sure they all understand X needs. Some are very good others don’t seem to be bothered."

We looked at the procedures in place for assessing and monitoring the service. The majority of people said no one had asked if they were satisfied with the service. Most people said they had never seen anyone check on what staff did in the home and no one had received a satisfaction survey. People said they were not told when their care worker was running late so were unsure if they would turn up or not.

The people we spoke with were happy to share their experiences and said they would have shared these with the agency if they had been asked.

We found the procedures in place for assessing and monitoring the service needed to be more robust to make sure people receive a consistent service that they are satisfied with.

People told us that their care and support needs had been agreed with them when the service started. We saw that people had given their consent and were involved in their care. People told us that care staff respected their privacy during personal care routines. One person told us, “Yes, they always make sure my privacy is maintained.” The files we looked at contained care plans that were personalised and included people’s preferences.

We found that people received calls at the time they were expected. People said that most of the staff took their time and did not rush. One person said, "They don’t exactly rush me but they always seem to be in a hurry.” Another told us, “No they never rush, they take their time and always talk to X to let him know what they are doing.”

People told us they had consistent care staff who were knowledgeable and knew what they were doing. One person said, “All the staff are very capable. They have to use a hoist and they know how to do this. They seem very informed about his condition and how it affects him.” The people we spoke with said all the care staff were friendly and polite.

People who used the service told us that they had been given information about making complaints. We saw that complaints were taken seriously and looked into. All the information we requested to see was made available to us. Documents we viewed had been fully completed and were easy to understand.

We visited DomCare on 7 and 13 January 2011 and we found that the home was not compliant with the regulations. We issued a warning notice to the service. When we visited again on 31 August and 2 September 2011 we found that there had been substantial improvements to the service people received.

The service provider had developed more robust systems to ensure that people’s visits were as they had been commissioned. People told us that this was their experience. We spoke to two social workers and Birmingham City Council contracts department and they told us that they had no significant information of concern about this service. People told us they were happy with their care. The service provider showed us the surveys returned from people as part of their quality assurance. They had received a very good response with about half of people receiving a service responding. Very few people were unhappy with the service. The service provider had contacted most of these people to resolve any issues.

The service provider had developed better information for care workers and to be given to people receiving a care service. This was now being put in place for all people receiving the service. The service provider was able to give us records and information more readily when we asked for it.