The service was last inspected on the 14 January 2016 where we identified concerns with how information was shared with staff about people’s needs and how the service monitored the visits that staff made to people’s homes. Soon after the inspection the provider confirmed that they had introduced a digital care management tool that staff would log into to state that they had arrived, logged that they had provided all of the care and then log back out when they had finished all of the care. Confidential information about people’s needs was able to be shared using this system.

This inspection was carried out on the 12 May 2017. Haslemere Homecare provides personal care and support for people in their own homes. This includes people that are old and frail, some of whom have disabilities. At the time of our inspection the service provided personal care to approximately 120 people. Other people who used the service were not receiving personal care.

There was a registered manager in post at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 were supported on the inspection by the registered manager and the deputy manager.

People were able to build caring and friendly relationships with the management team and the staff who supported them. People and relatives felt that staff and management went above and beyond their duties to care for people and their families in a compassionate way. One relative said “It’s a lifeline to me. My rapport with (the member of staff) is fantastic. I would be lost without (the carer). They go above and beyond. She (the carer) is very caring, competent and motivated. Do anything for anybody”

The manager and staff went out of their way to ensure that people and their relatives were comforted and looked after in a kind and compassionate manner and treated with dignity and respect. It was clear that staff understood people's needs and how to communicate with people. People and relatives were involved in the decisions about their care.

People told us they felt safe with staff. Relatives felt that their family members were safe with staff. Staff had received training in how to recognise and report abuse and were confident any allegations would be taken seriously and investigated to help ensure people were protected. There were sufficient staff at the service to provide care and support to people. Appropriate recruitment checks were undertaken before staff started work.

Staff understood the risks to people and ensured that people were kept safe. Staff encouraged and supported people to lead their lives as independently as possible whilst ensuring they were kept safe. People’s medicines were managed in a safe way. People were supported to manage their own medicines.

People received support from staff that knew them well, and who had the knowledge and skills to meet their needs. Training was provided to staff that was specific to the needs of people. People and their relatives spoke highly of the staff and the support provided. Staff received supervision to provide effective care to people.

People had detailed care plans in place which provided guidance for staff about how people liked their care provided. People told us staff always respected the way they liked things done

and respected their home.

Staff had a clear understanding of the Mental Capacity Act 2005 and how to make sure people who did not have the mental capacity to make decisions for themselves had their legal rights protected. No-one receiving support was assessed as lacking capacity to make day to day decisions. Staff knew what to do however if this situation arose.

Staff supported people with their nutrition

This inspection was carried out on the 14 January 2016. Haslemere Homecare Ltd is a domiciliary care service providing personal care for people with a variety of needs in their own homes. Most of the people who received care were older people who required support. At the time of our inspection the service provided care to 112 people.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. The registered manager is also the provider for the service.

People’s records were not always kept securely and improvements had not always been made in relation to feedback from people and relatives.

Staff did not always spend all of the time allocated to a person as there was no time in between calls allowed for travelling. People told us that they felt staff at times were rushed. We recommend that the provider reviews staff travel time between calls.

Assessments of people’s care had been recorded. There were clear plans for staff to show what care was needed for people. Care plans were written in a personalised way based on the needs of the person concerned.

There were sufficient numbers of skilled and experienced staff deployed to support the people who used the service. Team leaders provided support to care staff when needed.

People and their relatives told us they were often supported by regular staff who knew their needs and preferences well.

Systems were in place to ensure that people who used the service were protected from the risk of abuse. Staff were aware of procedures to follow to safeguard people from abuse. All staff underwent recruitment checks before they started work.

People told us they were involved in decisions about their care and were kept informed. Relatives we spoke with told us they were always consulted and felt involved.

People were offered support in a way that upheld their dignity and promoted their independence. Staff said they would they would close doors and curtains and make sure the person was covered when providing personal care. People were supported at mealtimes to have food and drink of their choice.

People’s rights were being upheld as required by the Mental Capacity Act (MCA) 2005. This is a law that provides a framework to protect people who do not have mental capacity to give their consent or make certain decisions for themselves. Staff were aware of their responsibilities through appropriate training in regards to the Mental Capacity Act 2005.

People were cared for by kind, respectful staff. People told us they looked forward to staff coming to support them.

Medicines were safely administered and people who used the service received their medicines in the way that had been prescribed for them. Each care file had clear instructions to care staff stating whether the person was to be administered medication as part of the care plan.

Services that provide health and social care to people are required to inform the Care Quality Commission, (the CQC), of important events that happen in the service. The provider of the service has informed the CQC of events which related to safeguarding concerns which have now been resolved.

We found one breach of the Health and Social Care Act 20014 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

On the day of our visit 70 people were using the service. They were supported by 28 care staff plus the registered manager, the director, and a care coordinator.

We spoke with six people who use the service, six staff: the registered manager and the director. The focus of the inspection was to answer five key questions:

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

This is a summary of what we found:

Is the service safe?

The service was safe. People who use the service told us they felt safe. Staff had received safeguarding training and knew how to recognise and deal with cases of suspected and actual abuse.

People’s care plans had included full needs and risk assessments to ensure they were treated in a way that did not put them at risk of receiving inappropriate care.

Is the service effective?

The service was effective. People told us they felt properly cared for and that staff were properly trained and competent to carry out their duties. Each person had a fully completed and up to date care plan which was tailored to their specific needs.

Staff would always ask people’s permission before offering them any kind of care or treatment. There were processes in place to ensure that decisions could be made in a person’s best interest if they lacked the capacity to make decisions for themselves.

People’s views were taken into account, for example through the use of regular satisfaction surveys, and staff also had the opportunity to give their feedback.

There were sufficient numbers of staff to provide an appropriate level of care to people. Care staff had either completed, or were in the process of completing, appropriate qualifications in health and social care.

Is the service caring?

The service was caring. People we spoke with were positive about the service they received. One person said “They (the staff) all have hearts of gold” and “they will do anything for me”. Another person said that staff “do their job very well” and were “very sweet and polite.”

Care staff had a good awareness of people’s needs. They were able to constantly monitor people’s health and wellbeing and where necessary make amendments to a person’s care plan.

Is the service responsive?

The service was responsive. Staff were usually punctual when they visited people and would take their time completing their work. The office would always let people know if staff were running late.

Care plans were regularly updated to reflect changes in people’s needs.

Is the service well led?

We found that the service was generally well led. The service had a registered manager. The provider regularly talked with all staff to seek their views, and to share any issues with them that might affect the service.

There were some systems in place to monitor and assess the quality of the service on a regular basis, for example a service user satisfaction survey. However, the service lacked a formalised and comprehensive process for monitoring and evaluating the whole service, for example through the use of regular audits.

At this inspection we spoke with one person who used the service, three relatives, three staff members and the manager of the agency. We carried out this inspection to check on compliance actions that had been set at our last visit.

People and family members told us that they were very happy with the services provided by the agency. They confirmed that staff maintained records of any medicines they administered. We were told by relatives that they had no concerns in respect of how staff provided support to their family members.

One relative said, "We are both very happy with the staff. They are knowledgeable, polite and good at their Job".

Another said, "They have been very supportive and treat us both with respect".

We found that the provider had taken steps to address concerns raised at the last inspection. Medicine management records were accurately maintained, there was evidence of the on-going monitoring of medicine administration tasks. The recruitment practices of the agency had been reviewed and improved to ensure people were safe.

We spoke to two people who received a service from the provider. They told us about the care and support they had received and confirmed they were satisfied with the way they were supported. They also told us that they found staff to be friendly, polite and respected them as individuals. They told us that they had regular staff and they had built up a rapport with them.

We also spoke with four relatives. They told us that they were very happy with the services provided by the agency. One relative said the staff that supported their family member was, "Excellent, very helpful. I feel reassured by the consistent service provided".

We spoke with five members of staff. They said that they had sufficient time on visits to provide a quality service. Four out of the five staff felt they had received a good level of training.

One member of staff said of the agency, "They are open and approachable and the support I have received so far has reassured me".

Despite everyone expressing satisfaction with the service they received we found that the agency was not maintaining accurate records in relation to medicine management and recruitment of staff. This put people at risk of receiving unsafe or inappropriate care.

As part of this inspection we carried out telephone interviews with people who use the service and staff. We spoke with two people who receive a service from the provider and three relatives of people who were unable to speak to us directly. Their comments were very positive. All felt that they were treated with respect and their dignity was maintained at all times.

One person said, "They do everything I ask of them, they are caring and sympathetic."

A relative said, "The carers provide good care and support, I have no concerns when they are here."

We spoke with the five staff members currently employed by the provider. They told us that they felt supported to carry out their work. Staff told us they were supported to understand their role through an induction and shadowing colleagues on visits.

We found that whilst staff felt supported in their role the training and support/supervision systems used by the provider were not effective in ensuring staff had training to meet peoples' needs.