About the service:

One to One Homecare Limited provides personal care and support to people living in their own homes. Some people who receive the service live in supported living houses which they share with other people. The service specialises in providing support to people with learning disabilities or mental health needs. At the time of the inspection there were six people receiving personal care from the service.

People’s experience of using this service:

The outcomes for people using the service reflected the principles and values of Registering the Right Support in the following ways; promotion of choice and control, independence and inclusion. e.g. People’s support focussed on them having as many opportunities as possible to gain new skills and become more independent.

People and their representatives were very happy with the service they received from One to One Homecare Limited. One relative told us, “You can’t fault it in any way.” Another said, “The service is superb. The staff really know what they are doing.”

People received their care from a small consistent staff team who they were able to build trusting relationships with. Everyone told us staff were caring and patient.

There were systems in place which made sure people received their allocated hours but staff were flexible to fit around people’s changing needs or wishes. One relative told us, “Their dedication is outstanding and their time keeping is exceptional.”

People received a safe service because the provider had systems and processes which helped to minimise risks. This included a robust recruitment procedure and training for staff about how to recognise and report suspicions of abuse. One person told us, “I feel safe because staff are always kind.”

People were involved in decisions about the care they received and staff knew how to communicate with each person to help them to make choices. 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 systems in the service supported this practice

People were supported by staff who had the skills and experience to help them to maintain and develop their independence. Staff treated people as individuals and respected their privacy and lifestyle choices.

The provider was open and approachable which enabled people to share their views and raise concerns. People told us if they were worried about anything they would be comfortable to talk with a member of staff or the provider.

The management structure in the service ensured people and staff had access to, and support from, a competent management team. The provider monitored quality, sought people’s views and planned on-going improvements.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection: Good. (The last inspection report was published in August 2016.)

Why we inspected: This was a planned inspection based on previous rating.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

This inspection was announced and took place on 06 and 07 June 2016. The provider was given 48 hours’ notice because the location provides a supported living service and we needed to be sure the manager would be available for the inspection. It also allowed us to arrange to visit people in their own homes.

One to One Homecare Limited provides personal care to people living in two supported living houses with shared occupancy and to people living in their own home. They provide care and support in the counties of Somerset and Devon. People who live in the shared supported living properties have individual tenancy agreements. At the time of the inspection they were providing personal care and support to six people. We visited two supported living properties to meet people and to discuss the care they received. One person agreed to talk with us about their experience of the care they received. Another person agreed to meet us although they had limited communication. Other people living in the shared accommodation chose not to talk with us whilst others were not receiving personal care. We observed how people interacted with staff and whether they were relaxed and happy.

The last full inspection of One to One Homecare Limited was October 2013. At that inspection there were concerns around the safeguarding processes for a specific person receiving care and we issued a Warning Notice. We checked on the provider’s progress with the warning notice in January 2014 and they were compliant with this area. At the October 2013 inspection we also found the provider had not ensured people’s safety as they had not obtained a criminal record check for staff before they started work. They also did not have sufficient staff to ensure the care hours were covered safely without staff working long hours. The provider had also failed to forward statutory notifications to the CQC when an incident occurred These are notifications providers must make when anything significant occurs within the service. These failures to comply were not followed up at the January 2014 inspection. The provider sent us an action plan telling us when they would be compliant. At this inspection we found the provider had improved and all areas were now compliant and being managed appropriately.

At the time of this inspection the registered provider was also the 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 were supported by sufficient numbers of staff who had a clear knowledge and understanding of their personal needs, likes and dislikes. We observed the deputy manager and staff took the time to talk with people during visits to their flats and homes. One person said, “I know who is coming and there are never any surprises. If they say it is [staff member’s name] I know they will be here.” Another person said, “We have regular staff so it is good to get to know who is coming.”

People who received care and support from One to One Homecare told us they were happy with the service provided. They said the registered manager and staff were open and approachable and cared about their personal preferences and maintaining their independence. One person said, “I have been in the care system for years and I am really happy here, the support is brilliant and I like all my staff.”

People told us they received care from care workers who were knowledgeable about their needs and were appropriately trained to meet them. Care workers had access to training specific to their roles and the needs of people, For example they had attended training in the use of alternative communication aids such as Makaton. Staff told us the training they received was good one staff member said

We carried out this inspection to check whether the immediate concerns found at a responsive inspection in October 2013 had been met. The visit in October 2013 highlighted serious issues about how the service safeguarded people from abuse, and we issued a warning notice in regard to outcome 7, Regulation 11 Health and Social Care Act 2008,(Regulated Activities).

We had identified other concerns during the visit in October 2013 which were in regard to how recruitment was carried out for new staff, whether there were sufficient staff on duty and that the provider had not reported serious incidents to the CQC when serious incidents had occurred. However, we plan to revisit and check compliance for these other areas at a later date.

During this inspection we spoke with one member of staff, the registered/managing director was not available. We did not speak to any people who used the service. However, they were asked if they did wish to speak with us, but they declined. We looked at the care records for three people in the registered office. We also looked at other records in regard to the management of the service.

We found the provider had taken reasonable steps to identify and reduce the risks of abuse occurring. This was through changing the system of how they supported people with their monies and ensuring checks were in place to monitor the potential risks if assistance was required as part of their planned care. The provider had reviewed and updated procedures to ensure staff had the systems in place to respond and act accordingly when significant events, concerns or people’s behaviour put themselves or others at risk of harm.

We checked on the five areas of non compliance found at the last inspection in November 2012. We did not speak to people who used the service on this occasion. At the time of the inspection the provider informed us that there were 20 people who used the service regularly. We spoke to two staff during the inspection visit. We looked at the care records for two people and a sample of the records for the administration and management of the service.

We obtained feedback from health and social care professionals who came into contact with the service. They told us people had voiced their opinion that the service met their needs and they were happy with what they received. We heard from another social care professional that the provider had worked well together with social services to support a person through difficult circumstances. We were told that they had provided a responsive service that adapted to the person’s needs and staff were very supportive to the person concerned and their family.

We found that there had been improvements in all five areas of the essential standards and the service was overall compliance to the regulations. However, we have not been able to test that compliance was sustained and we will continue to monitor the service.

This unannounced inspection visit was a scheduled visit and to check concerning information we had received about the service. We had been told of concerns about a safeguarding investigation in regard to the management of one person’s personal finances. We visited the service’s registered office, met with one person who used the service and spoke with two members of staff. We also looked at care records for three people that were held in the service office. We reviewed one care record held in a person’s home. We spoke via the telephone with five of the 18 people who were in receipt of support from the service and four staff. We reviewed other documents relating to the administration of the service.

People told us about their experiences with staff. They said, "friendly and sociable,""sort problems out," and "very helpful." One person described the staff as "happy bubbly people."

We found One to One Homecare Ltd non compliant for five of the six areas that were reviewed. This was in regard to the care and welfare of people, safeguarding people who use the service, requirements for and supporting workers and assessing and monitoring the quality of the service.

This inspection was carried out to follow up on action that we asked the agency to take when we visited in December 2011.

During our visit we were able to speak with people using the supported living scheme and people who were receiving care in the wider community. (Supported living is where people live in their own home and receive care and/or support in order to promote their independence. The support that people receive is often continuous and tailored to their individual needs.) We were also able to speak with six members of staff.

People using the service said that the staff who supported them were always kind and considerate of their views. One person told us “The staff are all excellent and never grumpy. They fit around me and what I want to do.”

We observed that people appeared very relaxed with the staff who supported them and the management of the service.

Everyone asked said that they would not hesitate to speak with a member of staff if they had any worries or concerns. One person said “I feel very safe with all the staff, I could discuss anything with them and they would always listen” another person said “They help me through things, which makes me feel better.”

People we spoke with were complimentary about the staff and their skill level. Comments included “They know what they are doing,” “I know I’m in safe hands” and “All the staff who work with me are excellent.”

Since the last inspection the agency had purchased an on line social care training package. Some staff spoken with said that they had begun to use the training programme. One member of staff told us that things had improved greatly in the past few months and there were now more opportunities for ongoing training.

Staff said that they had recently received individual supervision where they were able to identify their training and support needs.

We carried out this inspection because of concerns received by the Care Quality Commission about the service. These concerns were in regard to how the service managed some finances on people’s behalf, that appropriate recruitment was carried out for new staff, sufficient staff on duty and management of staff. We also had received concerns about the provision of one service user’s support from the service from the local police force.

During this inspection we spoke with five staff, the registered manager and a managing director. We met and spoke with three people who used the service. We looked at records in the registered office and in people’s own homes. These included records for three people who currently used the service and one person who had recently left the service. We also obtained information from the social work teams supporting people who used the service. We obtained information from the local police force.

When we spoke with three people who used the service, two people clearly expressed that they felt safe and supported by the service. Whilst we were speaking with one person who used the service they disclosed information that indicated there was a possibility of risk of harm to them. The provider referred this disclosure on prompting to the local authority safeguarding team for investigation.

We found practices at the agency did mirror the concerns we had received, for which compliance actions have been made for the service to rectify. The provider had not taken reasonable steps to identify or prevent the risk of abuse occurring. For example, the manager had not acted on safeguarding information in a timely way or kept people’s personal information secure. We also found that a police check had not been carried out on a new member of staff before they had started working with vulnerable people. At times there were not enough staff for people to have one to one support they needed.