This inspection was announced and took place on 11, 12, 13 and 14 July 2016. We gave the provider short notice of the inspection as we needed to make sure we were able to meet with key staff, access records and gain permission from people who used the agency to telephone them.

The last inspection of the service was carried out on 18 May 2015. At this last inspection a shortage of staff at all levels had impacted on the service’s ability to provide a safe service. At this inspection there had been key appointments made at management level. Recruitment of planners, supervisors and care staff had also been successful. Some vacancies remained and the service continued to pursue targeted recruitment to areas where staff were short. The recruitment of staff was pro-active and professional with a variety of initiatives being used to attract and retain staff.

Somerset Care Sedgemoor provides personal care and support to people living in their own homes. At the time of this inspection this large agency was providing support with personal care to approximately 550 people in Somerset. The area covered by the agency extended from Porlock to Burnham and Cheddar and included towns, villages and widespread rural areas.

There was no registered manager in post. 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 had been effective interim management arrangements in place. An experienced and enthusiastic manager had taken up post two weeks before the inspection and their registration process with us had commenced. Further time was needed to embed the new structure of the service and to complete planned improvements.

This was a very large service and most people and their relatives were very complimentary about the quality of the service provided and of the management and staff team. Whilst the majority of the people felt safe and comfortable with the way staff supported them they did not always feel the service was delivering a service that was fully responsive to their needs and preferences. Improvements were still required in this area. There were two recurrent themes that had an impact on how satisfied people felt. These were the timing of visits and the continuity of care. This meant having a team of regular staff who knew them well.

People did feel they were cared for by kind and understanding staff. There was a wealth of evidence to show people found staff helpful and supportive. People valued their relationships with the staff team and felt they would help them in any way they could. People told us “Staff are lovely”, “Staff are kind and caring”. “Nothing is too much trouble”. “They couldn’t do anything better”. “They are marvellous. I don’t know what I would do without them.” “They are always cheerful” “They have been absolutely wonderful.”

Staff knew how to recognise signs of abuse and all said they were confident that any issues raised would be appropriately addressed by the manager. People felt safe with the staff who supported them. Where allegations or concerns had been bought to a care manager’s attention they had worked in partnership with relevant authorities to make sure issues were fully investigated and people were protected.

Care was planned and delivered in a way that was personalised to each person. Staff monitored people’s healthcare needs and supported them when they were unwell or had health emergencies. Where changes in needs were identified, care was adjusted to make sure people continued to receive care which met their needs and supported their independence.

New staff received a thorough introduction when they began work and there was a system of training and up-dating staff so they maintained and developed their

The inspection was announced and visits to the service took place on 18, 19, 20 and 21 May. We made telephone calls to people using the service from 28 May 2015 to ask them their views of the care they received.

Somerset Care Community (Sedgemoor) is a domiciliary care agency providing personal care and support to people living in their own homes and in sheltered accommodation. At the time of the inspection they were providing a service to approximately 700 people. The majority of people received personal care. Some also received a shopping or domestic cleaning service. These activities are not regulated by us and did not form part of the inspection.

This was the first inspection of the service following the merging of the two locations of Somerset Care (West Somerset) and Somerset Care (Sedgemoor) in April 2015. All administration and records are now kept at the Bridgwater office. The service is managed from this office and key staff visit Minehead each week. The office in Minehead provides a base for staff, supervisors and managers to meet.

We inspected the services in September and December 2014 and found that there were missed and late calls. We had received concerns from people receiving care and their relatives about the shortage of staff which had impacted on all aspects of the service. We required that the provider took action. During this inspection we found that sufficient improvements had not been made.

The provider aimed to improve the planning of calls to people and to reduce the duplication of administration and management systems by bringing the two services together.

The systems in place to manage this large service were still developing. At the time of the inspection the registered manager was supported by the area manager. We found there had been improvements to the service and the action plan had been addressed. Additional care and supervisory staff had been recruited and the planning team had been re-structured. However aspects of the service needed further improvement.

Six geographical areas had been designated for the purposes of organising the delivery of care. Planning staff arrange people’s care visits and allocated care staff. A team of supervisors monitored delivery of care and supported staff.

There was a registered manager in post. 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. The registered manager had a clear vision for the service. There was a commitment to provide high quality care tailored to people’s individual wishes. These values were communicated to staff through staff meetings, training and supervision.

People felt the service provided was safe however staff shortages continued to impact on people and potentially put them at risk. We were told about occasions when people had not received care as planned. The agency had recruited substantial numbers of people and continued to recruit new staff to maintain staff numbers and meet peoples changing needs. Staff had also left the service so there continued to be vacancies. People felt there were insufficient staff to provide a consistent service that fully met their needs. When we looked into complaints and concerns about the service they were caused by shortage of staff or visit planning issues.

People’s experience of the service varied. People told us how their planned care met their needs. Whilst the majority of people we spoke with were satisfied with the actual care they received there were a significant number who had not been satisfied with the overall service because of staff shortages and changes. There were very few negative comments about the care staff or the care provided.

People talked to us about problems around the times of visits and the number of care staff who visited them. They wanted to know who was coming to support them. Some people told us they had some regular staff visiting them most of the time and were very satisfied. Others said they had “no idea” who would be visiting them and did not feel the service met their needs in the way they wished. A substantial number of people we spoke with said the timing of visits could be improved. They said staff did not arrive when expected.

The service was working to improve the continuity of staffing and had implemented measures to improve the planning of staff visits and to reduce missed visits

There were risk assessments and plans in place which meant care was planned in a manner that kept people as safe as possible whilst promoting their independence and choices.

There were systems in place to monitor the quality of care and plan on-going improvements. People were contacted through telephone calls and visits to monitor their satisfaction with the care they received.

People received care following the assessment of their needs and had their carevaried if their health or social circumstances varied. People received effective care and support from staff who had the skills and knowledge to meet their needs. Care staff were supported through the delivery of training, observations and supervision meetings.

People found staff to be kind and caring towards them. There were many positive comments about staff. People valued the support of regular staff. Staff showed they understood the importance of their role in supporting people and maintaining people’s independence and dignity.

People were able to make complaints or raise issues about any aspect of their service. People were encouraged to express their views and be involved in the planning of their care. Customer services staff were dedicated to sort out any problems and resolve concerns. However comments from people indicated some issues recurred or were not satisfactorily resolved.

The manager of the service led a team of staff who were clear about the standard of service they wanted to deliver however this had not yet been achieved. There were plans in place to further develop aspects of the service in the way people had requested.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

At the time of the inspection Somerset Care Community (Sedgemoor) provided personal care to over 500 people. One adult social care inspector carried out this inspection. An expert by experience made telephone calls.

61 questionnaires were sent to people using the service. Each person was also sent an additional questionnaire to give to a relative, friend or advocate for completing. A total of 19 questionnaires were returned.

We contacted 25 people by telephone. 11 people were available to speak with the expert by experience. The inspector spoke with six relatives, 10 people and visited one person in their own home. We spoke with ten members of staff and looked at six support plans. We considered all the evidence we had gathered under the outcomes we inspected.

We found overall that some people were satisfied with the care they received however a small but significant number of people and their relatives were concerned about the reliability of the service.

We used the information to answer the five questions we always ask:

• 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?

We had received concerns from relatives of people receiving care from the service before we commenced the inspection. They were concerned shortage of staff had led to missed calls and this had put people at risk. We found there was a shortage of staff and this had impacted on several aspects of the service. When visits to people were missed there was the risk people had not received the care and treatment they needed. We were told by relatives of occasions when they had stepped in to provide care because the agency had missed a visit.

Staff tried to ensure people received safe and effective care which was in accordance with people’s individual needs. Some staff worked extra shifts to make sure visits were “covered.” Planning staff worked hard to ensure wherever possible care visits were made on time and as recorded in people’s support documents.

The people we spoke with told us they felt safe when receiving support from care staff and they commented on the kindness they received. Comments included “Yes I feel safe. There are not any that I wouldn’t want in my house.” All who responded to our questionnaires felt they were safe when the care workers visited them.

The provider had a range of policies and procedures in place to protect the people who lived in the home. The staff we spoke with had a good understanding about how to report any concerns.

Each support plan contained details of how to access the person’s home and any necessary information regarding the security of the person and the environment. Support plans contained contact details of relatives or friends who could be contacted in an emergency. Relatives told us they had been contacted when care staff were not available to deliver care.

Is the service effective?

Staff vacancies in all positions had impacted on the effectiveness of the service. The manager told us about the staff shortages that had occurred in all staff positions. There continued to be vacancies for care and support staff. There were vacancies for senior carers. This meant there were fewer experienced staff available to pick up calls, cover sickness and carry out reviews of peoples care.

There were shortages of supervisors and planners in the office. The manager told us additional support from other areas of the company had been arranged. There was still a large amount of “firefighting to be done each day.” This meant staff were asked to provide care at short notice. People told us that they often did not know who was coming to deliver their care or at what time.

Is the service caring?

People told us staff were kind and caring. We talked with staff who told us how they supported people in a committed and professional manner. Staff talked about working extra hours so people were not “let down.”

The people we spoke with were complimentary about the care they received and of the staff who supported them. People mentioned regular carers by name. One person said “They are more like friends than carers.” Everyone we spoke with told us they looked forward to the carer’s visits.

Is the service responsive?

When we reviewed the questionnaires returned by people who use the service and their relatives we found over half (66.7%) felt that people got the care and support they expected. People mostly thought their support and care helped them to be as independent as they could be.

Some people who contacted us were not satisfied with the care they received. We heard from relatives who were very concerned about missed or late calls from care staff.

The care records we read showed staff initially assessed people’s needs and planned their care with them. There was a system of annual reviews in place so care and support plans could be up-dated. However some of the people we spoke with said they had not had a review within the past year.

Is the service well led?

There was a registered manager in post. A registered manager is a person who has been registered by the Care Quality Commission to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider.

An experienced deputy manager assisted with the daily running of the service.

There were systems in place which monitored and sort to improve the quality of the service provided. There were plans in place to recruit new staff.

Risks to people were assessed and reviewed. If risks could be reduced then appropriate measures were taken. If any incidents or missed visits occurred they were reviewed to see if any lessons could be learnt or trends identified.