Somerset Care Community Services (Wiltshire) provides domiciliary care and support services to meet a wide range of individual needs, including older people, individuals with physical disabilities, and people living with dementia. At the time of our inspection 378 people were being supported by this service.

This comprehensive inspection took place on 24, 25 and 30 January 2018. This inspection was announced, which meant the provider was given 48 hours’ notice of the inspection. This was because the location provides a domiciliary care service. We wanted to make sure the manager would be available to support our inspection, or someone who could act on their behalf.

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.

During our last inspection in December 2015, we identified two breaches of the regulations, one for Care Quality Commission (Registration) Regulations 2009 and the other of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because incidents that required reporting to the police, had not been notified to the Commission and a referral had not been made to an external regulator following a safeguarding investigation.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question of well-led to at least good. During this inspection we found improvements had been made and the provider was notifying us of important events as per regulations.

The medicine administration records did not always show people’s medicines were safely managed. This was because staff didn’t always sign that they had administered the medicines. Medicines audits had identified the shortfall and each staff omission was dealt with.

We received mixed feedback about the continuity of care calls. This was because the agency is a provider for the local authority’s Help to Live at Home contract. The contract specifies that people were not allocated a specific time, but time slots. This meant people did not always know when staff would visit.

People told us they felt save when carers visited them in their homes. Relatives confirmed they had no concerns regarding the safety of their family member.

Staff had the knowledge and confidence to identify safeguarding concerns and act on them to protect people. They had access to information and guidance about safeguarding to help them identify abuse and respond appropriately if it occurred.

The service developed safety packs to promote people’s safety in their own homes. This provided people with information for example about fire safety, extreme weather, financial well-being, keeping strangers out and fighting doorstep crime.

Risks associated with people’s mobility, eating and drinking, domestic tasks, environment and fire, had been identified. Records showed actions required to promote safety had been taken.

People were supported by staff who had access to a range of training to develop the skills and knowledge they needed to meet people’s needs. People told us they felt staff were skilled to meet their needs.

People told us they were happy with the care they received. Speaking with relatives they praised the care their family member received.

People were treated with kindness and compassion in their day to day care and support. Staff showed concern for their well-being in a caring and meaningful way.

People’s support plans were clearly written and we saw evidence that people and/or their relatives were involved in the development of the plan.

The service had identified that some people could be socially isolated at home, finding it difficult to access the comm

Somerset Care Community Services (Wiltshire) provides domiciliary care and support services to meet a wide range of individual needs, including older people, individuals with physical disabilities, and a specialised branch called Petals for people with dementia. At the time of our inspection 378 people were being supported by this service.

This inspection took place on 9 and 14 December 2015. This was an announced inspection which meant the provider was given short notice of the inspection. This was because the location provides a domiciliary care service. We wanted to make sure the manager would be available to support our inspection, or someone who could act on their behalf.

There was a registered manager in post at the service at the time of our inspection. 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 manager was accessible and approachable throughout the inspection. Staff, people who used the service and relatives felt able to speak with the manager and provided feedback on the service.

We found two breaches of the regulations during our inspection. One breach concerned incidents that required reporting to the police, had not been notified to the Commission. We discussed this with the registered manager and the operations manager who had been previously unaware of the need to report these events.

This was a breach of Regulation 18 (2) (f) Notification of other incidents of the Care Quality Commission (Registration) Regulations 2009.

A second breach related to a referral not being made to an external regulator following a safeguarding investigation.

This was a breach of Regulation 19 (5) (b) (Fit and proper persons employed) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.The registered manager said this would be rectified in going forward and took action around this immediately. You can see what action we told the provider to take in relation to these breaches at the back of the full version of the report.

People told us they felt safe and staff were responsive to their needs. Systems were in place to protect people from abuse. Staff had a good understanding of safeguarding and whistleblowing procedures. They also knew how to report concerns and had confidence in the registered manager that these would be fully investigated to ensure people were protected.

Safe recruitment procedures were followed and staff said that they undertook an induction programme which included shadowing an experienced member of staff. Staff were appropriately trained and told us they had completed training in safe working practices and were trained to meet the specific needs of people who used the service such as dementia care. The provider had undertaken recruitment checks on prospective new staff to ensure they were suitable to care for and support vulnerable adults.

Staff we spoke with were knowledgeable about the requirements of the Mental Capacity Act 2005. Where appropriate best interest decisions had been made and these were recorded in people's care plans.

People were supported to access healthcare services to maintain and support good health. People were protected from the risks associated with nutrition and hydration. Where people were at risk, the service worked alongside the community professionals. Staff were proactive in encouraging fluids and ensuring people were left with drinks.

People and relatives were complimentary about the caring nature of staff. Staff were knowledgeable about people’s needs and we were told that care was provided with patience and kindness. People’s privacy and dignity was always respected. Staff explained the importance of supporting people to make choices about their daily lives. Comments included, "I can’t speak too highly – they are all very efficient and very caring”,“very, very patient” and “I am always asked how I like things”.

People had opportunities to give their views about the provider and their care, including completing a survey and telephone opportunities.

The registered manager had robust quality assurance systems in place to monitor the service. This meant regular audits picked up areas needing improvement and action could be taken immediately.