Courtesy Care Ltd

Courtesy Care Ltd is a domiciliary care agency which provides personal care and support to people living in their own homes in Axminster and Seaton and the surrounding areas. At the time of the inspection 44 people were receiving support with the regulated activity of personal care. Some people received help with tasks that were not related to personal care including, shopping, cleaning and welfare checks. The Care Quality Commission (CQC) only inspects where people receive personal care.

People’s experience of using this service and what we found

People were happy with the standard of care and support provided to them. Comments included, “No concerns at all, it is a great service…a small and personal service” and “They are a great help to me”.

We have made a recommendation for the provider to continue with improvements to their governance systems to assess and monitor the quality and safety of the care people received.

Improvements had been achieved since the last inspection. Environmental risk assessments had been completed and any issues of concern had been addressed. Improvements were seen in the initial assessment information obtained. It was appreciated that during the pandemic face to face assessments had been limited. However, assessments completed assured the service could meet people’s needs and preferences.

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. Consent had been obtained in relation to care and support provided for individual people. If a person lacked capacity, a mental capacity assessment had been completed to ensure any decisions about care and support were made with their best interest.

People were supported by reliable, kind and caring staff who they trusted. There were sufficient staff to ensure people received visits as planned. People said the service was reliable and staff always arrived as expected.

People were safe and protected from avoidable harm because staff knew how to identify and report any concerns relating to the risk of abuse. Medicines were safely managed for people.

All staff had received the provider's mandatory infection control training and had access to appropriate protective equipment. People told us they felt safe when staff visited as they always wore personal protective equipment (PPE), such as masks, aprons and gloves.

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

Rating at last inspection

The last rating for this service was requires improvement (published 22 August 2019). At this inspection enough improvement had been made and the service has been rated as good.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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

People’s experience of using this service:

People on the whole were happy with the service they received. People told us staff were kind and caring. People received their care from a small team of staff who they had been able to build trusting relationships with. Most people told us they always saw the same staff, and this enabled them to feel comfortable and relaxed.

People and staff were not always protected because environmental risk assessments were not being completed. We have made a recommendation that all care files are reviewed, and environmental risk assessments completed where necessary.

People and relatives were involved in planning their care when they started to use the service. People’s needs, choices and preferences had been assessed before a package of care was arranged. However, these assessments were very brief and would benefit from more detailed information being obtained. We made a recommendation that a more robust system was needed for assessing people’s needs, so the staff team had a clear picture of individual needs and how these are to be best met.

Improvements were needed in some people’s care plans to ensure they had the information needed to guide staff consistently. Action was started during the inspection to address this with further planned reviews to be undertaken.

Medicines were safely managed for people. All staff had received the provider’s mandatory infection control training and had access to appropriate protective equipment.

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. Although consent had been obtained in relation to some areas of care and support provided for individual people, a mental capacity assessment had not been conducted on behalf of one person who had been diagnosed with a mental health condition. We have made a recommendation that mental capacity assessments always be conducted as appropriate to establish if people need support to make decisions in their best interests.

The registered manager did not have a formal system to monitor the quality of the service. They said they were in control of the day to day running of the service and were aware where there were issues. Monitoring visits were undertaken to assess quality and individual staff practice. Staff received regular supervisions and said they felt supported. We discussed the importance of formally monitoring accidents and incidents and missed visits and having a more robust system in place to identify if a visit was missed potentially placing a person at harm.

Rating at last inspection: The last rating for this service was good (published 25 October 2016). At this inspection the ratings for the service have changed to requires improvement.

Why we inspected: This was a scheduled/planned inspection based on date of registration

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.

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

This inspection was undertaken on 7 and 9 September 2016.

We last inspected the service on the 09 July 2013. At that inspection we found the provider was meeting all of the regulations we inspected.

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.

People said they were safe using the service because it was reliable, staff were well trained and caring. Comments included, “This service is ideal. The staff are extremely helpful” and “I am very fortunate to have this service. I get my regular carer who knows me very well.” Relatives were also happy with the service. Comments included, “I would recommend this service. I can’t fault it…” Professionals were equally complimentary. One said, “We have no concerns about the service. It is a good service overall…”

There were sufficient numbers of staff employed to provide people with their planned service. People said they had never experienced a missed visit; that staff arrived on time and stayed the expect length of time.

Staff were knowledgeable in relation to safeguarding people from abuse and they knew how to keep people safe from avoidable harm. Risks to individuals had been identified and there was guidance for staff on how to keep people safe. Where people were assisted with their medicines this was managed safely.

There was an effective recruitment and selection process in place and the necessary relevant checks had been obtained before staff started to work alone.

People were provided with the care and support they wanted by staff who had the knowledge and skills they needed to do so. People's right to make decisions for themselves was respected and staff sought consent when delivering care and support. People were supported to ensure they had a sufficient amount of food and fluid to promote their wellbeing. People received support from staff who understood and responded to their health needs.

People were very happy with the care and support they received. People said staff were kind and caring and offered support which met their needs and promoted their independence. They said this enabled them to live in their own home. Staff demonstrated a caring and respectful attitude towards people and knew people well and how they preferred their care to be delivered.

People were able to express their views and be actively involved in making decisions about their care. Staff were friendly and approachable. They were also respectful of people's dignity and privacy.

The service was well managed by the registered manager and a director of the provider company. Staff learning and development was supported. Regular audits and surveys were used to monitor the quality of the service.

People told us the support given by the agency met their needs and their dignity was respected whilst staff also promoted their independence. We heard examples of how people received personal care in a private and dignified manner. Comments included ''They are great, I've got the A Team, I couldn't ask for better', 'We have never had any problems, really good' and 'They are always very thorough and stay and chat, never rush, I've never known anyone to be late and I know who is coming which makes it easier'.

Care and support was well assessed and planned, with people being involved with deciding how their care should be delivered. Detailed plans were in place to minimise identified risks and ensure that staff had the information to meet people's needs. Staff showed us how they cared for people in an individualised way and identified changes in need in a timely way.

Clear and organised records were kept and there was a robust recruitment system in place followed by good communication and attention to staff welfare which had resulted in a stable, competent staff team. Staff said 'I work here because it is so lovely'.