We carried out a themed inspection looking at domiciliary care services. As part of this programme of targeted inspection we asked people to tell us what it was like to receive services from this agency. The inspection was led by a Care Quality Commission inspector and involved using a person who has had direct experience of using the services of a domiciliary care agency. This 'expert by experience' took part in telephone surveys of people who used the agency and their findings were incorporated into this report.The inspection process included a visit to the office where we spoke with the registered manager. We reviewed care files of people who were using the service and supporting documentation about the standards of care they would expect to receive. Recordings concerning adverse incidents, complaints and quality were also looked at. We made visits to four people's homes and asked them or their relatives about the standards of care people were receiving. The Expert by Experience made 15 telephone calls to people or their relatives. During our visits to people's homes we held face to face discussions with three care workers and later conducted three telephone interviews with care workers.
Without exception the people we spoke with told us that care workers promoted their dignity and respect and they were able to influence how their care was provided. One relative who we asked if staff were respectful said:
'Oh yes always. They have developed a rapport with X, X likes that.'
People told us they were happy with the standards of care they received from care workers when they were in their homes. One person said:
'Very good, they are pretty good to me.'
We were told by some people that they received their care late because care workers had arrived later than the designated time and in some instances they did not arrive at all. This meant that people were not receiving safe or appropriate standards of care.
We were told that people who were using the service felt safe. They said that care workers carried identification with them so they could confirm who they were.
People told us the regular care workers knew what their needs were and they felt satisfied that care workers had received appropriate training to carry out their roles effectively. Some people told us they were dissatisfied with the high number of newly appointed care workers because the person would have to tell them what they needed to do for them.
People told us they were asked for their opinions about the quality of the services provided to them. We identified that there was a system in place for auditing and monitoring the quality of the services. However, there were gaps in the registered provider's processes for monitoring quality. We found that senior agency staff and the registered manager were failing to identify a trend of poor practices that had not been identified as, or treated as a formal complaint. There was evidence that formal complaints received were not being dealt with in appropriate way.