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Archived: TOB Care services Ltd

Overall: Inadequate read more about inspection ratings

The Senate, Southernhay Gardens, Exeter, Devon, EX1 1UG 07861 792958

Provided and run by:
TOB Care Services Ltd

All Inspections

9 February 2022

During a routine inspection

About the service

TOB Care Services Ltd is a domiciliary care service, supporting adults in the community who require assistance with personal care. This included people living with dementia, physical disabilities, mental health needs and sensory impairments. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. At the time of our inspection there were seven people using the service.

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

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

There were inadequate risk management processes in place to ensure people received safe care and support. Initial assessments and ongoing assessments of need were inadequate to clearly detail how to support people who had risks identified. For example, risk of falls, malnutrition and dehydration, catheter care, skin damage and accessing people’s properties.

The provider was accepting new packages of care without having done any assessments to check the service could meet people’s care and support needs. This had led to the provider having to hand back a package of care which did not provide consistent support to people.

There weren’t always written care plans or risk assessments for staff to follow in line with best practice. There was a lack of appropriate recording of incidents for example when someone developed blisters (which became infected) from their catheter. The involvement of medical professionals wasn’t recorded.

The provider had failed to record falls, incidents and accidents or to notify other health and social care professionals to ensure people were receiving safe care and support. This did not demonstrate that the service had oversight of issues affecting people’s care and support needs to ensure they received a safe service.

People were not protected from abuse and improper treatment as systems and processes were not established and operated effectively. The provider did not demonstrate an understanding of their safeguarding role and responsibilities or the importance of working closely with commissioners, the local authority and relevant health and social care professionals on an on-going basis. Policies did not give staff clear instructions to ensure they provided safe care. It was not clear whether staff had received safeguarding training to ensure they had up to date information about the protection of vulnerable people.

Recruitment practices were not safe. There was limited or no recruitment documentation in place, and what was available was incomplete. The provider was not able to be clear with us about who they had employed and when they had started or ceased working for the service.

Staffing arrangements did not match the support commissioned by the local authority. People’s preferences with regard to visits were not decided by them, nor in line with hours commissioned by the local authority. This did not demonstrate a service providing care and support in line with both people’s preferences and commissioned hours.

Medicines management was not robust. There was little evidence that staff had received medicine training and competency assessments to ensure they were competent to carry out this task. Neither was there any written evidence that the provider had checked medicine practice whilst working with staff in the community and via records.

Infection control practices were not safe. Not all staff had received training in infection control, which meant we could not be assured that staff were following good hygiene practices during care and support.

People’s legal rights were not protected because staff did not know how to support people if they did not have the mental capacity to make decisions for themselves. People’s capacity to make decisions about their care and support were not assessed on an on-going basis in line with the Mental Capacity Act (MCA) (2005).

The providers systems to assess people’s needs and develop care plans were ineffective. The information in care plans was inconsistent and did not reflect the information in assessments. The provider did not have the relevant knowledge and skills to ensure care was delivered in line with standards, guidance and law. There was a lack of relevant training and seeking involvement from health and social care professionals. This did not enable the provider to support people and provide them with evidence-based care and support according to their individual needs. We were not assured of the provider’s competence at meeting people’s health care needs with appropriate/timely liaison with health professionals.

Not all staff had the right skills to make sure people received compassionate support and have enough time to get to know them as individuals, including having enough time to enable them to understand people’s care and support needs, wishes, choices and any associated risks.

People were not always supported in a way that made them feel like they mattered. People were not treated with dignity and respect and staff did not see people’s privacy and dignity as a priority.

People did not receive care and support which was person-centred and took account of their needs and wishes. Staff did not always adopt a positive approach in the way they involved people and did not respect their independence. The provider was unable to give any information to us about how the service respected people’s diversity and any arising needs.

The service was unsafe, ineffective, uncaring, unresponsive and was not well-led. A whole service safeguarding enquiry was in progress with the local authority. A suspension of local authority placements was in place, and the provider agreed a voluntary suspension of new private placements.

The provider had not recognised the quality of the service placed people at risk of unsafe care. The provider did not have adequate systems in place to monitor and review the quality of care and ensure the service was meeting people's needs. This demonstrated a failure to understand their responsibilities of their registration and in line with regulations.

Following our inspection we made safeguarding alerts to the local authority and action was taken to move packages of care to alternative providers.

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

Rating at last inspection

This service was registered with us on 8 June 2021 and this is the first inspection.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

The inspection was prompted in part due to concerns received from the local authority about a complex package of care being handed back to them, poor care planning, a lack of robust recruitment, a lack of relevant policies and procedures, a lack of understanding of the Mental Capacity Act and the provider’s poor understanding of regulations and legislation. A decision was made for us to inspect and examine those risks.

Enforcement

We will continue to monitor the service and will take further action if needed.

We have identified six breaches in relation to safe care and treatment; person-centred care; need for consent; good governance; staffing and fit and proper persons employed.

Please see the action we have told the provider to take at the end of this report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for TOB Care Services Ltd on our website at www.cqc.org.uk.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe, and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it, and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.