Background to this inspection
Updated
15 August 2023
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
Inspection team
This inspection was carried out by 2 inspectors and 2 Experts by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.
Registered Manager
This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.
At the time of our inspection there was a registered manager in post.
Notice of inspection
We gave the service 48 hours’ notice of the inspection. This was because it is a small service and we needed to be sure that the provider or registered manager would be in the office to support the inspection.
Inspection activity started on 20 July 2023 and ended on 25 July 2023. We visited the location’s office/service on 20 July 2023.
What we did before the inspection
The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We reviewed action plans sent since the previous inspection. We used all this information to plan our inspection.
During the inspection
We spoke with 4 people who used the service and 12 of their relatives about their experience of the care provided. We met with the registered manager, business manager, accounts and marketing manager and spoke with 9 care workers. We looked at written records, which included 11 people's care records and 3 staff files. A variety of records relating to the management of the service were reviewed.
Updated
15 August 2023
About the service
Town and Country Homecare is a domiciliary care agency providing personal care to people in their own homes. The service was supporting 90 people at the time of inspection, including older people, those living with Dementia and people with a physical disability.
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.
People’s experience of using this service and what we found
People and their relatives told us they felt safe using the service and care staff knew how to report concerns of abuse.
Since our last inspection improvements had been made to safely manage and mitigate risks to people. New risk assessments were implemented where necessary and were reviewed regularly. People were receiving their medicines safely and improvements had been made to the recording and oversight of medicines management. Care staff were recruited safely and people were positive about the care they received from staff that knew them well.
Improvements had been made to people’s care plans. They had been reviewed and updated to ensure relevant and up to date information was available for staff to follow. Where people experienced heightened emotions, care plans were implemented to help staff to support them in the best way. Staff training delivery had been changed to a new online system and staff were positive about this change. Lots of training had been made available to help meet people’s needs more effectively. People were supported to eat and drink to maintain a healthy diet.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
People and their relatives were happy with the care and the support they received from the service. They told us staff were kind and caring. People were supported to remain independent and had their dignity respected at all times.
People were involved with their care plans and had reviews carried out with the management team since our last inspection. People felt more involved and care plans were updated and implemented where necessary to provide personalised care. Care plans to help people to talk about end of life care had been implemented and care staff were now receiving training to help support people receiving palliative care.
A new quality assurance system was put in place to ensure effective oversight of the service. Audits were now being carried out on a variety of areas such as medicines and care people are receiving through care notes and charts. Accidents and incidents were also being analysed and reviewed for patterns and trends. Feedback had been sought through questionnaires and actions taken. Meetings were now being carried out with the staff to improve communication. People, relatives and staff were all positive about the management team. Care staff felt supported by their manager and felt confident to raise concerns.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was requires improvement (published 24 February 2023) and there was a breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.
Why we inspected
This inspection was carried out to follow up on action we told the provider to take at the last inspection.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.