Town and Country Care Services Limited

Town and Country Care Services Limited is a domiciliary care service providing personal care to people living in their own homes. The service provides support to older people, people with dementia, people with physical disabilities and younger adults.

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 43 people using the service. 38 of these received personal care.

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

Systems in place for recording the administration of medicines were not robust. We identified gaps in the records. Action taken to address the issue had not been effective.

Risks associated with people’s health were documented and staff had clear guidance on how to mitigate known risks. They had received appropriate training to provide them with the skills and knowledge required to support people safely.

There were enough staff to support people in line with their identified package of care. Staff had been recruited safely. Before starting work independently, new staff completed shadow shifts to help ensure they understood people’s needs.

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.

There were systems in place to gather people’s views of the service. People and staff told us their opinions were sought out and taken into account.

The management team were described as “open and available.” People were highly complimentary of managers and the wider staff team.

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 2 November 2022). At this inspection we found the provider remained in breach of regulations.

At our last inspection we recommended that improvements were made to the way in which the administration of medicines was recorded. At this inspection we found actions to make improvements had not been effective.

Why we inspected

We carried out an announced comprehensive inspection of this service on 29 September 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve recruitment processes, staff training and oversight of the service.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

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

Enforcement and recommendations

We have identified a breach of regulations in relation to the recording of the administration of medicines.

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

We have made a recommendation about monitoring and auditing systems.

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.

Town and Country Care Services Limited is a domiciliary care service providing personal care to people living in their own homes. The service provides support to older people, people with dementia, people with physical disabilities and younger adults. At the time of our inspection there were 33 people using the service.

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. 29 people were in receipt of personal care at the time of the inspection.

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

Some people had health conditions which were not included in the care planning system used by the service. No care plans or risk assessments had been developed to provide staff with the appropriate information and guidance. The registered manager took immediate action to start updating the care plans in place.

Recruitment systems were not robust, application forms did not request all the relevant information. References had not always been followed up.

Training identified as necessary by the service had not been completed by all staff. New staff completed shadow shifts before working independently. Staff told us they were well supported by managers and there was a strong sense of team working.

We identified shortcomings in how the administration of medicines were recorded. We have made a recommendation about this in the report.

There were enough staff to cover all planned visits. People told us staff were caring and unhurried in their approach. People were supported by staff they knew and who were familiar with their needs.

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.

There was a strong community based ethos. The service supported people to be active members of the local community.

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 20 August 2021 and this is the first inspection.

Why we inspected

We inspected this service in order to provide a rating for this previously unrated service.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to staffing, recruitment and management of the service. We have made a recommendation about the recording of the administration of medicines.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.