TLC Homecare Limited

TLC Homecare Limited is a domiciliary care service which provides personal care to people in their own homes. The service provides support to adults with a range of care and support needs, including older people and people living with dementia. At the time of our inspection there were 168 people using the service.

Not everyone who used the service received the regulated activity of personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do receive personal care we also consider any wider social care provided. At the time of this inspection there were 131 people receiving personal care from the service.

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

People felt safe when receiving support from the service. Risks to people were assessed and managed well. Staff understood their responsibility to safeguard vulnerable people from abuse. People received safe and effective support with their medicines. There were suitable systems in place to control the spread of infections.

People were supported by staff they were familiar with and staff turned up to their care visits on time. People were complimentary about the service and the care they received. Staff were recruited safely to ensure they were suitable to work with vulnerable people. The provider used a variety of approaches to proactively recruit new staff, to ensure the service had enough staff available to meet people’s needs.

The provider promoted a person-centred, caring culture. They monitored the service to help ensure it provided safe, high-quality care. People, their relatives and staff had opportunities to provide feedback about the service. Staff were well-supported in their roles and they enjoyed their jobs. The provider had close links with other social care professionals and community health services so they could work in partnership with these organisations.

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 17 April 2019) and we identified a breach of regulation at that inspection. We subsequently completed a targeted inspection in November 2020. We found the service had improved and the provider was no longer in breach of any regulations, however, we did not re-rate the service at that time.

At this inspection we found the improvements made to the service had been sustained. The rating for this service has therefore improved to good.

Why we inspected

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

This report only covers our findings in relation to the key questions, ‘is the service safe?’ and ‘is the service well-led?’. For those key questions not inspected, we used the ratings awarded at the last comprehensive inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. 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 TLC Homecare Limited on our website at www.cqc.org.uk.

Follow up

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

TLC Homecare Limited is a domiciliary care agency. It provides personal care to people living in their own homes in the community. At the time of this inspection there were approximately 250 people using the service.

Not everyone who used the service received the regulated activity of personal care. The Care Quality Commission (CQC) only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where people do receive personal care, we also consider any wider social care provided.

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

People were happy with the support they received with their medicines. Staff followed detailed medicine management plans to ensure people were supported with their medicines in a safe way.

After the last inspection, the provider had enhanced their quality assurance process in respect of medicines management. This had led to improvements with the management of people’s medicines.

The provider and registered manager had good oversight of the service. This supported them to ensure people received good quality and safe care.

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 17 April 2019). At the last inspection we identified a breach of Regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider completed an action plan to show what they would do and by when to improve. At this inspection we found the provider had made improvements and they were no longer in breach of Regulation 17.

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice we served after the last inspection in relation to Regulation 17 (Good Governance) had been met.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question. As this was a targeted inspection, the overall rating for the service has not changed and the service remains rated requires improvement.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for TLC Homecare Limited on our website at www.cqc.org.uk.

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.

TLC Homecare Limited is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. At the time of this inspection there were approximately 350 people using the service.

People’s experience of using this service:

• Some people were happy with the support they received with their medicines, whereas others told us staff sometimes forgot to provide them with this support. We identified ongoing issues with the records staff made about the support they gave people with their medicines. We saw audits of medicines records accurately identified incomplete recording by staff of the support they had given people with their medicines. These audits had not been effective in preventing on-going issues with record keeping in this area. The provider had implemented a system to make the necessary improvements, however this had not been embedded at the time of this inspection. The service therefore remained in breach of Regulation 17; good governance. We have also made a recommendation about the recording of medicines support.

• We received mixed feedback from people about whether staff usually turned up on time and about the number of care workers they received support from so that they had a regular team of staff. The registered provider had implemented a system to monitor and improve the continuity of staff people received.

• When people started using the service, their needs were assessed and a care plan was developed which provided staff with clear guidance about the support they needed to provide to each person. People were involved in this process and their care records clearly highlighted their preferences. People’s care records were person-centred and they were updated if people’s needs changed or if they required a different level of support.

• Risks to people were appropriately assessed and staff were provided with clear guidance about how to safely support people whilst minimising any identified risks.

• Staff received a range of training which supported them to provide effective care to people. People using the service told us they thought staff knew what they were doing.

• People told us staff were kind and caring. People felt well-treated and respected by staff. Where people had regular care workers they told us they had developed positive relationships with them and staff knew their routines and how they wished to be cared for.

• 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. People’s capacity to make decisions about their care was assessed where appropriate, and any decisions made in people’s best interests were clearly recorded. We have made a recommendation about staff obtaining copies of Lasting Powers of Attorney granted by people using the service.

• The provider had a complaints policy in place which they regularly highlighted to people using the service. Where complaints were received, they were recorded, investigated and responded to. People told us they felt comfortable raising any issues or concerns with their care workers.

• People who used the service, their relatives and staff were provided with regular opportunities to provide feedback about the service. People were involved in reviews of their care. We have made a recommendation about how the service records this.

• Staff told us they felt well supported by their managers and could always contact someone if they needed any advice or to report any concerns. All staff knew how to recognise and respond to potential abuse and were confident their managers would act on any concerns they raised.

• Although staff felt supported, they did not receive regular supervisions or regular direct observations of their care practice in people’s homes, in line with the requirements set by the provider’s own policy. This issue had already been identified by the provider.

• A range of audits took place each month to check the quality and safety of the service provided.

• More information is in the full report.

Rating at last inspection:

At the last inspection the service was rated requires improvement (published 1 March 2018). We also identified a breach of Regulation 17; good governance. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safe and well-led to at least good.

At this inspection, we found some improvements had been made, however the service remained in breach of Regulation 17. This is the third consecutive occasion the service has been rated requires improvement.

Why we inspected:

This was a planned inspection based on the rating awarded at the last inspection.

Enforcement:

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up:

We will continue to monitor the intelligence we receive about this service until we return to visit as part of our re-inspection programme for those services rated requires improvement. 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 service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service mainly to older adults and to some people with physical and learning disabilities. At the time of this inspection there were approximately 620 service users.

TLC was last inspected in August 2016. It was rated as ‘Requires Improvement’ in the key questions of Safe, Effective, Responsive and Well-led, and ‘Good’ in Caring. We identified breaches of the regulations relating to safe care and treatment, consent and good governance. We asked the provider to complete an action plan to show what they would do and by when to improve the key questions to at least good.

At this inspection we founds some improvements had been made, however, this is the second consecutive time the service has been rated Requires Improvement.

The service had a registered manager. They had registered in July 2017 and were not present at the last inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

At this inspection we found concerns about the way medicines administration by care workers was recorded; there was no system in place to ensure records of people’s prescribed medicines were regularly updated.

One care worker’s records did not include details of their full employment history; all other recruitment records evidenced a robust system was in place.

Sufficient care workers were employed to cover people’s care visits and people told us they had continuity in terms of the care workers who supported them. We received some mixed feedback about people’s care visit times.

People told us they felt safe. Care workers could demonstrate their understanding of safeguarding procedures. Risk assessments had improved since the last inspection in August 2016, although work was underway to increase the amount of person-centred detail they contained.

Records showed, and staff told us, they received the training and support they needed to provide people with effective care.

The service was now compliant with the Mental Capacity Act 2005. This was an improvement from the last inspection in August 2016.

People received support with meal preparation in accordance with their needs and preferences. None of the people we spoke with needed assistance to make healthcare appointments, but said they felt able to ask for help if they needed it.

We received positive feedback about TLC from healthcare professionals involved with people who used the service. Records showed communications with the various TLC teams covering the wide geographical area were consistent and promoted effective team-working.

People and their relatives told us care workers were kind and caring. They also said care workers were respectful and mindful of their privacy and dignity at all times.

We heard staff going the extra mile to try and resolve an issue for a person. The service had a Christmas present scheme whereby care workers could nominate people in need of specific items or who would appreciate a treat.

Care workers supported people to retain their independence; records showed people had been involved in developing and reviewing their care plans.

The service had an open and inclusive culture whereby people were encouraged to express their diverse needs and preferences.

People’s care plans, with the exception of some for medicines, were up to date and contained person-centred information. Systems were in place to ensure care plans were reviewed regularly and the care planning process was constantly improved.

Records showed most complaints had been managed appropriately; we saw the registered manager had improved her oversight of complaints made when there had been a breakdown in communication and she had not been informed a complaint had been made.

The TLC management team and assessment and review officers were devising ways to improve the service’s responsiveness to people needing end of life care.

With the exception of medicines, the registered manager and registered provider had oversight of quality and safety at the service.

People, their relatives and staff had opportunities to feedback about TLC. The service had implemented innovative means of improving staff recruitment and retention, and had achieved accreditation for their commitment to improving employee health, safety and wellbeing.

The registered provider was in the process of launching a set of vision and values for the service developed with people using the service and staff.

TLC worked in partnership with other local stakeholder organisations.

We found one breach of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.”

The inspection took place on 9 August 2016, and was an announced inspection.

TLC Homecare is a domiciliary care service. The agency office is based in Barnsley.They are registered to provide personal care to people in their own homes in the Barnsley and Rotherham areas of South Yorkshire. At the time of our inspection the service was providing personal care for approximately 500 people. There were approximately 170 staff employed by the agency who were providing approximately 5990 hours of care each week..

There was a manager in place .It is a condition of registration with the Care Quality Commission that the service has a registered manager in place. 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.

Our check of medication records identified that medicines were not always safely managed and recorded. This meant that people accessing the service may not be protected against the risks associated with the unsafe management of medication.

Risk assessments for people who received a service were either missing or incomplete. Risk assessments which were present in the care plans did not provide detailed person specific information to mitigate the risks.

Some staff did not receive regular supervisions and appraisal .

Most people felt most staff were caring and respected their privacy and dignity. However there were examples where this was not the case.

People's needs had been assessed when they started to use the service but not all care plans were in place. Care plans were not all up to date and some had not been reviewed for some time.

Some people felt complaining did not improve the service they received as any concerns they raised weren’t acted upon.

There were some systems in place to assess and monitor the quality of service provided. However these were not effective or acted upon to ensure care provided was monitored, and that risks were managed safely, and the service achieved compliance with the regulations.

We found three breaches in the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were breaches in Regulation 12; Safe Care and Treatment, Regulation 11:Need for consent and Regulation 17 Staffing: Good governance.

You can see what action we told the provider to take at the back of the full version of the report.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes.

People who used the service told us that they were happy with the care and support they received at TLC Homecare. All people we spoke with were ‘happy’ with their care. Their comments included, "The girls[staff] are brilliant,” “No worries at all, the staff are all lovely,” “Staff are very, very good, they are kind, I wouldn’t be without them,” “They [staff] are like family, they are smashing,” and “I would recommend TLC to other people, all the staff I have come across are very good.”

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

People were cared for, or supported by, suitably qualified, skilled and experienced staff. The provider had appropriate and effective recruitment procedures in place.

The provider had an effective system to regularly assess and monitor the quality of service that people received.

We talked to five people who used the service and one relative by telephone during our inspection visit. People said that all the care staff spoke with them in a respectful way. People told us that their support was personalised to their needs.

People confirmed that members of staff came at the agreed time and provided care and support for the agreed period of time. Some comments captured included, “Staff are very polite and really good”, “Brilliant staff, really good” and “I couldn’t pick better care staff they are brilliant.”

People had a written plan of care that set out their identified needs and support and the actions required of staff to meet these.

We found that relevant training and support was provided to staff so that people's welfare and safety was promoted.

People told us that they felt safe, and if they had concerns they would speak with a manager at the agency’s office.

We contacted Barnsley Metropolitan Borough Council social services contracts and safeguarding departments. They said that they had no concerns or dissatisfaction with the care and support people had received from the service.