Twilight Years Limited

About the service

Twilight Years Limited is a domiciliary care agency. It provides personal care to people living in their own homes. The service supports people living in the Furness, South Lakeland and Carlisle districts in Cumbria. There were 180 people receiving personal care when we inspected.

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

Right Support: Staff focused on people’s strengths and promoted what they could do, so people had a fulfilling and meaningful everyday life. They supported people to make decisions following best practice in decision-making. Staff communicated with people in ways that met 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.

Right Care: People received person-centred care from staff who knew them well. The service had enough appropriately skilled staff to meet people’s needs and keep them safe.

Right Culture: Staff provided people with care, which met their needs and took account of their preferences. People and those important to them were involved in planning their care. People told us they would recommend the service.

People were protected from abuse. Staff were trained in how to identify abuse and how to report concerns about people’s safety. Risks to people’s safety had been identified and managed. Staff were trained in how to provide care in a safe way. There were enough staff to support people. Staff supported people, as they needed, to take their medicines. People were protected from the risk of infection. Staff were trained in infection control and used appropriate personal protective equipment. The registered manager had systems to ensure lessons were learned from any incidents to ensure the safety of the service.

The provider had introduced additional systems to seek people’s views and used feedback received to improve the service. Staff worked with other services which supported people, to ensure people received the care and support they needed. The provider usually notified us of significant incidents. We found they had not informed us promptly when two reportable incidents had occurred. They had introduced additional systems before our inspection to ensure notifications of incidents were provided promptly as required.

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

Rating at last inspection

The last rating for this service was good, (report published 19 June 2018).

Why we inspected

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

During our review we identified the provider may not have notified us promptly about significant incidents which had happened during the delivery of the service. We undertook a focused inspection to review the key questions of safe and well-led only.

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 good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Twilight Years 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.

Not everyone using the service receives regulated activity; CQC only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

At our last inspection of this service between June and August 2015 we assessed the overall rating to be good. However we assessed the key question of safe to be requires improvement. At this inspection in February and April 2018 the rating for the key question of safe had improved to good. We found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

At our comprehensive inspection of this service in 2015 we found a breach of legal requirements. Although people had been protected against the risk of harm, the records around medicines did not identify the medicines that people had taken. This meant it was not possible to check that people had been supported to take their medicines as their doctor had prescribed.

After that inspection the registered provider wrote to us to say what they would do to meet legal requirements in relation to the breach. At our inspection in February and April 2018 we looked at the actions the registered provider had taken and found that legal requirements had been met.

People were safe receiving care from the service. Hazards to people’s safety had been identified and managed. The staff understood how to protect people from abuse and harm.

New staff were recruited safely. All new staff were checked to ensure they were suitable to work in people’s homes.

There were enough staff to provide people’s care. The staff were trained to ensure they had the skills and knowledge to provide people’s care.

The registered manager and care staff worked with local health and social care services to ensure people received the support they required. People received their medicines safely and were supported, as they needed, to access local health services.

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 could refuse any part of their planned care and the decisions they made were respected.

The staff treated people in a kind and caring way. Care staff told us their visits were planned so they had time to spend with people and understood this was important in supporting people’s wellbeing. However, some people felt the staff were rushed and required more time to provide their care. This was discussed with the registered manager.

Care was planned and delivered to meet people’s needs. People who used the service were included in planning and reviewing their care.

The registered manager was supported by an office manager and team of care coordinators. People who used the service knew how they could contact a member of the management team if they needed.

The registered provider had a website which gave information about the services provided, how people could contact the agency and how people could raise a complaint. People had access to important information about the service.

The agency worked with appropriate services to support people who were reaching the end of their lives.

The registered manager had systems to monitor the quality of the service. People were asked for their views in formal and informal ways. Some people were not aware if any action had been taken in response to their feedback. We have made a recommendation about improving how information is shared with people about the actions taken in response to their comments.

Further information is in the detailed findings below.

People told us they knew how to contact the agency if they needed to. Where people had asked for a change to the service they received, they said this had been agreed.

Everyone we spoke with said they were able to refuse any part of their planned care if they wished.

Most of the people we spoke with told us they were happy with the care staff who visited them.

They told us,

'The staff are very good, I have never had any trouble whatsoever. I have regular carers and have been very lucky',

And said, 'My carers are very, very good, I couldn't ask for any better'.

Some people said that they were supported by a number of different care staff. They told us that, while they were generally happy with the care staff who visited them, they would prefer to receive support from care staff who they knew.