Archived: TLC - Domicillary Care Agency

At the time of our inspection 29 people were receiving a personal care service. These services were funded either privately or through Cornwall Council.

We carried out this announced inspection on 6 July 2017. The inspection was announced a few days advance in accordance with the Care Quality Commission’s current procedures for inspecting domiciliary care services. At the last inspection, in April 2015, the service was rated Good. At this inspection we found the service remained Good.

We visited some people in their homes, and spoke to some people and their relatives by phone to gain their views on the service. People told us they felt safe using the service. Relatives also said they thought the service was safe. Comments included, “I am very pleased with the service”, “Excellent service” and “I haven’t had any cause to complain.”

Staff treated people respectfully and asked people how they wanted their care and support to be provided. People and their relatives spoke positively about staff, commenting, “They are wonderful”, “The staff always have a smile and leave me with a smile”, “The carers are so helpful, kind, attentive”, “They are all excellent” and “I’d be lost without their support, they help me so that I can live in my own home.”

People had a team of regular, reliable staff, they had agreed the times of their visits and were kept informed of any changes. No one reported ever having had any missed visits. People told us, “Staff always turn up”, “If staff are running late they ring and let us know” and “I know all the carers.”

Staff were knowledgeable about the people they cared for and knew how to recognise if people’s needs changed. Staff were aware of people’s preferences and interests, as well as their health and support needs, which enabled them to provide a personalised service. Staff were appropriately trained to support people with their medicines when this was needed.

People had a care plan that provided staff with direction and guidance about how to meet people’s individual needs and wishes. These care plans were regularly reviewed and any changes in people’s needs were communicated to staff. Assessments were carried out to identify any risks to the person using the service and to the staff supporting them. This included any environmental risks in people’s homes and any risks in relation to the care and support needs of the person.

Staff were recruited safely, which meant they were suitable to work with vulnerable people. Staff had received training in how to recognise and report abuse. All were clear about how to report any concerns and were confident that any allegations made would be fully investigated to help ensure people were protected. Staff received appropriate training and supervision. New staff received an induction, which incorporated the care certificate. There were sufficient numbers of suitably qualified staff available to meet the needs of people who used the service.

The service was acting within the legal framework of the Mental Capacity Act 2005(MCA). Management and staff understood how to ensure people who did not have the mental capacity to make decisions for themselves had their legal rights protected.

There was a positive culture within the staff team and staff spoke passionately about their work. Staff were complimentary about the management team and how they were supported to carry out their work. The registered and deputy managers were clearly committed to providing a good service for people. Comments from staff included, “It’s a lovely company to work for. The managers are very approachable,” “It’s like a small family unit” and “ I love working for TLC and have recommended it as a place to work.”

People and relatives all described the management of the service as open and approachable. Comments from people included, “The service is well managed”, [Manager’s name] is very good” and “Excellent organisation; I can’t think of any area that they could do better.”

There were effective quality assurance systems in place to help ensure any areas for improvement were identified and action taken to continuously improve the quality of the service provided. People told us they were regularly asked for their views about the quality of the service they received. People had details of how to raise a complaint and told us they would be happy to make a complaint if they needed to.

During this inspection we found that a new care planning system had been introduced, staffing levels had increased and all staff had been provided with a weekly rota of care visits. Staff told us they revived their rota 'every Monday', 'we have a lot more staff now' and 'the workload is manageable and reasonable'.

We reviewed the care records for 13 people who used the service. We found care visits had been provided at agreed times, were of the correct duration and that the quality of daily care records had improved.

We spoke with seven members of staff during the inspection. their oppinions were devided. Some staff reported that they were happy and enjoyed their jobs while others told us'moral is a bit poor at the minute' and 'things are very very stretched'.

People's views and wishes in relation to the timing of their care visits had not been respected.

Care was not planned and delivered in a way that was intended to ensure people's safety and welfare.

There were enough qualified, skilled and experienced staff to meet people's needs.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

The provider did not have an effective system in place to assess and monitor the quality of care provided. The system of visit planning was not sufficiently robust to protect people who used the service from risks associated with missed care visits.

People told us the staff who visited them were usually good timekeepers, but this could be a problem sometimes. People said it was usually the same carers who visited them, and they had no complaints about the staff as individuals or the care provided. People said they had confidence in the agency, and comments included: 'the staff are lovely', 'I am happy with the service', and 'the staff are always polite and professional'.

People told us they were aware of their care packages, and we found the care provided met people's expectations and needs. People were protected from abuse, and the staff were supported by training and supervision.

People were protected from the risk of infection and from unsafe or unsuitable equipment.

Care documentation showed some variation in the level of detail provided.