Archived: Tabitha Home Care Limited

Tabitha Home Care is a domiciliary care service providing personal care or support to 152 people living in their own home.

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 and daily living activities that people may require support with.

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

The service had experienced a period of change since the last inspection. A new management team was now in place, including a new registered manager who was also the provider. Progress had been made to address the concerns we highlighted at the last inspection.

People told us they felt comfortable with the staff who supported. The provider recruited and retained a more consistent staff team so that people could develop relationships with staff that know them well. The provider was following safe recruitment procedures and people were now receiving support from the same care staff.

Staff monitored people’s health needs and worked well with healthcare professionals to ensure people received the right support.

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 his practice.

Staff treated people with care and respect and understood how to promote people’s dignity and independence. People had mixed views about their call times, most people spoken with told us their calls where within the time framed agreed. Some people told us they arranged times with staff to come early or later and some people told us that their calls were late or early.

Where staff supported people with their medication, records were not always signed by staff to confirm people had taken their medication. The providers monitoring systems had not identified that there were omissions in medication records. All people spoken with who had support with their medication told us that no medication had been missed.

Support plans had been reviewed and updated and were now a more accurate reflection of people’s wishes and preferences.

Recently new systems for monitoring the service had been introduced since the last inspection. The provider had also registered as the registered manager. This meant that some concerns were being picked up more promptly and action taken. However, more time was needed to ensure these systems were fully embedded, so improvements could be sustained.

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 requires improvement with a breach of Regulation 17 good governance (published 23 August 2018). 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 a planned inspection.

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.

Tabitha Homecare Ltd provide care to people in their own homes. Approximately 187 people were in receipt of personal care at the time of our inspection. This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community.

When we last inspected the service in September 2017 we rated the service Good overall with Requires Improvement in Well led. At this inspection, some of the improvements we recognised last time had not been sustained and further improvements required were identified.

A registered manager was in not in post and had left shortly before this inspection. 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. The service was managed by a director of the service.

People felt safe with staff in their home who they knew and felt comfortable to be with. Staff understood how to report concerns to the office based staff who would follow up their concerns.

Risks assessments were completed for staff to refer to and these had been reviewed and updated where appropriate. The registered provider had begun the process of electronically monitoring calls although this was not embedded across all of the service, people were not consistently experienced calls at their agreed time. Staff recruitment included background checks so the registered provider understood if staff were suitable to work at the service. Where a person’s needs had changed the information was shared with staff so they were able to implement changed where needed.

People were supported by staff that had access to supervision but their training was not always planned to ensure they received it in a timely way. Staff had not consistently received training to maintain their skills and knowledge support people with their medicines in a safe manner.

People were supported to maintain a healthy diet through the choices of meals and drinks staff offered them. People were supported to access support from healthcare professionals where this was appropriate. People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

People knew and liked the staff supporting them because they saw staff regularly. People made decisions about their day to day care. People were treated with dignity and respect. Staff understood what it meant to individual people in terms of maintaining their dignity.

People were involved in discussions about planning their care. People understood how to complain and understood the process for doing so. The registered provider had a system in place for recording communication with people however so that concern were responded to. However, concerns were not always investigated to understand the causes of complaints so that trends could be identified.

The registered provider’s system for reviewing and improving people’s experience of care could not always be evidenced. Staff training had not been monitored to ensure training was up to date. Negative feedback received had not been analysed to ensure trends could be monitored to prevent any repeats.

Whilst staff were positive about their feedback about the registered provider, it was not clear how systems were embedded to continually improve people’s experience of care. There were also missed opportunities to improve people’s care through better relationships with training providers.

Further information is in the detailed findings below.

At our last comprehensive inspection of the service in June 2016 we found the provider to be in breach of two regulations relating to recruitment practices and the governance of the service. A warning notice was issued due to our continued concern about the governance of the service; we also held a meeting with the provider to allow them the opportunity to outline how they intend to make the necessary improvements. We conducted a focussed follow up inspection in relation to these two breaches in October 2016 and found the provider had made adequate improvements. However as at that time there was insufficient evidence that these improvements had been sustained, the provider kept their Requires Improvement rating issued in April 2016.

Tabitha Home Care Limited is registered to deliver personal care to people living in their own homes. The service provides support to younger and older adults who may have dementia, a learning disability or autistic spectrum disorder, a mental health condition, an eating disorder, physical disabilities or a sensory impairment. At the time of our inspection 164 people received personal care from the provider.

The service had a manager in place since January 2017 and who had commenced the process of registering with us. The previous registered manager withdrew their registration with us in February 2017. 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.

Pre-employment checks were in place, such as Disclosure and Barring Service (DBS) checks to ensure care staff were suitable to work with vulnerable groups. People using the service were supported safely and protected by care staff. Assessments were conducted to highlight any obvious areas of risk relating to care delivery. Care staff were aware of the various types of abuse people might experience and understood their responsibility to report any concerns they had. Effective checks on records relating to the administration of medicines and care staff competence were undertaken.

On the whole people were satisfied with the care they were provided with although they were not always confident that care staff had sufficient levels of training. Records we reviewed in relation to training provision demonstrated that a number of care staff had outstanding training requirements that they needed to attend and/or be provided with. New care staff received an adequate induction which involving shadowing more experienced senior care staff. Care staff were supported and supervised well. Care staff sought people’s consent before supporting them. People were appropriately supported to eat meals of their choice and to drink sufficient amounts.

People were supported by friendly and caring staff. Care staff gave people time by listening to them, and reassuring them. Care staff supported people well and were mindful of their preferences for how they wished to receive support. People were listened to and were provided with the information they needed and were consulted about their care. Care staff behaved respectfully towards people and promoted their independence.

People received care that was appropriate to their needs from care staff. Care staff were knowledgeable about people’s needs and demonstrated they knew the importance of personalised care. Care staff had the most up to date information about people’s support that was in line with their preferences. People’s care was reviewed regularly to ensure it met their changing needs. Complaints received by the provider were acknowledged, investigated and responded to in line with their own policy.

The provider had made significant improvements in relation to the quality assurance of the service; however some areas such as staff training and the timing of calls remained lacking. The provider was keen to actively involve people to express their views about the service provided. We saw that information about any changes to practice following incidents was cascaded to staff in a timely manner. Care staff were well supported and were able to speak openly and honestly to the management team.

We carried out a comprehensive inspection of this service on 2, 10, 13 and 14 June 2016. Breaches of legal requirements were found. These related to there being insufficient provider oversight and quality monitoring systems in place and unsafe recruitment practices. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We undertook this focused inspection to check that they had followed their action plan and to confirm that they now met the legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Tabitha Home Care Limited on our website at www.cqc.org.uk.

Tabitha Home Care Limited are registered to deliver personal care. They provide Domicillary care to people living in their own homes. People who used the service had a range of support needs. At the time of our inspection 180 people received personal care from the provider.

There was a registered manager in post. 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.

The provider had taken action and the legal requirements had been met.

Staff provided all the appropriate documentary evidence so the provider could carry out the necessary checks of their fitness to work with people using the service. Systems in place were audited and overseen by the provider to ensure safe practice in recruitment practices were maintained. The appropriate criminal records checks, identification documents, references and full employment history were sought and/or undertaken by the provider.

The provider had effective quality monitoring systems in place to support their oversight and effective governance of the service. A management meeting was held each week and attended by senior staff which enabled planning in terms of quality checks due/undertaken and to review action plans in place as a result of any issues identified.

People were satisfied with how they were responded to and the communication they received form office staff when any unforeseen delay was likely to occur in them receiving the support they needed. Records in relation to the risks staff needed to be aware of when supporting people had been reviewed and updated.

Tabitha Home Care Limited are registered to deliver personal care. They provide Domicillary care to people living in their own homes. People who used the service had a range of support needs. At the time of our inspection 196 people received personal care from the provider.

The service had a registered manager. 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.’ The registered manager was on leave on the day of our inspection, so we were supported to gather the evidence we needed by the directors and deputy manager.

The provision of medicines was not monitored effectively within the service. Assessments that had been undertaken to identify any issues that may put people using the service at risk had not been updated in a timely manner.

Incidents that occurred within the service were not recorded and investigated proactively by the provider or reported to external professional bodies as necessary. People had experienced delays in receiving the support they needed and responses to this from the provider did not demonstrate they were caring. Recruitment practices at the service were not robust.

Staff were provided with and completed an induction before working for the service. Staff had access to supervision but the formal provision of this by the provider was irregular. Staff had received training and people felt the support they received was delivered well. Staff had received training and were knowledgeable about the importance of gaining informed consent from people.

People were supported with their nutritional needs by carers. People were supported to access the healthcare they needed by staff as necessary. Care plans contained information about people’s abilities, preferences and support needs, but these were not reviewed in a timely manner.

People valued the service provided to them and were complimentary about the caring and kindness shown to them by staff. People described how staff acted in a way that maintained their privacy and dignity whilst encouraging them to remain as independent as possible. People were supported to take food and drinks in sufficient quantities to prevent malnutrition and dehydration.

The provider sought people’s feedback about the service questionnaires and phone contacts about the quality of the service. Systems in place for the investigation and responses in relation to complaints received were lacking. Responses to concerns raised were not always to people or their relative’s satisfaction.

The provider failed to provide evidence that they had a clear oversight of the service through regular auditing and effective quality assurance systems. The provider did not have the structures in place to support effective monitoring of the safety of the service.

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