Archived: Torcare Domiciliary Service

The inspection was announced and started on 10 December 2018 and ended on 19 December 2018. The provider was given 48 hours' notice because the location provides a domiciliary care service and we needed to be sure that someone would be available in the office. It also allowed us to arrange to visit people receiving a service in their own homes.

Not everyone using Torcare Domiciliary Service received a 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 the time of the inspection there were 13 people receiving personal care.

There was a new manager in post who had submitted their application to become registered with the Commission. 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.

At our last inspection in December 2017 the service was rated requires improvement, because people’s medicines were not always managed safely and the provider did not have effective systems in place to monitor the quality and safety of the service. The provider submitted an action plan to the Commission detailing how they would make changes. At this inspection we checked to see if action had been taken, and found that improvements had been made. Therefore, the service has been rated Good overall.

People’s medicines were now managed safely and they had detailed care plans in place.

People told us they felt safe when staff were in their homes. People were protected from abuse because staff knew what to action to take if they were concerned about a person’s safety.

Overall, people were supported by staff who had been recruited safely to help ensure they were suitable to work with vulnerable adults. People told us there were enough staff to meet their needs, but the new manager was aware that some people had experienced some late and missed visits. They had therefore made this area a priority to make the necessary improvements.

In the event of adverse weather or significant staff sickness, the provider had an emergency staffing contingency plan which helped ensure people still received support, in such circumstances.

People’s risks associated with their health and social care were documented and known by staff, and environmental risks were assessed to help keep staff safe when working in people’s own homes.

People were protected by infection control practices.

People and their relatives told us their needs were met by staff who had received suitable training. When new staff joined the organisation, staff received an induction to help ensure they got to know each person, and were introduced to relevant policy and procedures. The providers induction followed the principles of the Care Certificate. The Care Certificate is a national induction training programme introduced to support all staff new to care to obtain a basic level of understanding of good care standards. Staff received supervision of their practice to help monitor and ensure ongoing high standards.

The provider had considered the Accessible Information Standard (AIS) in the delivery of the service. The AIS aims to make sure that people who have a disability, impairment or sensory loss get information that they can access and understand. For example, people’s individual communication needs were understood by staff, and some records had been adapted to help people to understand them better.

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.

The provider worked with external agencies when they were concerned about changes to a person’s health. When required, people were effectively supported with their nutrition.

People told us staff were kind and caring and staff were respectful of their privacy and dignity. People told us they were involved in their care, and staff consulted with them about what they wanted and needed at each visit.

People’s individual equality and diversity was respected. The service had a culture which recognised equality and diversity amongst the people who used the service and staff. Staff were sensitive and respectful to people’s religious and cultural needs. People were not discriminated against in respect of their sexuality or other lifestyle choices.

People received personalised care. People’s care plans had been redesigned with them. They were regularly reviewed to help ensure they received care which met their needs, and was delivered in line with their wishes and preferences. People who were at the end of their life received compassionate and individualised care.

People had a copy of the provider’s complaints policy, which they were given in their welcome pack when they joined the agency. When people had complained, the manager and provider had politely apologised and used people’s complaints to help improve the service. The manager and provider were pro-active and outward thinking which helped ensure learning took place when things went wrong. The provider had strengthened their quality assurance processes, meaning that the service was now effectively monitored to help ensure its ongoing quality and safety.

People told us the service was well managed. Staff were complimentary of the new manager, telling us that they felt “listened to”, “valued” and part of the ongoing development of the service.

The new manager told us they felt well supported and received informal and formal supervision of their practice and leadership, from the providers nominated individual.

The provider and manager promoted the ethos of honesty, learning from mistakes and admitted when things had gone wrong. This reflected the requirements of the Duty of Candour. The Duty of Candour is a legal obligation to act in an open and transparent way in relation to care and treatment.

There was a strong ethos of care and compassion within the service, despite the provider not having a formal set of values that underpinned the care and quality of the service. The provider told us they would commence undertaking a piece of work with people, families and staff to design meaningful values for the service.

There was a whistleblowing policy in place and staff told us that they would not hesitate to report poor staff conduct to the manager, so that action could be taken.

The provider worked in partnership with external agencies in an open and transparent way, for the benefit of people, and there was continuous learning taking place to help facilitate improvement.

Further information is in the detailed findings below.

The service provides help with people’s personal care needs in Torpoint and surrounding areas. The service supports some people who may require support with personal care needs at specific times of the day and/or night. At the time of the inspection 24 people were receiving support with their personal care needs.

There was a manager in place who also had responsibility for a residential home owned by the same company. They had been in post for three weeks and were in the process of registering with the Commission. 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.

Medicines were not always managed safely. The level of support people required to take their medicines safely was not always recorded in their care plan. Staff had not all received the correct training to provide the level of support some people required to take their medicines. This meant they might not be following best practice when providing this support. Medicines administration records (MARs) were not always completed fully which meant it was not always clear whether people had had their medicines or not.

People did not always have risk assessments in place to guide staff how to reduce risks to them or how to identify that their specific health risks may be affecting them.

The provider had not ensured records relating to people’s care were monitored effectively to help ensure they covered all of people’s up to date needs.

People and their relatives spoke highly of the staff and the support provided; and told us staff had the knowledge and skills to meet their needs. Comments included, “The staff are very good, exceptional.” People were supported by staff who treated them with care and compassion. Comments included, “The staff are lovely. I wouldn’t be without them.”

There were sufficient numbers of suitably qualified staff to meet the needs of people who used the service. People reported receiving care from a consistent staff team who had got to them know well and helped them maintain their independence.

People had care plans in place which gave staff guidance about the support they needed and their preferred routines. People told us they were able to make choices about how their care was delivered and knew how to raise a concern or a complaint.

People told us they felt safe using the service. Staff were recruited safely and had received training in how to recognise and report abuse. They confirmed they were confident any allegations would be taken seriously and investigated to help ensure people were protected.

Staff knowledge and skills were regularly updated to help ensure they remained aware of best practice. The manager and staff had received training about the Mental Capacity Act 2005 and knew what action to take if they suspected someone was losing their capacity to make their own decisions.

There was a positive culture within the service. The provider had clear visions, values and enthusiasm about how they wished the service to be provided and these values were shared by the whole staff team. People were consulted regularly for their views of the service and given opportunity to suggest improvements. Information was used to aid learning and drive improvement across the service. People and their relatives told us the management team were approachable.

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