Total Community Care

Total Community Care is a domiciliary care agency providing support to people living with spinal injuries and neurological conditions in their own homes.

At the time of inspection, the service was providing support to 47 people across the country.

The last rating for this service was requires improvement (published 16 September 2021) and there were breaches of regulation resulting in a warning notice being served. The provider completed an action plan 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.

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

The management of medicines had improved since the time of the last inspection. Records were being kept of medicines administered and there were systems in place to check they were being administered safely. When people took control of managing their own medicines, records did not always reflect prescribing guidelines. This was actively being reviewed and addressed to protect the person and the staff supporting them. Staff were knowledgeable of medicines administration processes and supported people to lead their support making the process person centred.

Staff were committed to provide person centred care and records reflected people’s needs and wishes. Risks were assessed and managed appropriately.

Staffing problems challenged the provider when aiming to provide consistency. The provider was actively recruiting and reviewing staffing terms and conditions to assist with retaining staff.

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.

The service was well-led. Staff felt supported by their managers. The structure of management provided layers of leadership and at all levels immediate managers were supportive and approachable.

The registered manager had quality assurance processes in place to monitor the quality of the service provided and audits identified areas where improvements were required. The provider listened to feedback and produced action plans for change.

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.

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. There were concerns about medicines management and leadership and governance. The overall rating for the service was requires improvement.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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 Total Community Care 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 reinspection programme. If we receive any concerning information we may inspect sooner.

Total Community Care is a domiciliary care agency providing support to people living with spinal injuries and neurological conditions in their own homes.

At the time of inspection, the service was providing support to 75 people ranging in age from 20 to 80 across the country.

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

Medicines were not always administered safely. We found some people were being administered medicines without necessary documentation being in place. This placed them at risk of potential harm as staff did not have the appropriate guidance about how to administer medicines.

Daily records were not always completed which placed people at risk of not having their needs met consistently.

Staff were passionate about providing person centred care and provided support in a way that empowered people.

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 did not always support this practice.

The service was not always well-led. Whilst staff felt supported by their colleagues and management, systems were not robust at identifying areas that needed improvement or to drive consistency with how care was provided.

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 good (published July 2019).

Why we inspected

We received concerns in relation to how some people’s complex care needs were being met. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Total Community Care on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to how people received their medicines, and how daily records were kept. We also found breaches in how the service was led and governed at this inspection.

Please see the action we have told the provider to take at the end of this report.

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.

Total Community Care is a domiciliary care agency providing personal care to people living with spinal injuries or neurological conditions in their own homes throughout the United Kingdom. At the time of the inspection 55 people were receiving personal care.

People continued to be cared for safely and with compassion. Staff were appropriately recruited and there were enough staff to provide care and support to people to meet their needs.

Medicine systems were organised, and people were receiving their medicines as prescribed. The provider needed to strengthen the systems in place where people chose to administer their own medicines. We have made a recommendation about medicines management.

Staff had access to the support, supervision and training they required to work effectively in their roles. People's needs were assessed prior to them receiving the service to ensure that staff were able to fully meet their needs. Staff supported people to have a healthy balanced diet.

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 systems in place for recording mental capacity assessments required strengthening; we have made a recommendation about mental capacity assessments.

Staff were caring, person centred and inclusive. People were treated with kindness, dignity and respect and staff spent time getting to know them and their specific needs and wishes.

People had personalised plans of care in place to enable staff to provide consistent care and support in line with people’s personal preferences. Staff encouraged people to follow their interests and people were supported to access many varied activities and interests.

Information was provided to people in an accessible format to enable them to make decisions about their care and support. People knew how to raise a concern or make a complaint and the provider had implemented effective systems to manage any complaints received.

There was no end of life care being delivered at the time of the inspection. However, the provider’s policies required further development to detail the support that staff would provide to people in preparing for the end of their life. We have made a recommendation about end of life care planning.

The service had a positive ethos and an open culture. The management team were approachable, understood the needs of people, and listened to staff. People that used the service and their relatives had the opportunity to feedback on the quality of the support and care that was provided. Any required improvements were undertaken in response to people's suggestions. There were effective systems in place to monitor the quality of the service and drive improvements.

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 (published 19 November 2016).

Why we inspected

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

Total Community Care is a domiciliary care service providing care and support to people with spinal injuries and neurological conditions supporting them to live in their own homes. The office is based in Kibworth Harcourt, Leicestershire. The service provides support to people nationwide. They operated a bespoke model of care which was centred on the individual that received the care and support. At the time of our inspection there were 54 people using the service.

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 feedback we received from people who used the service, their relatives, care staff and other professionals was consistently positive highlighting a person-centred care provision.

People’s care was planned and designed to meet their individual needs and preferences. The care they received reflected their preferences and was responsive to their needs. This enabled people to achieve positive outcomes in their health and general wellbeing. This also supported them to be active members of society.

People were safe from harm because staff understood their responsibility to keep people safe from avoidable harm. They were knowledgeable about the support that people required to manage their health conditions safely and provided this in a prompt manner.

The provider had robust systems in place to assess and manage the risks associated with people’s care. This guided staff to respond effectively in varying situations and emergencies including relieving people of any discomfort that may be associated with their health needs.

The provider had a person-centred approach to staff recruitment which ensured that people were supported by staff who had the right skills and experience, and met the preferences of people who they would support. There were enough staff readily available to meet people’s assessed needs in a timely manner.

Staff had the relevant skills they required to meet people’s needs effectively. People that used the service were empowered to be involved in training their care staff on their personal requirements for the care that they received. The provider employed specialist qualified staff who supported staff to meet people’s changing needs.

People were supported to be in control of their care packages. They were supported to make their own decisions in accordance with relevant legislation and guidance.

Staff provided people with effective support to manage their health and social care needs. They were knowledgeable about people’s health conditions. They worked proactively with health professionals and ensured that people had prompt access to health services when required.

Staff were kind and compassionate to people. They treated them with utmost dignity and respect. They were empathetic about the needs of people that received round the clock care and ensured that they provided opportunities for people to have privacy. They treated people’s information confidentially and supported people to be independent as possible to minimise risks of intrusion.

People received support that was focused on achieving positive outcomes for them. They were empowered to participate in daily living activities of their choice. The provider ensued that people had the relevant equipment and support that they required to be active members of society.

The provider listened to feedback from people using the service and staff. People told us that staff acted promptly on their feedback.

People were empowered to be involved in the running of the service. The provider had a clear culture that people were at the heart of the service it offered. Staff had a shared commitment to see people empowered to be actively involved in their care and wellbeing.

People and staff were highly complimentary of the leadership of the organisation. The managers had specialist experience in providing health and social care services. They demonstrated a commitment to continuous improvement and quality assurance to ensure that they provided an excellent standard of care to people that used the service. The registered manager understood their responsibilities.

Staff felt supported to deliver a high standard of care as expected of them. They had easy and regular access from managers when required.