Tamworth Home Care Limited

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

The service was not effective. We found improvements had not been made and the service was not always effective in supporting people to achieve good outcomes. Improvement continues to be needed in this key question. Overall, people had been involved in their care planning, but this had not led to their wishes being met. Limited information about people’s preferences had been recorded by the management team when assessments took place. When people received consistency in their care staff, they were, overall satisfied with their support. However, most people did not experience consistency in their care staff which led to dissatisfaction with the service received. People did not always experience their care calls at the times they expected and were not always informed when staff were running late. Mental capacity assessments were completed and included in people’s plans of care.

This service scored 42 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We received mixed feedback from people and their relatives about their level of involvement in the planning and review of their care. Most people felt their wishes had been discussed with them during an initial assessment. However, some commented that whilst they were asked about their wishes this did not always mean they were met. Some recalled being asked questions as a part of a care plan review but others did not.

The service manager told us that people’s needs were assessed, and senior care staff developed plans of care based on these assessments. Overall, staff told us that people’s needs were listed as tasks on an electronic App they could refer to during care calls. However, 1 staff member told us, “More could be added to the tasks. The person I support needs [name of medicine] before being supported with their personal care because the exertion tires them, but this is not listed as a task. I don’t think it is in their care plan.”

The provider had processes in place to assess people’s care needs. Pre-admission assessments to the service had, overall been completed, including the use of recognised best practice tools such as those to assess the risk of skin damage. However, the quality of information was mixed. Those people who were newer to the service, overall had some improvement on the quality of the information recorded. However, care plans were generic and lacked personalised information. Preferences around care call times, gender of care staff and information about a person’s cultural or religious beliefs were either very limited or had not been recorded. There was no record of any ‘future wishes’ discussions having taken place with people or relatives which meant in the event of a person’s health declining there was no advance plan in place for this.

Where people had consistent care staff, they mostly gave positive feedback about staff knowing what they were doing. However, most people told us they did not have consistency in their care staff, and this meant staff did not always consistently know how to support them. One person told us, “When my regular carer comes, they know everything that needs to be done, with new carers they have to be shown and told (by me) what to do.” A relative told us, “My relation has so many different carers visiting them they have to keep telling them what to do.” This meant staff members scheduling peoples care calls did not always ensure care staff members undertaking the care calls had the skills they needed for the care calls they were undertaking.

The provider had delegated staff training to a named staff member but had not ensured this staff member had the necessary skills and knowledge themselves to deliver up to date, evidence-based training to other care staff. For example, the staff member had not completed any specialist training on ‘React to Red’ skin or alternative pressure care training, and yet directed care staff on this topic during their induction. The staff member shared with us that there were numerous other topics which they delivered to staff but had not undertaken specialist training on themselves. Whilst the staff member attempted to source information themselves and had previously raised concerns about the induction slides being focused on residential care homes, the provider had failed to address this shortfall.

Staff told us they worked with healthcare professionals and entries in care records demonstrated this. Despite staff telling us they would report concerns “to the office” there was a need for improvement in care plans to give staff sufficient guidance to enable them to fulfil their tasks on care calls. For example, 1 person was receiving treatment from the district nursing team for damaged skin and whilst staff assured us, they would report any concerns to the office staff, further details were needed to direct them to check and monitor dressings remained in place and actions to take if there were concerns.

Effective systems were not in place to ensure best practice guidance was considered and followed by staff. The provider had not identified that care plans were not based on best practice.

Whilst some people and their relatives were satisfied with the service provided, others felt improvements were needed, especially in the communication between the care staff and office staff team. One person told us, “My recent lunchtime care call was over 2 hours late. I found out the carer had asked the office to call me, but they never did. I wanted to phone the out of hours staff, but the number in my folder (care plan) was not working, that’s because the management put my folder there over 2 years ago and never updated it, so I could not check on the carers.” A relative told us, “Last year my loved one’s health deteriorated considerably. The service didn’t do a review, but last week (over a year later) phoned to book a review.” This meant some people felt the staffs ability to work together was not always effective.

Staff told us they worked well with other health care professionals. For example, staff told us they contacted the district nurse team if they had concerns about people’s wellbeing. However, we found where people’s skin integrity was a concern, staff had not asked sufficient information from district nurses such as what settings specialist equipment should be on.

Commissioners shared with us (CQC) that the service manager was engaging with them to implement improvements needed to the service. However, commissioners felt progress on the improvements had been slow.

Processes were being further developed to ensure staff, teams and services worked together. Both the service manager and safeguarding manager were developing processes to work in greater partnership with a range of external health and social care professionals. The recently appointed safeguarding manager told us they were learning when referrals and information about emerging risk needed to be shared with commissioners at the local authority.

Some people told us that improvements were needed to ensure staff consistently had the skills and experience needed to adequately support them to live healthier lives. One person told us, “The carer I had could not cook” and another person said, “The porridge the carer made was so thick, you could stand a spoon up in it.” However, other people told us staff made them drinks and heated meals for them and were satisfied with the support. One relative told us, “We have 1 dedicated carer, the food they cook is amazing. We are lost when they are not on shift.”

Staff did not always have the training or information they needed to support people to lead healthier lives. For example, 1 staff member had been buying sugary drinks and foods for a person with diabetes when they should have been avoiding sugar rich items. Staff told us they would record any concerns in the daily task notes and / or inform a person’s relatives.

The provider had no process to ensure information was personalised to people’s needs. The provider had put generic fact sheets into some people’s care plans about healthy eating and some known health conditions, however these were not person-centred and did not give staff the information they needed. For example, 1 person had damaged skin, but their care plan only contained generic information about risks to skin and nothing more. Some people had health conditions and yet their care plan contained either little or no information about their condition. The safeguarding manager confirmed to us that the daily notes completed by care staff on care calls were not being checked or audited at all by the management team. This meant any concerns entered by care staff may not be acted on in a timely way or at all.

Some people’s care plans reflected their needs and the outcomes they wished to achieve. For example, 1 person wished for staff to support them to manage their anxiety and increase their social skills. However, other care plans were not personalised and did not reflect the outcomes people desired from their support. Some people and relatives told us their feedback had been sought but others told us they had not been asked or received a questionnaire survey to complete.

Staff told us they felt positive about the changes in management and that “things would now improve for everyone in the service.” The service manager acknowledged there were multiple areas needing to be improved and told us they hoped to use the provider’s business consultant to guide them on creating and implementing a service improvement plan which would improve the service overall and outcomes for people.

The provider could not demonstrate they were consistently monitoring and improving outcomes for all the people they supported. The quality of information in care plans and daily notes varied and some care plans had not been reviewed for over 12 months. There was no recorded evidence to show that people or their relatives had been involved in any review of their care.

Consent was not always gained from people and their relatives when needed. For example, 1 relative told us they were not asked for consent when new staff shadowed existing care staff and told us this caused distress to their family member. When personal care tasks were being undertaken, some people and their relatives told us consent was asked for, but this was not always the case. One relative told us, “Yes, staff ask consent.” Another relative told us, “Regular carers ask for consent, but others are not always as respectful.”

Staff told us mental capacity training was covered in their induction. Staff spoken with could give examples of when they asked people for their consent.

Effective systems were not in place to ensure consent was consistently gained from people who had the ability to make decisions about their care. The service manager told us that staff sometimes took photographs on their own mobile phone, because not all staff had a work mobile phone, when they had concerns about a person’s skin. This was at district nurse requests so assessments could be made if they needed to visit. We requested to see a policy for this, but the service manager and provider’s business consultant were unable to share any policy or process for gaining consent from the person about this or directing staff to immediately delete any such images. We found that although staff told us they understood how to obtain consent from people, this did not always happen in practice. The provider did not have an effective process in place to assess and monitor staff’s compliance with obtaining consent.

The provider was working within the remit of the Mental Capacity Act 2005 (MCA). Care records reviewed informed staff if people had capacity to make day to day decisions or not and whether a Power of Attorney had been appointed. Mental capacity assessments had been completed when people started to use the service, however, some had not been reviewed for over 12 months which meant any changes in people’s mental capacity may not have been recorded.