Archived: Tailored Care Ltd

We last inspected the service on 25 January 2017. The service was rated as “Inadequate” overall following this inspection and placed in special measures. The provider wrote to us outlining what actions they were going to take to make significant improvements at the service. We carried out this inspection to see if the provider had made the improvements required.

Tailored Care Ltd provides personal care for people in their own homes. At the time of the inspection there were 29 people receiving personal care from the service.

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.

We found that people continued to experience late, missed or shortened calls as a result of insufficient staffing numbers. This had a negative impact on the care and treatment they received.

We found that people received support with medicines in order to promote their wellbeing. Any risks to people had been assessed, taking into consideration any conditions which may impact on activities.

The provider had taken appropriate steps to ensure staff were appropriate people to deliver care by the use of employment checks. People experienced communication challenges with staff whose first language was not English.

Staff knew how to reduce the risk to people safe by reporting issues of concern.

Staff did not always receive the supervision and training required to enable them to support people effectively. People were supported with food and drink which promoted their wellbeing.

Staff knew the importance of ensuring people consented to their care and worked within the principles of the Mental Health Act 2005. Staff made appropriate contact and referrals to external healthcare when people required this in order to promote their health.

People and their representatives felt staff were caring people. Some people had found improvement in how the management team communication and approached people, although others told us this aspect still needed improvement.

People were involved in their care decisions and reported that staff respected their dignity, privacy and independence.

People were not always supported by a consistent team of staff who knew their care needs well.

Complaints were not always managed and resolved. People often had no response or unsatisfactory responses to their complaints.

People did not speak positively about the management of the service. People felt the management team did not care and staff did not feel supported.

There was a lack of quality assurance systems in place to monitor the quality of the service. The provider had not identified issues in staffing, call times or complaints management.

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

The overall rating for this service is ‘Inadequate’ and the service therefore remains in special measures.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the providers registration of the service, will be inspection again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Tailored Care Ltd provides personal care for people in their own homes. At the time of the inspection there were 59 people using the service.

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.

We found that people were supported by insufficient numbers of staff resulting in missed and late calls, and poor care. As a result of missed calls some people did not receive the medicines or food they needed to support their health and wellbeing at the correct times.

People had risk assessments in their care plans to guide staff on how to reduce risk. However, this guidance was not always detailed enough to provide staff with full and clear guidance. Risk assessments where not always adhered to, for example, in terms of how many staff needed to be involved in certain aspects of people’s care.

Guidance around when people required topical cream to be applied to keep their skin healthy was not always available to staff.

Staff were recruited safely, although we found an example of former employer references not being pursued by the provider. Staff were subject to police checks prior to starting their employment. Staff were clear about their responsibility to report matters of potential abuse.

While staff received regular training, staff told us the initial training new staff received was not always adequate. Some people and staff told us newer members of staff were not appropriately trained. People and staff were more positive about established staff’s abilities and the continuing mandatory training they undertook. Staff worked towards a recognised care qualification.

Not all complaints were processed appropriately under the provider’s complaints process. Some people told us they had not received feedback on issues they had raised or resolutions to problems. We saw the provider had completed surveys with people. We found not all issues raised by people during the survey had been actioned by the provider.

Most people felt the service was poorly run and that there were many areas where the management required improvement. Staff told us the culture at the service was negative and staff felt stressed and over worked.

People told us they did not always receive support from a consistent group of staff. People and staff reported a high staff turnover due to poor morale. We found the provider was in the process of recruiting new members of staff.

We found that safeguarding referrals had not always been shared with the registered manager by branch staff. Some issues raised by people with the branch manager had not always been shared with the registered manager or other relevant agencies, such as the CQC.

The provider had put in place appropriate audit systems and policies which would allow them to see where issues and challenges lay within the service. However, these audits had not been appropriately applied and were not, therefore, effective at identifying issues which impacted on people’s care.

Some people reported meals were missed or late due to late or missed calls. Staff knew about people’s dietary needs and preferences, and records provided guidance on people’s needs in respect of food and drink. Staff supported people to access healthcare professionals as required.

People were positive about staff who directly provided their care in terms of their level of compassion and caring. However, people told us the provider did not provide a caring service overall.

People were involved in the assessment and planning of their care. People or their representatives had signed most care records to show their understanding and consent of the contents of records. Staff promoted people’s dignity, privacy and independence. Most care records were written in a person centred way, which emphasised people’s independence.

The registered manager and staff knew how to support people’s choices appropriately and in line with legislation.

We found matters which amounted to breaches of the Health and Social Act 2008 (Regulated Activities) Regulations 2014.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

At the time of our inspection 54 people used the service.

There was a registered manager in place at the time of our inspection. The registered manager was also the provider of the service. 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.

People felt safe with the staff who provided their care and felt they were protected from the risk harm. Staff recognised signs of abuse and knew how to report this. The registered manager ensured people’s risks had been looked at and took actions to minimise risk without taking away people’s right to make their own choices.

People told us there were enough staff to support them at the times they needed them. Staff told us they felt there were enough staff to provide safe care and support to people. The registered manager told us that advanced planning of staffing levels meant they knew people’s calls were able to be met. People’s medicines were checked and managed in a safe way.

We found the care and support people received was in-line with their consent and agreement. Staff we spoke with understood and recognised the importance of gaining a person’s consent before carrying out any personal care for the person.

People were supported to eat a healthy balanced diet and were supported with enough fluids to keep them healthy. Staff supported people with access to healthcare professionals, and provided flexible times to ensure they made their doctor or hospital appointments.

People and where appropriate, family members, were involved in the planning around their care. People’s views and decisions they had made about their care were listened to and acted upon. People told us staff treated them kindly, with dignity and their privacy was respected.

People knew how to make a complaint and felt comfortable to do this should they feel they needed to. People were provided with the information they needed should they wish to raise a complaint. People told us they felt that if they had raised any concerns they would be dealt with. The provider had received 24 complaints over the last 12 months all of which had been responded to with satisfactory outcomes for the complainants.

We found that the checks the registered manager completed focused upon the experiences people received. Where areas for improvement were identified, systems were in place to ensure that lessons were learnt and used to improve staff practices. Staff felt supported by the registered manager to carry out their roles and responsibilities effectively.