Total Quality Care Services Ltd Birmingham

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

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last inspection we rated this key good. At this assessment the rating has remained good.

This meant people’s outcomes were good, and people’s feedback confirmed this.

This service scored 63 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

Care plans considered people’s health, care, wellbeing and communication needs, and people and their relatives were confident individual needs had been appropriately assessed. One relative said, “We had a full assessment and they did ask about female/male [staff] but [person] doesn’t mind - in fact [staff member] was one of their favourite carers. We have had reviews of care from time to time as things have changed.” However, we found some improvements were needed to ensure care plans contained accurate information that reflected the care and support people needed and relevant to their needs. For example, 1 person’s care plan identified they had hand tremors, however the risk assessment had not recognised this in the section ‘involuntary movements’ and categorised the risk as not relevant. The same care plan had referred to the person not having any prescribed medication although a list of medication was contained within the care plan. The provider informed us there had been errors in the text and confirmed they have now updated the relevant risk assessments and care plan. The provider also confirmed they have reviewed their own processes for monitoring and reviewing care plans, to make sure information was accurate and up to date.

People and relatives told us staff knew how to support people in line with their individual preferences. They confirmed they were kept informed of any changes (in loved one’s health) and felt fully involved in assessments and reassessments of their care and support. One person said, “I have a care plan and I decide on what care I want and need, I’m involved in everything.”

While the provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. It was not always clear this was in line with legislation and current evidence-based good practice and standards.

When reviewing care plans and risk assessments, it was not always clear what national clinical tools, or guidance had been used when assessing people’s needs. For example, people identified as high risk for pressure damage to their skin, there was no Waterlow completed. The Waterlow Assessment (or Waterlow Score) is a clinical tool used primarily across the UK health and social care sectors to evaluate a person’s risk of developing pressure sores. However, we found people who had been discharged from hospital with pressure damage to their skin, the provider had taken the appropriate action in making sure the district nurses were visiting. Body maps were in place for staff to show them where creams were to be applied. People and their relatives told us they felt staff knew what they were doing and competent when providing care and support.

We saw, where appropriate, people had regular input from visiting health care professionals such as district nursing team. Staff told us they had updates about people’s health and support needs through team meetings, supervision and/or spot checks.

Everyone we spoke with told us the provider and their staff delivered good care and support to them.

The provider worked with other health and social care teams and services to support people.

Staff were positive about their working relationships with the provider, family members and the people they supported.

All staff we spoke with accessed the information they needed about a person’s care through the provider’s ‘App’. People and relatives also had access to the App if they wanted.

People and relatives told us communication with the provider and their staff was good and felt comfortable in raising any concerns or issues as they arose.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives.

Staff told us how they worked with people and their family to support people’s health and social and emotional wellbeing. One person explained to us how staff would encourage them and help them to buy healthier foods to manage their medical condition. They said, “The girls get my shopping for me and always ask what I want and they make suggestions like fruit and food with less sugar in them.”

The provider did not always routinely monitor people’s care and treatment to continuously improve it. Some care plans lacked guidance for staff, regarding specific health and medical needs associated with their care such as diabetes.

People and relatives told us the registered manager, or a member of the management team met with them to discuss their care and support to make sure care plans were relevant and being followed. However, we found after reviews, care plans were not always reflective of people’s immediate care needs. For example, the issues we found regarding the accuracy of care plans and risk assessments had not been picked up in the provider’s own reviews which had been completed within the last 6 months.

The provider and their staff supported people with their daily lives to maintain their health and wellbeing. Care plans referenced monitoring healthcare needs but there were no clinical monitoring tools, used by staff to evidence action had been taken to improve outcomes for people.

People and relatives told us the staff that supported them understood their care and support needs and their input had helped to maintain their independence and achieved positive outcomes. One family member said, “The carers always stay while [person] is eating because she struggles with her food and is supposed to be on small, bite size. The carers are good and watch carefully.”

The provider told people about their rights around consent and staff respected these when delivering person-centred care and treatment.

Care plans considered people’s capacity and their ability to consent to their care and make decisions about the support needed. This meant the service worked within the principles of the Mental Capacity Act 2005 (MCA). Staff had completed their mental capacity training, and those spoken with gave examples of how they understood the importance of gaining consent from people and encouraging people to make their own decisions about their care and support. One staff member told us, “Some of the clients do have the capacity to make their own choices but others do not always have capacity to make choices but we will always get consent first. I ask them are they ok for me to do their personal care, or their food and they always say yes, if they didn’t I would go and do something else and try again later.” There was guidance for staff within people’s care plans, how consent might look for people, where they might lack mental capacity.

People and their relatives felt their views and wishes had been considered when care and support was being planned. People told us staff always sought their consent before delivering care. Relatives told us they were very much involved in supporting people with making decisions about their care where appropriate.