Total Quality Care Services Ltd Birmingham

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

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

This meant people were safe and protected from avoidable harm.

This service scored 69 (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 had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and reported safety events for investigation. Lessons were learnt to continually identify and embed good practice. One staff member told us, “Any complaints of anything we are told in supervision and team meetings. They [the provider] would have us re-trained. If (the incident) is serious you would be suspended and then back to the training and they [the provider] will get us on the right path.”

The provider had systems and processes in place for staff, people and their relatives to report any concerns, incidents, accidents and complaints. We reviewed complaints and safeguarding incidents and found they had been thoroughly investigated by the registered manager and provider. Outcomes of investigations had been shared with staff to enhance learning and introduce safer working practices to minimise the risk of reoccurrence. For example, there had been an issue with a staff member which had been dealt with promptly and assurances given to people the matter was being addressed appropriately.

People and their loved ones knew who they needed to contact if they were unhappy or had any concerns about people’s care.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

Since the last inspection, the registered manager explained to us how they had recently introduced a new electronic system and were in the process of updating and reviewing every person’s care plan and risk assessment with the person and their family members. At the time of this assessment there were still some risk assessments to be updated. The provider took immediate action to update all risk assessments to reflect people’s medical conditions. Staff knew people very well and people lived with their family members which mitigated the risk to people.

People and their relatives told us the provider worked with them and healthcare partners to establish and maintain safe systems of care. The information provided by people, their relatives and healthcare partners was recorded throughout people’s care plans and there was clear evidence to support healthcare agency support. This meant there was the continuity of care between services, or an admission into hospital, to reflect people’s support needs.

People and their relatives told us people’s care and support were planned and organised with the provider, and their views were listened to and considered. A relative told us, “The ‘App’ is very useful, it has the daily information which is what I look at. The care plan is on there and the (call) log is very helpful. The carers are very good and in contact with me and will text me if there is anything I need to get.” The App is a specialised program that is loaded onto a mobile device or laptop that can be accessed by staff when completing their daily tasks.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider told us there had been no safeguarding concerns, but if they had, they would share them quickly and appropriately with the local authorities.

Staff we spoke with all understood the importance of reporting safety concerns. They told us the registered manager was always quick to respond to any request from them and was very supportive when dealing with any issues that were raised.

People and their relatives told us they felt comfortable with the staff coming into their homes and felt safe. One person told us, “They [staff] have never upset me, they are all wonderful and I couldn’t do without them.”

Staff had completed their safeguarding training. One staff member said, “If I noticed a behaviour change, or the [person] was scared I would ask if everything was ok. I would also report to the manager, and they would report and record it. If I had any concerns the manager would not respond I’d contact The Care Quality Commission (CQC)”.

The provider had a safeguarding policy in place. The provider was aware of their legal duty to inform the CQC of notifiable incidents. Records we looked at had evidenced this.

While staff did provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them, the provider did not always work well with people to understand and manage those risks. We looked at where information to support staff was missing. For example, people who were prescribed creams containing flammable substances, there was no risk assessments to support staff on how to mitigate the risk of substance build up on clothing, bed linen and the dangers posed to smokers. The provider took immediate action and introduced new risk assessments, discussed with the people, into their care plans for staff and person awareness.

There was no guidance for staff on what to do in the event of a person, living with diabetes, having a Hyperglycemia (high blood sugars) or Hypoglycemia (low blood sugars) episode. The provider explained risk was mitigated because the people concerned lived with family and their diabetes was managed by district nurses who administered insulin daily. However, the provider agreed it was important for staff to have awareness of the symptoms and risk assessments would be updated, discussed with the person and their family and introduced into their care plans. One relative told us, “The District Nurses have come out for various things and have said how good the carers are at looking after [person].”

Staff were able to explain what action they would take in the event of a person becoming unwell. For example, 1 staff member said, “If I had any concerns about clients becoming unwell and their family are not around, I’d phone emergency services and report it to my manager so they can record it and contact the family. I would stay until the ambulance arrived and a family member was there.”

People told us the care they received supported their needs.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The provider had processes to detect potential risks in people’s home environments and completed an environmental risk assessment before people started using their service. This included assessment of potential risks related to using equipment, slips, trips and falls risks. The assessment also included areas outside the person’s home, such as local parking and pavements. This assessment was reviewed annually, or when people’s needs had changed, for example, on discharge from hospital and if there was a requirement for additional equipment to support the person.

The provider did not always make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support. They did not always work together well to provide safe care that met people’s individual needs.

Staff were not always recruited safely. Pre-employment checks had not always been fully completed. For example, following up references. It was not always clear when staff had completed their induction and shadowing because the documents had not always been dated and signed by the new staff member and manager or supervisor to evidence completion and assessed as competent to work on their own. The provider took immediate action at the time of the assessment to review their own policies and procedures to make sure going forward they would follow them when recruiting new staff.

Staff we spoke with told us they received training which provided them with the knowledge needed to deliver safe care. However, we found the training modules in some cases had been completed in 1 day. For example, 1 staff member had completed 19 training modules in a single day. This bought into question the effectiveness of the modules relating to quality and content and how useful the modules were for their learning. The provider had explained on this occasion they had allocated the training to the staff member and on reflection, it was too many to be completed at 1 time. Going forward, the provider said they would review the number of training modules they would allocate to staff to a more reasonable amount.

Staff competency assessments had been completed during spot checks at people’s homes. Conversations with people and relatives confirmed staff had been assessed by a manager in the person’s home as they were asked for their feedback on the provision of the care being given. One person told us, “I use a hoist. The carers are well trained, they understand the harnesses and slings and make sure it is all done right and I am safe. They are very secure with the hoist and make me feel comfortable because they know exactly what they are doing. The carers are very observant, they know me and they soon notice if I’m not right and if I say I am they make sure and ask again ‘are you sure you are feeling alright’ they are very thorough.”

The provider supported staff in their face to face learning. Staff particularly commented on the face-to-face moving and handling training. One staff member said, “I think the quality of training is good. The manual handling is really good because you get to know about the equipment, stairlifts, zimmer frames and it’s interesting.”

Staff told us they had completed their induction and received support from the provider through team meetings and supervisions.

The provider made sure there were enough staff on duty to support people. People told us they received support from a consistent staff team which they liked.

The provider did manage the risk of infections spreading.

The provider controlled the risk of infection spreading by providing staff with a sufficient supply of appropriate personal protective equipment.

People and relatives did not have any concerns regarding the infection control practices carried out by staff. Staff had completed their infection prevention training and if they had any concerns, they would report them to the provider. Staff competencies were checked and reviewed when the provider completed spot checks.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

Care plans identified people’s preferences around the support they wanted to receive with their medication. A lot of people received support with their medication from family members. Where appropriate, there were body maps in place to inform staff where creams should be applied.

Medication administration records (MARS) and topical cream medication administration records were in place, to demonstrate when and how the medication and creams were being administered to people and were monitored electronically.

Medication that was administered as and when, for example, to provide pain relief; the provider had appropriate protocols in place to give staff the information they needed. This made sure the medication was administered at the allocated 4 hourly intervals and the signs people would exhibit when in pain.

People and relatives spoken with raised no concerns with us about the support they received from care staff with their medicines.