Archived: Trafford Housing Trust Limited Also known as TrustCare

We last inspected Trafford Housing Trust (TrustCare) in May 2017 when we rated the service requires improvement overall and identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which were in relation to recruitment practices and good governance. We found that the provider had made improvements and was now meeting the requirements of these regulations. We have made two recommendations in this report, which relate to complaints and risk assessments.

This service is a domiciliary care agency and also provides care and support to people living in specialist ‘extra care’ housing. The service provides personal care to people living in their own houses and flats in the community or within the extra care schemes. Extra care housing is purpose-built or adapted single household accommodation in a shared site or building. The accommodation is bought or rented, and is the occupant’s own home. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for extra care housing; this inspection looked at people’s personal care and support service.

At the time of our inspection, the service was providing regulated care and support to a total of 129 people. This included 63 people who received support in their own homes in the community and 66 people living in four extra care schemes in the Trafford area. The four extra care schemes were named Elkin Court, Limelight, Newhaven and Fiona Gardens. The service primarily supports older people.

The service had approximately doubled in size since our last inspection. This followed the service starting to provide support to people living in the four extra care schemes. TrustCare took over as the lead care provider in the Newhaven, Elkin Court and Fiona Gardens extra care schemes on 01 February 2018. The Limelight extra care scheme was a new scheme that opened in October 2017.

Not everyone using TrustCare received support with a regulated activity. CQC only inspects the service being received by people provided with ‘personal care’, which includes tasks related to personal hygiene and eating. Where people do receive this support, we also take into account any wider social care provided.

Although the majority of people we spoke with were happy with the care they received, we found people’s experiences differed both within and across TrustCare’s services. The experiences reported by people living in the Fiona Gardens extra care scheme, and in particular, the Limelight extra care scheme, were the most significantly contrasting. At these extra care schemes, we received both positive and negative reports in relation to a range of areas affecting people’s care, including the consistency of care, handling of complaints and how approachable staff were.

The provider had strengthened the recruitment procedures, and we saw relevant checks were undertaken to help ensure staff were of suitable character before an offer of employment was made. Staff received a thorough induction, ongoing training and spot-checks of their practice to help assure the registered manager that they were able to undertake their role competently.

People received support from consistent teams of staff. The provider had made and kept to a commitment to not use agency staff to help improve people’s consistency of care. They undertook a range of activities to help try and improve staff retention and therefore the consistency of care people experienced. People told us that the provider had respected any preferences they had in relation to the staff who worked with them.

People were consistently positive about the kind, caring and respectful nature of care staff. People told us staff respected their privacy and supported them to retain as much independence as they could. The provider had systems in place to help ensure confidential information was kept securely and to investigate any potential breaches in data protection.

We received a mixed response when we asked people if they would feel confident raising any complaints or concerns. Some people recalled positive experiences of raising complaints and told us the registered manager had been responsive to their concerns. However, some people living the in the Fiona Gardens and Limelight extra care schemes told us they would not feel comfortable raising a complaint, or they felt their concerns would not be taken seriously. We have made a recommendation that the provider reviews how they identify and manage complaints.

Staff assessed risks to people’s health and wellbeing and took actions to help ensure people were kept safe. However, we found that whilst these actions had been recorded in people’s care notes, this information had not always been transferred to people’s care plans and risk assessments. Similarly, we found staff had detailed understandings of people’s needs, preferences and social histories. This information was also not always recorded in people’s care plans, although the provider did have other systems in place to share such information with staff. We have made a recommendation that the provider reviews their systems for updating care plans and risk assessments following a change in people’s assessed needs.

Medicines were managed safely, although further improvements could be made to records of administration and assessments to ensure they were sufficiently detailed and up to date. There were systems in place to help the registered manager identify any potential errors so they could take action to ensure people were safe.

People living in the community reported their care calls were timely, and they said they would be informed if staff were running late. We received a variable response from people living in the extra care schemes about whether their preferences in relation to call times were met. Some people told us the service worked flexibly to meet their needs and preferences. However, other people told us their calls were not provided at their preferred times, which could impact on activities they had planned or the time between their meals. The provider told us calls provided to people living in the extra care schemes were commissioned to be provided within three-hour time windows unless they were ‘time critical’. However, they told us people were allocated consistent times for their calls and stated that they always tried to accommodate people’s preferences when allocating calls.

The provider had a system to help them work out how many care staff they needed to employ to meet people’s planned calls. People told us staff were quick to respond to any calls at the extra care schemes. There were systems in place to help prevent missed calls in the community, and the provider learned lessons from any incidents of missed calls.

Staff were aware of their responsibilities in relation to safeguarding. We could see from notifications we had received that staff identified potential safeguarding concerns. The registered manager had responded to safeguarding alerts by reporting concerns to the local authority safeguarding team and taken any other required actions to help ensure people were not at risk of harm.

Staff supported people to access other health and social care services as required. We found evidence of staff working pro-actively with a range of other professionals to help improve people’s physical and mental health.

Staff were aware of the principles of the Mental Capacity Act (2005) and people told us their consent was sought before any care was provided. Where people were able, they had signed to consent to their planned care and agreements such as how their personal information would be shared. If people were not able to provide consent, we saw others involved in their care had been consulted.

Staff assessed people’s needs, which were reviewed at set intervals or as any change in need was identified. People told us they had been involved in assessments and reviews of their care. The provider told us there had been some ‘teething issues’ associated with setting up the Limelight extra care scheme. Some of these related to issues with the building, whilst other issues had arisen due to the length of time that had passed between when they had assessed people’s needs, and when the scheme started to operate. This had resulted in some people having a greater level of need than expected. The provider told us they had learned from these issues and were reviewing what changes may be needed to address people’s concerns.

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 received positive feedback from staff and other professionals involved with the service about the registered manager’s leadership and commitment to the service and people using it. A senior support co-ordinator and team of senior support workers supported the registered manager. Each extra care scheme was allocated one or more senior support workers to oversee the running of the care provision at those schemes. Whilst on the whole people using the service and staff felt they could discuss concerns with the management team, we also received reports that suggested the response they received could vary in quality.

The registered manager and provider had developed the systems in place to help monitor the quality and safety of the service. The provider carried out audits to help assure themselves that they were complying with the regulations. Checks also helped the provider identify any trends, such as in relation to accidents and incidents that might indicate furth

Trafford Housing Trust (TrustCare) was registered with the Care Quality Commission (CQC) to provide personal care in February 2015. This was the first inspection of this service we have conducted.

TrustCare is a domiciliary care agency that provided care and support to people living in their own homes within the areas of Trafford and Manchester. At the time of our inspection the service was supporting 74 people. The service supported a number of additional people with a service that did not include personal care.

There was a registered manager who had been in post since December 2015. 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.

At this inspection we identified two breaches of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to procedures followed in the recruitment of staff, and systems in place to check and improve the quality and safety of the service. You can see what action we have told the provider to take at the back of the full version of this report.

The provider had not always recruited staff following robust procedures to ensure they were of suitable character for the roles in which they were employed. Where checks highlighted potential concerns in relation to staff member’s suitability for the job role, there was no evidence the provider had carried out any assessment or further checks to reassure themselves that the staff member was suitable. The provider had recognised the shortfalls in their recruitment procedures, which they had revised. We saw the provider was in the process of checking that all staff had the required checks in place, although this had not been completed at the time of our inspection.

People who used the service were consistently positive about the kind and caring support they received from staff. People were supported by small teams of consistent staff members, which had helped staff and people using the service to develop relationships and get to know one another.

People’s preferences, likes, dislikes and social histories were recorded in their care plans, although the level of detail recorded varied. The registered manager showed us a new format of care plan that was due to be introduced that would help ensure this information was captured consistently.

People told us the service worked flexibly to meet their needs. Staff spoke positively about the electronic care management system used by the provider, which allowed staff to quickly and easily record and share information with other staff. They told us this helped them provide a person-centred and consistent service by being able to quickly update other staff on things that had worked well with people’s support, or noting any change in their preferences.

The service tracked staff recruitment and had given consideration to staffing requirements to enable them to undertake the calls they were committed to undertake. People told us staff were generally on time, and would contact them if running late. The provider monitored staff attendance at calls using remote electronic monitoring.

People told us they had been involved in developing and reviewing their care plans. We saw people had signed to show they agreed with the proposed plan of care. However, information in relation to a person’s capacity to provide their consent was not always clear. The registered manager showed us the new format care plan helped ensure this information was recorded.

Risks to people’s health and well-being were assessed. Whilst there was information in the care plans on how staff should reduce any potential risks, such as falls, this information was not always clearly presented.

People felt the staff that visited them were competent in their jobs. Staff undertook a range of training relevant to their job roles, and there were spot checks to assess their performance. Newly recruited staff told us they had received an adequate induction, and had been given opportunity to shadow more experienced staff until they felt confident to lone work.

The registered manager told us concerns were generally dealt with prior to formal complaints being raised. People we spoke with confirmed this, and told us they had been satisfied with the way any ‘niggles’ had been handled. We saw the provider was undertaking a project to improve the way they identified, recorded and acted upon customer feedback.

The provider had commissioned external reviews of the service. The most recent review had identified some of the issues we also found, such as in relation to safe recruitment procedures. The provider was taking action to make improvements as a result of these reviews.

Internal audit procedures were still in the process of being developed. At the time of our inspection we found checks of care records such as medication administration records (MARs) and daily care records were not robust. This would increase the risk that any shortfalls would not be identified promptly. The registered manager took action during the inspection and introduced a new medicines and care record audit.

Staff and people using the service felt the service was well-run and was organised. People told us there was good communication with staff in the office, and they felt comfortable approaching any staff member to discuss their care or any concerns they might have.

Staff we spoke with told us they felt valued for the work they did. The registered manager was visible within the service, and staff felt well supported by them. The provider had considered, and was undertaking further work to try to minimise staff turnover.