Archived: Tipton Home Care Limited

Updated 30 May 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

Our inspection of this service in September 2016 identified that the provider was in breach of Regulation 17(1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Good Governance. We found the provider had systems that were not effective in identifying the service’s shortcomings and addressing these.

We inspected again in March 2017 to check that they were meeting legal requirements. We found that the provider had taken some action to address the breach of regulation in respect of governance of the service.. There were still further improvements needed though, because the size of the service meant the provider needed more time to embed effective systems of governance and the maintain improvements so that all people had their care calls on time.

Following our inspection of the service in March 2017, the provider we found the provider was not displaying it’s performance rating at its office premises, and on its website. This was a breach of Regulation 20A of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Criminal enforcement action was taken and a fixed penalty notice was served. The provider accepted liability for the offence and paid the required penalty.

This announced comprehensive inspection of Tipton Home Care Limited took place on 4 & 5 April 2018. The inspection team comprised of two inspectors and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service. The Expert by Experience carried out telephone calls over a two day period to 15 people, and five relatives of people who were receiving a service.

The preparation for this inspection considered the information supplied to us by the provider in their Provider Information Return (PIR). This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we made the judgements in this report.

We contacted local authorities who provided the funding for people to ask them for information about the service. We were informed that concerns had been identified by the local authority which were being addressed with the service and monitored. We also considered information available from other sources which included complaints shared with us by people who used the service.

During our inspection, we spoke with the manager, the human resources [HR manager] and eight staff. We met the provider on site but he was not present for the inspection or the feedback.

We looked at the care records for five people who used the service, eight people’s medicine records, daily records, call log books, complaint records, safeguarding records, and records relating to the management and audit of the service.

Updated 30 May 2018

This inspection took place on 04 & 05 April 2018 and was an unannounced inspection.

At the last inspection in December 2016 the provider was found to be requiring improvement in each of the five key areas we looked at; safe, effective, caring, responsive and well-led. The provider was also in breach of Regulation 17(1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Good Governance. The provider’s quality assurance practices had not always identified or addressed shortfalls in the service in a timely manner.

We inspected the service again in March 2017. This was a focused inspection to check that the provider was meeting legal requirements. We found that the provider had taken some action and made the required improvements to ensure they were meeting Regulation 17.

At this inspection we found the provider continued to operate ineffective systems to audit, monitor and improve the quality of care and support people received. The provider’s systems to assess and monitor the quality of the service were not effective in identifying issues requiring improvement. There were a number of shortfalls such as poor information governance systems, risk oversight, call times and medicine arrangements. The manager was taking action and had made some improvements. However improvements identified in March 2017 had not been made. This meant that this inspection was the second consecutive inspection whereby improvements were required to the governance of the service and therefore the provider was in breach of Regulation 17 of the Health and Social Care Act 2008 (regulated activities) Regulations 2014. You can see what action we have taken at the end of our report.

Tipton Home Care Limited is a domiciliary care agency. It provides personal care to younger and older adults living in their own homes who may have a learning disability, physical disability, sensory disability or dementia. On the day of the inspection 350 people were receiving support; this included people who were being supported with a short enablement program following discharge from hospital.

Tipton Home Care Limited is required to and had 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The registered manager was not present for this inspection. A new manager had been in post for six weeks and told us following a successful probation period they were intending to apply to be the registered manager.

Whilst people told us they felt safe we found they were not always receiving the support they needed or at the times they needed it. The impact of late or missed care calls meant that they did not always get the help they needed to maintain their safety and well-being within their own homes. Staff received training in safeguarding people and knew where people were at risk of harm and knew how to keep them safe. However incidents were not always recognised as potential safeguarding concerns to ensure they were referred on to the appropriate agencies at the right time. Identifying risks to people's safety and well-being was inconsistent; assessments of the risks associated with people's specific conditions lacked guidance for staff. The arrangements for supporting people with their medicines was not clear so that staff could support people safely.

There had been a high turnover of staff and some staff required training to meet people’s needs effectively. Some improvements had been made to ensure staff had the support they needed to carry out their care roles. People were cared for in the least restrictive ways possible and staff understood their responsibilities associated with the Mental Capacity Act 2005. People were supported with their meals and staff ensured they had access to regular drinks. Where people needed health and social care professionals the provider worked collaboratively with other agencies.

People were pleased with their regular staff and the consistency of care this provided when they had the same staff and described staff as kind, caring and helpful. People were treated with dignity and respect and their independence was promoted. Staff had a good understanding of the need to involve people in making choices and decisions about their daily needs.

People knew how to make a complaint if they were unhappy but did not always feel their complaints were listened to or resolved. There had been a high level of complaints related to call times and people felt these had not been addressed. There was some improvement to the management of complaints to ensure these were reviewed and acted on more consistently.