Archived: Tipton Home Care Limited

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.

After the inspection, the provider wrote to us telling us what action they would take to meet the legal requirements in relation to the breach.

We undertook an announced focused follow up inspection on 30 March 2017. This focused inspection was to check that they had followed their action plan and check that they were meeting the legal requirements. Whilst we found that some improvements had been made in some areas, systems in place to monitor and improve the service were not being used consistently. This report only covers our findings in relation to those requirements.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Tipton Home Care Limited on our website at www.cqc.org.uk

Tipton Home Care Limited is registered to provide personal care services to people who live in their own homes. People who used the service had a range of support needs related to age, dementia, learning disabilities, mental health, physical disabilities or sensory impairment. At the time of our inspection 360 people were receiving support.

There was no registered manager in post. The recently appointed manager was applying to be the registered manager. 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.

Some improvements had been made to ensure that people received the support they needed at the times that they needed it. The provider had introduced a new electronic call system to assist them in planning and scheduling people’s call times. However some people had continued to experience missed or late calls and the impacts of this had meant their care needs were not met consistently.

Additional call handlers had been employed and people reported they could contact the office more easily and without long delays before someone would get back to them.

The systems in place to monitor the quality of the service were not fully effective across all aspects of the service because audits were not been undertaken consistently.

Whilst we heard from people that they were contacted about their views the provider’s system to analyse people views and drive improvements was limited. The provider had begun to consult people about their care but the review process had not ensured people’s views were captured or their care plans updated with essential information.

The recording of complaints had improved but not all complaints were captured or acted upon.

Tipton Home Care Limited is registered to provide personal care services to older adults in their own homes. On the day of the inspection, 338 people were receiving support; this included a recently acquired hospital service where 29 people were being supported with a short four week enablement program. There was no registered manager in post. The new recently appointed manager was applying to be the registered manager. 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.

While people told us they felt safe we found that they were not always receiving the support they needed on a timely basis and care staff did not always arrive. Care staff received the appropriate training in safeguarding people, so where people were at risk of harm care staff would know how to keep them safe. However we found while people were supported with their medicines, care staff did not always complete medicines administration records appropriately and there was no guidance in place so care staff could administer medicines as and when required consistently.

The provider showed that they had an understanding of their responsibilities within the Mental Capacity Act 2005 (MCA), but care staff required further training to ensure they knew how people’s human rights should not be restricted. Care staff were able to get support when needed to ensure they had the skills and knowledge to meet people’s needs.

The provider ensured that people were involved in the assessment process and how they were supported. Care staff were kind and caring and people’s dignity, privacy and independence was respected.

People were able to make complaints but the provider did not have the appropriate systems in place to record and handle and respond to complaints appropriately.

The provider carried out spot checks and audits on the service people received but we found the checks and audits were not effective in identifying areas that were lacking and needed improvement.

The service was not well led because people could not consistently contact the office by telephone on a timely basis when needed, did not receive support on a timely basis and on occasions care staff did not arrive at all. People did not all know who the manager was.

People were able to share their views about the quality of the service they received by completing a questionnaire; but the provider had no system in place to share the outcome or any proposed action plan for improvement with people.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. You can see what action we told the provider to take at the back of the full version of this report.