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Archived: Tailor Maid Care Solutions Limited

Overall: Requires improvement read more about inspection ratings

178 Huntingdon Street, Nottingham, NG1 3NE 0330 223 3855

Provided and run by:
Tailor Maid Care Solutions Limited

All Inspections

25 October 2018

During a routine inspection

We carried out an announced inspection of the service on 25 October 2018. Tailor Maid Care Solutions Limited is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It currently provides a service to older adults. Not everyone using Tailor Maid Care Solutions Limited receives a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided.

A registered manager was not present during the inspection, however at the time of writing the manager has now become registered with the CQC. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 the time of the inspection, Tailor Maid Care Solutions Limited supported 39 people who received some element of support with their personal care. This was the service’s third inspection under its current registration. During our previous inspection on 25 and 29 January 2018, we rated this service as ‘Inadequate’. However, found during this inspection that some improvements had been made and we have changed the overall rating to ‘Requires Improvement’.

During this inspection, we found staff punctuality had improved, but further work was needed to ensure all calls were carried out time. However, people’s medicine administration records were not always appropriately completed. The manager was aware of this and was taking action against the staff concerned. However, the action taken was not always carried it out an appropriate timeframe. Some improvements had been made to the process for assessing the risk to people’s health; however, there was still further work needed to ensure these assessments reflected people’s needs.

Accidents and incidents were now investigated and recorded appropriately; however, analysis of any trends or themes to reduce to the risk of reoccurrence was not always completed. There were now enough sufficiently skilled and experienced staff to meet people’s needs. Effective processes were now in place to ensure any allegations of abuse were actively investigated and reported to the relevant bodies such as the CQC or the local authority. People felt staff understood how to reduce the risk of the spread of infection in their home. People told us they felt safe when staff supported them in their homes.

Some improvements had been made to ensure that the principles of the Mental Capacity Act 2005 were applied when decisions were made for people. However, further work was needed to ensure people were always supported to have maximum choice and control of their lives and for staff to support them in the least restrictive way possible. The policies and systems in the service do not currently fully support this practice, and clearer documentation is required to ensure all decisions made clearly evidenced that they were in each person’s best interest.

Staff training was now up to date and staff received supervision of their role. People’s physical, mental health and social care needs were assessed prior to commencing using the service; however professional guidance was not always used to inform care planning. People were happy with the support they received with their meals. People were supported to access health or social care agencies.

Most people felt staff provided care and support that was kind, caring and respectful and they were treated with dignity. Staff spoke confidently about how they supported people living with dementia. People contributed to decisions about their care.

Improvements had been made to people’s care records. They now included more detailed reference to people’s personal choices and preferences. Care plans were reviewed and people contributed to the process. Steps had been taken to provide information for people with a sensory impairment in a way they could understand, however further development in this area was needed. People’s diverse needs were discussed with them and support offered where needed. Most people understood how to make a complaint. End of life care was not currently provided by the service.

People’s care records were now handled and stored securely, although we did find one example where they were not. The manager had ensured the CQC were notified of incidents that had or could have an impact on people’s health and safety.

At the last inspection, the manager had been in post for one week. Over the past nine months since our last inspection, they have focused on improving the main areas of risk at the service. This has reduced the risk to people’s safety. However, further improvements were needed to ensure that the risks identified at the last inspection and those that remain after this inspection, are reduced further. We were unable to judge the sustainability of these improvements, but we will be able to report on this in our next inspection.

We have made two recommendations for the provider to address, which will assist them in making improvements to the care and support people received.

This service has been in Special Measures following our inspection on 25 and 29 January 2018. Services that are in Special Measures are kept under review and inspected again within six months of the publication of the report. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements had been made and it is no longer rated as Inadequate overall or in any of the key questions. However, further improvements were needed to achieve an overall rating of Good.

25 January 2018

During a routine inspection

We carried out an unannounced inspection of the service on 25 and 29 January 2018. Tailor Maid Care Solutions Limited is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It currently provides a service to older adults. Not everyone using Tailor Maid Care Solutions Limited receives a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided.

A registered manager was present during the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 were informed that the registered manager was leaving the service on 9 February 2018. The new manager was present during the inspection. They were in the process of becoming registered with the CQC. We will monitor this application to ensure any delays are acted on in a timely manner.

At the time of the inspection, Tailor Maid Care Solutions Limited supported 82 people who received some element of support with their personal care. This was the service’s second inspection under its current registration. During our previous inspection on 6 January 2016, we rated this service as ‘Good’. However, due to the concerns identified within this report we have changed the overall rating to ‘Inadequate’.

During this inspection, we found on-going concerns with the punctuality of the staff. Staff did not always arrive on time and this placed people at risk of harm. People’s medicines were not always managed effectively. The risks to people’s safety had been assessed; however, people’s care planning documents were not always reflective of those risks. Accidents and incidents were not investigated and recorded appropriately to identify themes to reduce to the risk of reoccurrence. There were not enough sufficiently skilled and experienced staff to meet people’s needs. Effective processes were not always in place to ensure any allegations of abuse were actively investigated and reported to the relevant bodies such as the CQC or the local authority. People felt staff understood how to reduce the risk of the spread of infection in their home, but records showed staff had not received infection control training. People told us they felt safe when staff supported them in their homes.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible; the policies and systems in the service do not support this practice, clearer documentation was required to ensure all decisions made clearly evidenced that they were in each person’s best interest. The majority of staff training was up to date. However, staff were not provided with regular supervision, this meant opportunities to monitor and improve staff practice may have been missed.

People’s physical, mental health and social needs were assessed prior to commencing using the service; however support had not always been requested from health and social care professionals to aid them in providing care in line with current legislation and best practice guidelines. When people required support with their meals, staff were available to help them. People were not always provided with information about how they could contact other health or social care agencies, such as chiropodists and opticians. This limited people’s ability to make informed and independent decisions about their own care needs.

People felt staff were caring however, there were concerns raised by some relatives that their family members did not always receive the care they needed. People were not always introduced to new members of staff before they provided them with personal care. Information to support staff with communicating with people living with dementia was limited. People told us they had a care plan and had contributed to the information recorded in it. People were not provided with information if they wished to speak with an independent advocate. People and relatives felt staff treated them or their relatives with dignity.

Prior to starting with the service, assessments were carried out to ensure people’s needs could be met. However, when people’s care records were written, they did not always reflect these assessed needs, meaning people may not always receive the support they needed. Efforts had been made to review people’s care needs with them and to act on their views. People’s care records contained details about their personal preferences and life history to assist staff with supporting them in the way people wanted. Steps had been taken to provide information for people with a sensory impairment in a way they could understand, however further development in this area was needed. People’s spiritual and cultural needs had been discussed with them. Most people understood how to make a complaint although some felt their concerns were not always responded to appropriately.

We have made a recommendation about improving the quality of people’s care plans.

This service is currently suspended with local authority commissioners. This means they cannot currently provide care and support for any new people until they have made sufficient progress with the actions requested by the commissioners. Quality assurance processes were not effective in ensuring the risks to people’s health, safety and welfare were addressed. The representatives of the provider did not have effective input into the management of this service. The service was managed by a well-meaning but inexperienced registered manager, who did not have the skills or experience to manage the service effectively. This has contributed to the poor experience some people have received. People’s care records were not always handled and stored securely. The registered person had not always ensured the CQC were notified of incidents that had or could have an impact on people’s health and safety.

We identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of Regulation 18 of Care Quality Commission (Registration) Regulations 2009.

You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

The overall rating for this service is ‘Inadequate’ and the service therefore will be placed in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe, so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

6 January 2016

During a routine inspection

We carried out an announced inspection of the service on 6 January 2016. The Provider was given 48 hours’ notice of this. We gave notice of the inspection was given because the service. The inspection team consisted of one inspector, as this was a small service.

Tailor Maid Care Solutions Ltd is required by the Care Quality Commission to have a 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. The previous registered manager resigned from the service in December 2015, and the current manager was in the process of applying for the acting manager to become the registered manager.

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.

Tailor Maid Care Solutions Ltd is a domiciliary care agency that provides personal care to people in their own homes. At the time of our inspection, the service was supporting 13 people.

People we spoke to told us they felt safe. People were supported by staff who recognised signs of abuse and knew what actions to take to protect people and keep them safe. Any risks were recognized, and managed through the use of risk plans. The risk assessments were mainly generic, and not personalised to the individual. We spoke to the provider about this.

There were sufficient staff to meet people’s needs, and people usually received support from the same staff members. The provider had the relevant checks in place to ensure the staff were recruited safely.

People who needed help to take their medicines were supported by staff that had been trained to administer medication in a safe manner. Records showed medicines were given at the right time, and were recorded in the correct way by staff.

People were supported by staff who had been trained to work within the guidance of the Mental Capacity Act (2005). The Mental Capacity Act is the legal framework to ensure that where people are assessed as lacking capacity to make decisions for themselves, decisions are made in their best interests. Although most people using the service were deemed to have capacity, staff had received training in relation to Mental Capacity Act, and understood issues around consent and capacity.

People told us that they were supported by staff who knew their needs, and had the relevant training to carry out their roles and responsibilities. Staff received training, and had access to regular support and supervision to make sure they had the skills to carry out their roles and responsibilities.

People spoke highly of the support they received, and of the way staff interacted and supported them. Staff we spoke to clearly knew their needs and preferences of the people they were supporting, and showed warmth and care in discussions about the people they supported.

People felt involved in their care planning, and told us they were involved in assessments before the support had started. This meant that people received care that was appropriate to their needs, and that their choices and preferences were taken into account. Care records gave detailed information of what support was needed, and how this would be given. The service sought advice and support from other professionals when this was needed to ensure that people’s health care needs were met.

The service regularly monitored people’s satisfaction with the support they received through a variety of methods, including telephone checks calls, personal visits from managers, and satisfaction surveys. If people raised any issues, the service listened and responded appropriately to concerns raised.

There was a caring and open culture, and staff spoke positively about the acting manager and the area manager. Staff felt able to raise concerns and suggestions with the management team, and had faith that any issues would be acted upon promptly.

Care plans and risk assessments were regularly audited, and updated to reflect any changes in peoples support needs. The provider kept records of any incidents and accidents, and staff were kept updated on a regular and on-going basis