Background to this inspection
Updated
31 December 2019
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
The inspection was carried out by one inspector 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.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.
Notice of inspection
We gave the service 48 hours’ notice of the inspection. This was because it is a small service and we needed to be sure that the provider would be in the office to support the inspection.
Inspection activity started on 04 November 2019 and ended on 27 November 2019. We carried out telephone calls to people and their relatives on 04 November 2019. We visited the office location on 07 November 2019. We carried out calls to staff and reviewed evidence between 07 November and 27 November 2019.
What we did before the inspection
The provider was not asked to complete a provider information return prior to this inspection. 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 inspected the service and made the judgements in this report. We reviewed the information we held about the service including previous inspection reports. We also looked at notifications about important events that had taken place in the service, which the provider is required to tell us by law.
We contacted health and social care professionals to obtain feedback about their experience of the service. These professionals included local authority commissioners and Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. Healthwatch told us they had not been to the service since we last inspected and had not received any information about the service. We received feedback from a local authority quality assurance worker, who told us they had visited the service in January 2019. We used all of this information to plan our inspection.
During the inspection
We spoke with five people who used the service and three relatives about their experience of the care provided. We spoke with four staff including the provider.
We reviewed a range of records. This included five people's care records and multiple medicines records. We looked at two staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at training data.
Updated
31 December 2019
About the service
Tiger Lily Care is a domiciliary care service providing personal care to people living in their own homes. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. The service provided care and support to adults and children. The service was providing personal care to approximately 29 people at the time of the inspection.
People’s experience of using this service and what we found
Medicines were not always managed safely. Medicines administration records (MAR) were not completed in a safe way to make sure people received their medicines as prescribed as they were missing essential information.
There were systems in place to check the quality of the service. However, the systems to review and check the quality of the service were not always robust, they had not identified the concerns we raised in relation to medicines management. This was an area for improvement.
Improvements had been seen across the service since our last inspection. The provider and staff had worked hard to make sure people received quality care and support, however further improvements were still required.
People's needs were assessed, monitored and reviewed to ensure their needs were met. People were supported by competent, knowledgeable staff. Some staff had not undertaken all of their basic training. This was an area for improvement. Staff were supported by the provider.
People's care records contained in depth risk assessments to keep people safe. Risks to the environment had been considered as well as risks associated with people's health and care needs. The provider had systems in place to monitor accidents and incidents, learning lessons from these to reduce the risks of issues occurring again. The records of the action taken were not always clear. This was an area for improvement.
Staff were recruited safely. There were enough staff deployed to keep people safe. Staff told us that most of the time they had adequate time between care visits to travel between their calls. Some remote areas had not been allocated enough travel time. This was an area for improvement.
People were protected from the risk of abuse. The provider promoted an open culture to encourage staff to raise any concerns.
Where required, people were supported to ensure their dietary needs and preferences were met. Staff worked closely with occupational therapists and other agencies to assess people’s needs and ensure people were supported with their changing needs.
People and their relatives told us their choices and decisions were listened to and they were in control of their support. On a day to day basis people directed their care. People and their relatives told us they were asked how they liked things to be done. People said staff treated them with dignity and their privacy was respected. People were supported to be as independent as possible.
People gave us positive feedback about their care and support. They told us, “I believe I get all the care I need”; “They are good all of them”; “They are very friendly, we have a laugh really, very kind” and “The [staff member] is my favourite, I think the world of her.”
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The service was rated Requires improvement at the last inspection on 04 September 2018 (the report was published on 20 November 2018). There were four breaches of regulation. The provider had failed to operate effective quality monitoring systems. The provider had failed to effectively deploy staff to enable them to carry out their duties. The provider had failed to manage care and treatment in a safe way through assessment and mitigation of risks. The provider had failed to operate effective recruitment procedures. The provider completed an action plan after the last inspection to show what they would do and by when to improve. We also met with the provider after the last inspection to discuss the improvements required.
At this inspection we found improvements had been made. However, the provider was still in breach of one regulation. The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.
Why we inspected
This was a planned inspection based on the previous rating.
Follow up
We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.