Archived: Tiger Lily Care

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.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults, people living with dementia and younger adults with a physical disability. The service was also available to provide personal care for children, however there were no children being provided with personal care when we inspected.

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. There were 23 people receiving support with their personal care when we inspected.

At the last inspection on 20 December 2017 we rated the service Requires Improvement overall and rated the Effective domain Inadequate. The provider had failed to provide care and treatment with the consent of the relevant person. The provider had failed to establish and operate effective complaint systems. The provider had not ensured that leadership and quality assurance systems were effective to make sure people were safe and they received a good service. The provider had failed to operate effective recruitment procedures. The provider had failed to provide training and support for staff relating to people's needs. The provider had not ensured that people received appropriate care that met their needs and reflected their preferences. The provider had failed to manage care and treatment in a safe way and failed to ensure that medicines were suitably managed. We also recommended that the provider made it clear to people and their relatives the emergency contact arrangements relating to the service if they took a holiday. We imposed a condition on the provider's registration.

The provider submitted an action plan on 06 March 2018. This showed they had met two regulations by 01 March 2018. The provider planned to meet the remainder of the Regulations by 31 March 2018.

At this inspection we found the provider had met some of their actions. However, there continued to be four breaches. The service has been rated Requires Improvement overall. This is the second consecutive time the service has been rated Requires Improvement.

People told us they received safe, effective, caring, responsive and well led care. They had nothing but positive feedback about the service they received.

The provider had made some improvements to their recruitment processes. However, further improvements were required. Two of the four staff files we viewed showed gaps in employment history that had not been explored which meant the provider had not always followed effective recruitment procedures to check that potential staff employed had the skills and experience needed to carry out their roles.

At the last inspection staff had not attended training relevant to people's needs. At this inspection training had improved. However, some staff had not received basic training before providing care and support to people in their homes. Medicines training had not yet been completed by some staff; these staff were administering medicines to people. This is an area for improvement.

Staff told us they received regular supervision meetings and regular spot checks to ensure that they were putting their training into practice. They felt they had good support from the provider.

Although some improvements had been made to risk assessment processes since the last inspection. People’s care records did not always evidence that the provider had assessed risks to people's safety. One person’s care file detailed that they were cared for in bed. There was no risk assessment for staff to detail how staff should safely manoeuvre the person when providing personal care, there was no information about what equipment was in place.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

Systems were in place to enable the provider to assess, monitor and improve the quality and safety of the service. These systems were not fully robust as they had not identified the areas for improvement we found during the inspection.

People were supported appropriately by a planned assessment and care planning process to make sure their needs were met. The assessment process did not explore people’s gender, nationality or ethnicity. This was an area for improvement.

People were supported and helped to maintain their health and to access health services. Timely action had been taken when people's health changed. Any accidents or incidents that had occurred had been appropriately recorded. Appropriate action had been taken when accidents and incidents had occurred. We noted there were no sections on the incident and accident forms to evidence that the provider had reviewed the information and what additional action had been taken to reduce the risks of the incident occurring again. This is an area for improvement.

At this inspection care plans had improved. Care plans had been reviewed and amended regularly including when people's needs had changed. Some people’s care plans provided a detailed account of what staff needed to do and what the person could do for themselves in relation to their personal care. This included making sure that people received oral care to maintain healthy teeth and gums. However, some care plans did not detail fully what help and assistance people required. This was an area for improvement.

People knew who to complain to if they needed to. The complaints procedure was available in the office and people had copies within their handbooks in their homes. People had opportunities to feedback about the service they received.

People were protected from abuse or the risk of abuse. The provider was aware of their roles and responsibilities in relation to safeguarding people.

Some people received support to prepare and cook meals and drinks to meet their nutritional and hydration needs. Some people’s daily records did not show clearly what people had been given to eat. This was an area for improvement.

People and their relatives told us Tiger Lily Care was well run. They knew the provider and had confidence in the staff. Relatives told us they had recommended the service to their friends and families.

There were suitable numbers of staff on shift to meet people's needs. People received consistent support from staff they knew well. People told us that staff were kind and caring. Staff treated people with dignity and respect.

People's information was treated confidentially. People's paper records were stored securely in locked filing cabinets.

People were protected from the risk of infection. Staff were provided with appropriate equipment such as gloves and aprons to carry out their roles safely.

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

Tiger Lily Care is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults, people living with dementia and younger adults with a physical disability. The service was also available to provide personal care for children, however there were no children being provided with personal care when we inspected.

Not everyone using Tiger Lily Care receives 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. At the time of our inspection they were supporting 16 people who received support with personal care tasks.

The provider had not always followed effective recruitment procedures to check that potential staff employed were of good character and had the skills and experience needed to carry out their roles.

There were procedures in place and guidance was clear in relation to the Mental Capacity Act 2005 (MCA 2005) that included the steps staff should take to comply with legal requirements. Staff had a limited understanding of the MCA 2005 to enable them to protect people’s rights. Care plans and documentation did not evidence that the MCA 2005 had been followed.

Effective systems were not in place to enable the provider to assess, monitor and improve the quality and safety of the service. People had opportunities to feedback about the service they received in an informal manner. However they were not given the opportunity to provide feedback anonymously.

People were supported and helped to maintain their health and to access health services. Timely action had not always been taken when people’s health changed.

Risks to people’s safety and welfare were not always managed to make sure they were protected from harm.

Staff had not attended training relevant to people’s needs. Supervisions for staff required improvement.

Medicines practice was not always safe. Staff had not received medicines training and had not had their competency assessed. Medicines had not always been recorded adequately.

People's care plans did not always make it clear how staff should meet their care and support needs. Essential information about people such as their life history, likes, dislikes and preferences were not included. Care plans did not always reflect each person's current need or specific healthcare needs.

People did not always know who to complain to if they needed to. The complaints procedure was available in the office and in some people’s care files in their homes. The complaints procedure did not give people all the information they needed to take their complaint further if they needed to.

People were not always clear how to contact the provider out of hours. We made a recommendation about this.

People were protected from abuse or the risk of abuse. The provider and staff were aware of their roles and responsibilities in relation to safeguarding people.

Some people received support to prepare and cook meals and drinks to meet their nutritional and hydration needs.

There were suitable numbers of staff on shift to meet people’s needs. The provider worked with people providing care and support on a regular basis. People received consistent support from staff they knew well.

People’s information was treated confidentially. People’s paper records were stored securely in locked filing cabinets.

People and relatives told us that staff were kind and caring. Staff treated people with dignity and respect.

Staff were positive about the support they received from the management team. They felt they could raise concerns and they would be listened to.

People and their relatives told us the service was well run.

We found seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. 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 any concerns found during inspections is added to reports after any representations and appeals have been concluded.