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Inspection carried out on 6 June 2019

During a routine inspection

About the service

Tetra Live In Care is a domiciliary care service that provides 24 hour live in support to people who have a spinal cord injury. They were providing support to four people at the time of the inspection.

People’s experience of using this service and what we found

People told us they felt safe at the service and staff protected them from risks they faced.

People were supported by staff who had been through a thorough recruitment process and had completed appropriate checks. People were happy with how their medicine was managed and told us they received this in a safe way. Staff followed safe hygiene practices.

Staff had received in depth training and received ongoing support from the service to ensure they had the relevant skills and knowledge to support people. People told us staff knew what they were doing and showed they were competent to help them in their daily lives.

People were happy with the staff who supported them and told us they were kind and compassionate. One person said, “[Staff] really goes out of his way.” The service wanted people to have good working relationships with the staff who supported them and acted promptly to find alternative staff if people wanted someone else to support them. Staff treated people in a respectful manner and did not discriminate against people.

People were involved in the preparation of their care plan and care was personalised. People’s preferences were respected, and people were supported by attentive staff who knew their likes and dislikes. Where people were not happy with any aspect of care the service actively listened and aimed to resolve it to the person’s satisfaction.

People and staff felt the management of the service were committed to providing a quality service and were available for support whenever they were needed.

The management of the service had improved the quality of audits to monitor the quality of the care and they regularly sought feedback from people who used the service and from their staff.

The management actively met with other organisations and charities who specialised in spinal injury to build community links and knowledge.

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

The last rating for this service was requires improvement (7 June 2018) and there were two breaches of the regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Inspection carried out on 28 March 2018

During a routine inspection

This inspection took place on 28 March 2018 and was announced. The provider was given 48 hours’ notice as they are a small service providing care to people in their own homes, we needed to be sure someone would be in.

This service is a domiciliary care agency. It provides personal care to people living in their own homes. It provides a service to adults with spinal cord injuries. At the time of our inspection they were providing care to four people.

The service was last inspected in June 2016 but was not rated because there was only one person using and we could not make a judgement about the care provided.

There was 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The provider did not have robust recruitment practices in place to ensure staff were suitable for working in the caring profession. The provider had not always obtained an employment history, proof of identity and up to date criminal record checks for staff. Staff did not always receive refresher training in line with the provider’s requirements.

People managed their own medicines and had signed a consent form stating staff would not record the medicines administered on medicine administration records. However as staff supported some people to dispense medication from their container we have recommended the service follow NICE medication guidelines in recording this type of support.

The provider was not set up in a way that promoted safe care through effective quality monitoring because the service’s audits had not highlighted and addressed the concerns we found during the inspection.

People and staff told us there were sufficient staff to ensure people’s needs were met by a consistent team and they felt safe and were protected from the risk of potential abuse. People were protected from risks to their health and wellbeing because risk assessments to guide staff provided sufficient detail for staff about how to manage specific risks.

People told us they were supported to get enough to eat and drink and were supported to attend appointments with healthcare professionals if they were unwell. Staff were provided with gloves and aprons to prevent the spread of infection.

People told us staff developed good relationships with them and respected their diversity and privacy. People were involved in planning their care and care records included information about people's likes and dislikes and promoting their independence. People’s consent to care was recorded in their care plans.

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

Inspection carried out on 28 June 2016

During a routine inspection

This inspection took place on 28 June 2016 and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service; we needed to be sure that someone would be in. This was the first inspection since the provider registered with the Care Quality Commission in 2011. The provider had only started to provide a regulated activity from September 2015.

Tetra Live-in Care is registered as a domiciliary care provider supporting people living with high level spinal cord injuries with live-in carers providing 24 hour care in their own homes. At the time of the inspection, one person was receiving a live in care service from the provider. This meant that although we were able to carry out an inspection we did not have enough information about the experiences of a sufficient number of people using the service over a consistent period of time to give a rating to each of the five questions and an overall rating for the service.

The service 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Risks to people were documented and managed so that people were kept safe. These were assessed during an initial assessment and thereafter reviewed every six months.

Care records were based around people’s preferences and were written in a person centred manner. They were developed by speaking with people and their relatives, and covered a number of areas highlighting where people required support.

Care records included details of people’s support needs in relation to their diet and ongoing health monitoring. These were managed appropriately by care workers. Care workers completed records relating to people’s diets, health care appointments and medicines in a timely manner.

Care workers received a thorough induction which covered mandatory training and also specialist training based around supporting people with spinal cord injuries. They were familiar with people’s preferences and how they liked to spend their day.

Care workers told us they felt support by the management team who were always available to provide advice when needed.