Archived: Total Health Support and Training Services Limited

We had concerns about medicines training for all staff, including the registered manager. The provider did not ensure staff handling medicines had the competency and skills needed to ensure medicines were administered safely. At this inspection we found the provider had taken action to ensure staff received training to enable them to support people who use the service safely. They also assessed care workers competency to administer medicines, and completed regular observations of staff in people's homes. Other mandatory training had also been completed for staff, including safeguarding of vulnerable adults (SOVA) and moving and handling. Where the provider had identified mandatory training that needed updating they had ensured this had been booked for all staff.

The statement of purpose contained all the correct information as required by the regulation.

We did not speak to people who use the service on this occasion.

This is a summary of what we found-

Is the service safe?

We found the service was safe because people were protected against the risks associated with poor medicines management.

The inspectors gathered evidence against the outcomes we reviewed to help answer our five key questions; is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found. The summary describes what people who use the service, relatives and staff told us, what we observed and the records we looked at.

Is the service safe?

Possible risks to people had been identified in their care plans and the appropriate action taken to manage those risks. These included risk of falls, moving and handling and managing emotional needs.

The provider had not protected people who use the service against the risks associated with the unsafe use and management of medicines. This was because they did not have suitable arrangements in place to ensure safe keeping, administration and recording of medicines.

We have asked the provider to take immediate action to meet the requirements of the law in relation to the management of medicines.

Is the service effective?

People's needs were assessed and care was planned and delivered in line with their individual care plan. We looked at six people's care records. The plans of care contained all the relevant information to enable staff to appropriately care for people.

People and relatives we spoke with told us they thought care workers were well trained. One relative said: 'I think they are very experienced.' We noted that supervision, appraisals and most mandatory training was up to date for staff. However, we found there was a risk that people would not be protected against the risks associated with the unsafe administration of medication because staff were not appropriately trained. We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to supporting workers.

Is the service caring?

We spoke with three people who use the service and three relatives. They were all complimentary about the care they or their family member received. One person said: 'I am very happy with the care they provide'. Another said: 'they seem so caring'.

Is the service responsive?

We saw care records and risk assessments had been recently reviewed and updated. If any changes to people's needs were identified these were made. Care plans were then updated and staff informed.

Staff confirmed that if they raised any concerns about people's care needs, managers would act on it. If required a review of care would be undertaken, and care plans updated accordingly.

Is the service well led?

People and relatives we spoke with confirmed they were regularly asked for their feedback about the service and it was acted on. The provider identified, assessed and managed risks relating to the health, welfare and safety of people who use the service and others, with the exception of those related to medication.

The provider's statement of purpose did not contain all of the information required by the regulation. They had not regularly reviewed or updated the statement of purpose. We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to their statement of purpose.

This report refers to the regulated activity of personal care only. The provider was not performing the regulated activity of nursing care at the time of our inspection.

We spoke with people who use the service, family members, staff, the care manager and the registered manager. A family member we spoke with said that the service "was good" and that staff were "very pleasant" and "do everything you ask of them."

We looked at people's individual files which incorporated their personal profile, care routines and risk assessments and found they encompassed the safety and well-being of people who use the service. People who use the service, a family member and staff we spoke with told us that they knew how to raise a concern or complaint and felt confident in doing so. People said if they had any issues they could "talk to the manager."

There were policies and procedures in place providing guidance and all staff had received relevant training which was confirmed within the training records and by staff we spoke with.

We reviewed the quality of the service and found the provider had systems and procedures in place to monitor and evaluate the quality of the service provided. We reviewed the medication records and found shortfalls in the way daily recordings were completed which may have an impact on the people who use the service. We found that people who use the service were not protected against the risks associated with the administration of medicines.

People thought generally the service was a reliable one. Staff were flexible in their work. They said, 'I tell them what I need on the day. They keep me clean, safe and comfortable and are always on time'. People's views on how they wanted their care and support provided had been recorded. Staff knew about people's values and beliefs that were to be respected.

People told us they knew what to do if they had any concerns. They said they felt safe in their homes. Staff followed their instructions on how to gain entry and secure their home when they left.

People were cared for by staff who had been subjected to strict character checks to ensure they were suitable to work with people using the service. People were cared for by staff that had been adequately trained. and who received good training.

People viewed staff as being helpful, kind and caring. One person said 'Some of the carers are outstanding. They are supportive and kind, diligent and hardworking'.