24 April 2018
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.
This inspection took place on 13 March 2018. It was announced and was carried out by one inspector. We gave the registered manager 48 hours' notice because the location provides a domiciliary care service and we needed to make sure someone would be in the office.
We used information the provider sent us in the Provider Information Return (PIR). 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. Prior to the inspection we looked at the PIR and all the information we had collected about the service. This included previous inspection reports, information received and notifications the registered manager had sent us. A notification is information about important events which the service is required to tell us about by law.
We spoke with the registered manager and the office staff. As part of the inspection we sought feedback from 17 people who use the service and received responses from four. We received feedback from five relatives of people who were not able to give us their views. We requested feedback from seven community professionals and received responses from two. We also requested feedback from 28 members of staff and received eight responses.
We looked at five people's care plans, daily notes, monitoring records and medication sheets. We saw six staff recruitment files, staff training records and the staff supervision and appraisal log. We reviewed a number of other documents relating to the management of the service. For example, audits, policies, incident forms, staff meeting minutes, compliments and concerns records.
24 April 2018
This inspection took place on 13 March 2018 and was announced. We gave the registered manager 48 hours' notice because the location provides a domiciliary care service and we needed to make sure the relevant staff and information would be available in the office.
At the last inspection in February 2017 we found the service was not meeting all fundamental standards as required. Staff were not being provided with appropriate training, competency assessment and performance appraisals and the provider had not established an effective system that ensured their compliance with the fundamental standards. Following that inspection, we asked the provider to complete an action plan to show what they would do, and by when, to improve the key questions safe, effective and well-led to at least good. At this inspection we found the provider had taken the action they said they would and had improved the service to an overall rating of good, with a rating of good in all key questions.
Total Health Support and Training Services Limited is a domiciliary care agency. It provides personal care to people living in their own homes in the community. It provides a service to older and younger people, some of who may be living with dementia. This service also provides care and support to younger adults who have learning disabilities or autistic spectrum disorder living in ‘supported living’ settings. This is so that they can live in their own homes as independently as possible. In supported living, people’s care and housing are provided under separate contractual agreements. The Care Quality Commission (CQC) does not regulate premises used for supported living; this inspection only looked at people’s personal care and support. At the time of our inspection there were 82 people receiving a service. Of those 82 people, 14 were living in supported living settings in five different houses.
The provider is also registered to provide nursing care to people in their own homes. No nursing care was being provided at the time of this inspection.
The service had a registered manager as required. A registered manager is a person who has registered with the 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. The registered manager was present and assisted us during the inspection.
People were protected from the risks of abuse. Risks were identified and managed effectively to protect people from avoidable harm. Recruitment processes were in place to make sure, as far as possible, that people were protected from staff being employed who were not suitable.
People were treated with care and kindness. They were consulted about their support and could change how things were done if they wanted to. People were treated with respect and their dignity was upheld. This was confirmed by people and the relatives who gave us their views. People were encouraged and supported to maintain and increase their independence.
People received care and support that was personalised to meet their individual needs. In the supported living houses, people were supported to access local events to enhance their social activities. This meant people had access to activities that took into account their individual interests and links with different communities.
People received effective care and support from staff who knew them well and were well trained. They told us staff had the training and skills they needed when providing their care and support. People received effective health care and support. Medicines were stored and handled correctly and safely.
People knew how to complain and knew the process to follow if they had concerns. People's rights to make their own decisions were protected. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.
Where people were potentially being deprived of their liberty, the service had made the relevant commissioning authorities aware. This was so that commissioners could make applications to the Court of Protection for the appropriate authorisations.
People's right to confidentiality was protected and they received support that was individualised to their personal preferences and needs. People's diversity needs were identified and incorporated into their care plans where applicable.
People benefitted from a service which had an open and inclusive culture and encouraged suggestions and ideas for improvement from people who use the service, their relatives and staff. Staff were happy working for the service and people benefitted from staff who felt well managed and supported.