We undertook an announced inspection of Tamar Care UK Limited on 28 August 2018. Tamar Care UK Limited is a domiciliary care agency registered to provide personal care to people in their own homes. The Care Quality Commission only inspect the service 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 inspection, the service provided ‘personal care’ to 11 people.
There was a registered manager in post. 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 previous inspection on 20 July 2017 found three breaches of regulation and made two recommendations. We rated the service as "requires improvement". During this inspection on 28 August 2018, we found that the service had made improvements in respect of care documentation, staff employment checks, staff training, supervision, quality checks and audits. However, during this inspection we identified that risk assessments and medicines management could be improved.
People who used the service and relatives told us that they were satisfied with the care provided. People told us they were treated with respect and dignity and felt safe when cared for by care workers. They spoke positively about care workers and management at the service.
Our previous inspection found a breach of regulation in respect of recruitment checks. We found that appropriate recruitment checks were not carried out prior to staff commencing work. Our inspection in August 2018 found that the service had made improvements. We found that the service had a recruitment procedure in place and carried out necessary checks to ensure that care workers recruited were suitable and had the appropriate checks prior to being employed.
Risk assessments were in place which detailed potential risks to people. However, we found that these did not consistently include sufficient information to support care workers on how to effectively and safely mitigate identified risks. We raised this with management and they confirmed that they would ensure that risk assessments consistently included this information.
Systems and processes were in place to help protect people from the risk of harm. Care workers had received training in safeguarding adults and knew how to recognise and report any concerns or allegations of abuse.
At the time of our previous inspection in July 2017, the service did not support people with their medicines. During this inspection in August 2018, the registered manager confirmed that the service supported two people with their medicines. We saw that Medicine Administration Records (MARs) were completed by care workers when administering medicines. These included details of the prescribed medicine and dosage. We discussed with management the importance of ensuring that copies of completed MARs were kept at the office and they confirmed that this information would be kept at the office. However, there was no documented evidence that MARs were consistently audited by management and we raised this with management.
The majority of people and relatives we spoke with told us that there were no issues with regards to care worker’s punctuality and attendance. They told us that care workers were usually on time and if they were running late, the office called to inform them of the delay. At the time of the inspection, the service was in the process of implementing an electronic system for monitoring care worker’s timekeeping and duration of their visit and advised that this would be running by November 2018.
Our previous inspection found a breach of regulation as we did not see sufficient evidence to confirm that staff had been consistently supported to fulfil their roles and responsibilities through training, regular supervisions and appraisals. Our inspection in August 2018 found the service had made improvements in respect of this. We saw evidence that the service had a training programme to ensure care workers were competent and able to care effectively for people. Training was provided by an external organisation and included infection control, safeguarding adults and children, fluids and nutrition, moving and handling, medication administration, health and safety and equality and diversity. We also saw documented evidence that care workers had received necessary support and supervision from management staff and this was confirmed by care workers we spoke with.
The service had a Mental Capacity Act 2005 (MCA) policy in place. Our previous inspection of the service found that some care workers had not completed training in the MCA. During this inspection in August 2018, we found that staff had completed MCA training. When speaking with care workers they had a basic understanding of the MCA.
Our previous inspection found that care support plans contained limited information about people’s dietary needs. Since our previous inspection, the service had reviewed and amended their care support plans. Care support plans now included information about people’s dietary needs as well as their individual preferences. We saw documented evidence that care workers had completed nutrition and hydration training.
Care workers were aware of the importance of respecting people’s privacy and maintaining their dignity. They told us they gave people privacy whilst they undertook aspects of personal care. People who used the service told us that they felt confident in care provided by the service.
Our previous inspection in July 2017 found that there was a lack of information in people’s care support plans to indicate that that people were supported to express their views and be involved in decisions about their care and support and we made a recommendation in respect of this. During our inspection in August 2018, we found that the service had taken steps to address this. Care support plans now included information about people’s preferences and choices and details for staff on how to meet people’s needs. Care plans identified people's religion under the 'personal details' section and where necessary included further information under the “personal profile” section of the care support plan.
Our inspection in August 2018 found that the service had implemented two formal systems for obtaining feedback from people through feedback questionnaires and reviews with people. People and relatives we spoke with told us that they were involved in the care provided and said that the service encouraged them to provide feedback.
There was a management structure in place with a team of care workers, office staff, the care manager and registered manager. Staff spoke positively about the management and culture of the service and told us the management were approachable if they needed to raise any concerns.
We previously found that the service did not have effective systems and processes in place to assess, monitor and improve the quality of the services provided and we found a breach of regulation in respect of this. The previous inspection found that the service failed to carry out regular and consistent checks and audits in relation to recruitment, care plans, training and development and accidents and incidents. Our inspection in August 2018 noted that the service had made improvements. We saw that there was a formal system in respect of monitoring training and development through supervisions and spot checks. Care plans were reviewed and we noted that the service had carried out formal recruitment checks. We also noted that there was a system in place for monitoring accidents and incidents.
Our previous inspection identified areas of improvement and we rated the service as "requires improvement". During this inspection on 28 August 2018, we noted that the service had made improvements but found that medicines management and risk assessments could be improved. At the time of the inspection, the quality systems in place had not identified these areas for improvement. However, following discussions with management we were confident that the service would be able to address these promptly.