Archived: Total Care Norfolk

Total Care Norfolk is a domiciliary care agency which provides care and support to people in their own homes in the Downham Market area.

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.

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

The service was not well-led, and this had a negative impact on people’s care and support. The nominated individual, who is legally responsible for the service, had not fully assessed and reduced risks to people’s health and welfare. Systems designed to report significant information, such as accidents and incidents were not effective. The provider did not have oversight of the service and issues or poor care and neglectful practice had not been appropriately reported, investigated and addressed.

Recruitment procedures were not robust and did not fully protect people. Staff training was not delivered as soon as staff were first employed. This meant some staff did not have all the skills and knowledge they needed to carry out their roles safely. Staffing levels were not always well monitored and rotas did not easily enable staff to ensure all calls were timely.

Medicines were not always well managed. Records relating to medicines needed to be clearer to ensure staff had the guidance they needed.

Although some people who used the service were very happy with their care and we observed good care being provided, we are not confident in the provider. The provider failed to ensure all the people who used the service had safe care and treatment.

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 good (report published 10 April 2018.)

Why we inspected

We received concerns in relation to untrained and unskilled staff, poor recruitment practices and poor management of falls. As a result, we undertook a focused inspection to review the Key Questions of Safe and Well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other Key Questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those Key Questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

Since our inspection the provider has told us that they have taken action to implement new reporting systems. These have been designed to ensure key information about risks to people’s health and welfare is monitored more effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Total Care Norfolk on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to the management of risk, management of medicines, leadership, staffing and recruitment at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan and will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

The overall rating for this service is ‘Inadequate’ and the service is in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe, and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it, and it is no longer rated as inadequate for any of the five key questions, it will no longer be in special measures.

This was the first inspection for this service which was registered with the Care Quality Commission (CQC) in March 2017.

Total Care Norfolk is a domiciliary care agency. It provides personal care to people living in their own homes. At the time of our inspection five people were using the service which provides care to people in the Downham Market area.

The service did not have a registered manager in post. A manager had previously been appointed but had left the service in October 2017 before they were registered with CQC. The provider had not yet appointed a new manager and was carrying out this role herself in the meantime. 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.

There were systems in place designed to help protect people from abuse. Staff understood their responsibilities and the service had raised concerns appropriately with the local authority and taken their advice.

Risks to people’s health and safety were assessed and managed well. Staff understood risk, including how to manage the risks relating to the spread of infection, and information about protecting people was clear.

Staff were recruited safely and there were enough staff to meet people’s needs. A small staff team provided consistent care to people.

The provider carried out a detailed assessment of people’s needs and encouraged people to be involved in decisions about their care and support. Staff received the training and support they needed to carry out their roles. Staff supported people to manage their healthcare needs and access the care they needed.

People consented to their care and their choices were respected. Staff worked in accordance with the Mental Capacity Act 2005 (MCA). The MCA ensures that people’s capacity to consent to their care and treatment is assessed. If people do not have the capacity to consent for themselves the appropriate professionals, relatives or legal representatives should be involved to ensure that decisions are taken in people’s best interests according to a structured process.

Staff treated people with patience, warmth and kindness and relationships were good. Staff respected people’s privacy and maintained their dignity. People were encouraged to be as independent as possible.

People received flexible, person centred care which met their individual needs and preferences. Staff treated people as individuals and were committed to ensuring that people received their care in the way they chose.

A complaints procedure was in place but no formal complaints had been logged. People knew how to make a complaint and felt comfortable raising any informal issues with the provider.

There was no structured system of audits in place, although the provider was regularly on the shift rota and was monitoring the quality of the service by speaking with people directly.

The provider demonstrated that they needed a clearer understanding of some aspects of the role of regulation.

Staff felt supported and the provider promoted an open culture which welcomed constructive criticism.