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Dementia Care TLC is a domiciliary care service providing personal care to adults with a range of support needs including people living with dementia. At the time of the inspection the service was providing personal care to 30 people living in their own homes in the local community.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

At the time of the inspection, the location did not care or support for anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.

Right Support:

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. Staff supported people with their medicines safely. Staff assessed environmental risks and followed safe infection control procedures. Staff supported people to access specialist health and social care support in the community.

Right Care:

The service had care plans and guidance for staff to support people with their individual risks. Staff understood how to protect people from poor care. Staff had training on how to recognise and report abuse and they knew how to apply it. People received support to maintain a balanced diet. The service had enough appropriately skilled staff to meet people’s needs and keep them safe.

Right Culture:

People’s quality of life was enhanced by the service’s culture of improvement and inclusivity. Improvements had been made since the last inspection. Systems were in place to monitor the quality of the service; people spoke positively of the leadership team and support they received from staff. The service enabled people and those important to them to work with staff to develop the service. Staff ensured risks of a closed culture were minimised so that people received support based on transparency, respect and inclusivity.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published January 2021) and there were breaches of regulation. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an announced comprehensive inspection of this service on 16 November and 7 December 2020. Breaches of legal requirements were found relating to Regulation 11 (need for consent), Regulation 12 (safe care and treatment) and Regulation 17 (good governance). The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, need for consent and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Dementia Care TLC is a domiciliary care agency registered to provide personal care to people in their own homes. The service provides care and support to people which include personal care, food preparation and medication support. At the time of this inspection, the provider informed us that they were providing care and support to 50 people who used the service.

Not everyone using Dementia Care TLC receives a regulated activity. CQC only inspects the service received by people provided with 'personal care'; 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

People and relatives were happy with the care workers who supported them. Each person benefited from regular staff who knew them well. Comments included, “I couldn’t wish for better staff. They are respectful and helpful” and “The carers have been wonderful and understand her dementia. They know her likes and dislikes and really work well with us.”

People felt safe and comfortable when staff were in their home. People's records identified risks but there were not always clear plans in place to tell staff how these risks should be managed or reduced. Despite this, staff knew the risks and told us how they would respond. The provider had systems and processes in place for the safe administration and use of medicines. However, these processes were not always followed. The provider’s records for medicines administration did not give assurance about the safe administration of medicines. Staff recruitment practices were safe. Staff understood their responsibilities in relation to infection control.

People and relatives told us people were asked for their consent and permission before receiving care. People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Where some people lacked capacity to make decisions, the care plan did not contain evidence to show decisions had been made in the person’s best interests.

People received a personalised service to meet their specific needs, preferences and wishes. People were involved in making decisions about their care and supported to maintain their independence. However, care plans did not always contain enough detail for staff to know how to deliver care effectively and consistently. Despite the lack of information in care plans, staff knew people well and people spoke positively about the service they received which met their needs and preferences.

People told us the service was well managed. Comments included, “I think it is extremely well organised and (name of provider) is a good leader” and “On the whole I think it seems a well-managed company.” There were systems in place to assess and monitor the quality of the service provided. However, monitoring systems had not identified the issues found at this inspection. When we identified issues during the inspection, the provider immediately started work on making improvements.

Rating at last inspection

The last rating for this service was Good (published 6 June 2018).

Why we inspected

This inspection was initially carried out as part of a pilot exploring virtual approaches to inspection. However, during the inspection we identified concerns with risk assessments, care planning, medicines management and governance. This meant that under the terms of the pilot we needed to convert the inspection to one that included a site visit.

This inspection considered the key questions of safe and well-led and provide a rating for those key questions. Only parts of the effective, caring and responsive key questions were considered, and therefore the ratings for these key questions are those awarded at the last inspection.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to records such as risk assessments, the safe management of medicines, consent, and the governance of the service at this inspection.

You can see what action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

At the time of the inspection 35 people were receiving the regulated activity ‘personal care’.

This inspection was announced and took place on 9 May 2018. This was the first inspection since the provider registered the service in April 2017.

The service was run by Mrs Jacqueline Archer as a sole provider. As a sole provider they are not required to employ a registered manager. Instead they had opted to manage the service themselves. 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.

People were protected from abuse because the provider had systems in place to ensure checks of new staff, and their suitability to work with vulnerable adults were carried out. Staff had also received training in protecting vulnerable people from abuse.

People said they felt safe when being cared for. All incidents and accidents were recorded and reviewed by the provider. People were supported by small teams of carers and calls were well planned to ensure people received their allocated time for the calls and they were not rushed.

People were supported by staff who had a clear knowledge and understanding of their personal needs, likes and dislikes. People had a regular small team of staff who they knew, and had built relationships with.

People were supported by staff who were motivated in their role. People told us the staff were kind, caring and they were treated with dignity and respect.

People's care needs were recorded in care plans and reviewed regularly. Some of the care plans required further information to enable an unfamiliar staff member to support them.

The service worked in partnership with other organisations to make sure people's needs were met. Records showed the service responded to concerns and complaints and learnt from the issues raised.

There were systems in place to manage the service. The provider worked with a small team with areas of responsibility for planning, staffing and client services.

There were systems in place to monitor the care provided and people's views and opinions were sought through regular contact with the provider and an annual survey.