True Homecare Limited

True Homecare Limited is a domiciliary care agency providing personal care to people in their own homes. 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. At the time of inspection, 50 people were receiving personal care.

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

Although we were satisfied people received their medicines as prescribed, some aspects of medicines administration and recording were not always safe. We have made a recommendation about this in the 'safe' section of this report.

People told us they felt safe. Staff understood their responsibilities about keeping people safe. Risks were identified and managed. Incidents and accidents were recorded so that they could be considered and reflected upon to make improvements to the service. Staff understood their responsibilities to prevent the spread of infection whilst working in and between people's homes. Staff were recruited safely and people were happy staff arrived on time and stayed for the correct length of time.

People told us staff were kind and caring. People said staff, including the registered manager, had met their expectations of a care service. People and relatives had high levels of trust in staff which had a positive impact on their wellbeing. Staff supported people to remain independent and promoted their dignity. 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. People's privacy was respected and their personal information was kept confidentially.

Staff had completed training in key areas and were supported to carry out their roles. People and relatives had confidence in staff and were content with the care they received. People were supported to access health services if needed. People's dietary needs were assessed and, where required, were supported with their meals.

People's care plans were up to date about their individual needs and preferences. People received support that met their needs. People and their relatives knew how to complain, although none we spoke with had any complaints.

The service was managed by a registered manager and overseen by a provider representative. They had a clear vision about the quality of care they wanted to provide. Staff were aware of their roles and responsibilities. There were quality assurance systems in place to monitor the quality and safety of the service. There was a focus in the service of openness and continuous improvement.

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 (published 4 August 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

True Homecare Limited is a domiciliary care service that provides personal care to people who live in their own homes. At the time of the inspection there were 93 people using the regulated services of personal care. The inspection was undertaken by one adult social care inspector.

The service was last inspected in June 2016. During that inspection we found breaches of one of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014. This resulted in us making two requirement actions. This was because medicines were not being managed safely and risks were not being assessed or mitigated properly. We also made three recommendations; that the service developed recording systems in relation to monitoring service quality and safety, that a structured approach to the provision of supervision and appraisal to staff be developed and that it improved its approach to care planning and assessment.

Following the inspection the provider wrote to us to tell us what action they intended to take to ensure they met all the relevant regulations. During this inspection we checked if the required improvements had been made. We found that improvements had been made, the requirement actions had been met and the service had acted on our recommendations.

The service has a registered manager who was present during our inspection. 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.

All the people we spoke with were positive about the registered manager and the way they ran the service. Staff spoke very respectfully and fondly about the registered manager. We spent time with the registered manager throughout our inspection and found them to be committed to providing a good quality person centred service. Staff we spoke with shared this commitment.

There was a safe system in place for managing people’s medicines.

Individual and environmental risk assessments were person centred and gave staff guidance on how to minimise and manage identified risks. Care records, including initial assessments, were detailed and person centred. They contained information based on people’s needs and wishes and were sufficiently detailed to guide staff in how to provide the support people required. One staff member said, “The care plans tell us everything people want us to do and how they want things to be done.”

Care records, including care plans and risk assessments, had been reviewed regularly to ensure they reflected people’s changing needs and wishes. We saw that people who used the service had been involved in the reviews.

People who used the service told us they felt safe. Staff had received training in safeguarding adults. Staff were able to tell us how to identify and respond to allegations of abuse. They were also aware of the responsibility to ‘whistle blow’ on colleagues who they thought might be delivering poor care to people.

There was a safe system of recruitment in place which helped protect people who used the service from unsuitable staff. Staff received the induction, training, support and supervision they required to ensure they had the skills and knowledge needed to carry out their roles effectively. Staff told us they felt supported.

Visits were planned well. People told us the service was reliable and staff had enough time to provide them with the support they required. One person said, “They come at regular times and know what I want.”

Procedures were in place to prevent and control the spread of infection and systems were in place to deal with any emergency that could affect the provision of care.

People in their own homes are not subject to Deprivation of Liberty Safeguards ( DoLS). However, staff were trained in the Mental Capacity Act (MCA) and DoLS to ensure they were aware of the principles. People who used the service told us they were consulted about the care provided and staff always sought their consent before providing support.

People supported by the service lived in their own homes and could therefore eat what they wanted. People we spoke with told us staff supported them with their meals. Staff had received training in food hygiene, nutrition and hydration.

People we spoke with told us staff arranged health care appointments for them and accompanied them if needed. People who used the service said, “I am going to the dentist next week. Straight away [when the appointment was made] they said they would go [with the person]” and “They support me to go to the hospital and to appointments.”

People who used the service told us the staff were helpful, caring and friendly. They told us “They carers are good people”, “They are absolutely wonderful, nothing is too much trouble for them.” During our inspection we saw staff had a good rapport with the people they were supporting. We observed interaction that were relaxed and friendly. Staff we spoke with took pride in the person centred and caring nature of the service provided.

Staff and managers of the service had detailed knowledge of people and were able to tell us what was important to people, their likes and dislikes and the support they required.

Staff meetings were held regularly where staff had an opportunity to raise any issues and were used to look a developing good practice. Staff we spoke with liked working for the service and one told us, “We are more than work colleagues, we’re like family. We [the service] have doubled in size but we have retained that.”

There was a good system of quality assurance in place. The registered manager and other managers of the service carried out weekly and monthly checks and audits. These were used to assess, monitor and review the service.

Information was given to people who used the service to let them know what to expect from the service. Arrangements were in place to seek feedback from people who used the service. People we spoke with knew how to complain and were confident the managers of the service would deal with any issues they raised.

The CQC rating and report from the last inspection was displayed in the office and on the providers website.

True Homecare is a domiciliary care service that was launched in 2012. It is based in Cheadle, Stockport and provides personal care for people in their own homes. At the time of our inspection the service was providing support to approximately 80 people.

The service had a registered manager in post. 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.

We last inspected True Homecare on 24 June 2013 when we found the service to be meeting all standards inspected. The inspection on 24 June 2013 was a follow-up inspection to check the service was meeting requirements in relation to breaches of the regulations identified during an inspection on 08 March 2013. These related to safeguarding, training and supervision and safe recruitment.

At this inspection we identified two breaches of one of the regulations in relation to the safe management of medicines, and in relation to assessing and mitigating risks. You can see what action we have told the provider to take at the back of this report. We have made three recommendations. We recommend that the service develops its' recording systems in relation to monitoring service quality and safety; that it develops a structured approach to the provision of supervision and appraisal to staff; and that it develops its' approach to care planning and assessment.

We found records relating to the support people required with their medicines were not always clear. It was not possible to tell with certainty which medicines staff had prompted people to take as it was unclear if the records of people’s medicines were up to date. There was also a lack of clarity or assessment in relation to the support people required with their medicines. This increased the risk people might not be receiving the correct support to manage their medicines safely.

We saw risk assessments were carried out to help identify risks. However, these assessments did not always identify risks that had been documented elsewhere, and they did not always clearly detail what steps should be taken to help reduce any potential risks. For example, we saw risks including self-neglect, falls and weight loss had been identified in local authority assessments. However, the service’s care plans and risk assessments did not set out how staff should manage these risks.

There was sufficient numbers of staff to enable all calls to be met. We received three reports of calls having been missed due to factors such as staff not turning up or administrative errors. People told us this was not a common occurrence however, and we saw instances where missed calls had been investigated and actions taken if required.

People told us they were supported by the same staff on a consistent basis. Staff were able to demonstrate that they knew people well, and people reported that they found staff to have a caring and considerate approach.

Staff were able to describe in detail how they had supported people in a sensitive manner and helped to maintain their privacy and dignity. All the people we spoke with told us staff respected their privacy, and relatives told us they did not find staff to be in anyway intrusive.

People told us they felt safe with the staff who provided support to them. Staff were aware of procedures for reporting any concerns they may have in relation to an individual’s health or wellbeing, and were able to provide examples of when they had reported such concerns.

Staff received training in a variety of areas including safeguarding, moving and handling, dementia care, first aid and communication. We saw staff had received supervision and their competency had also been assessed through ‘spot-checks’ carried out by the managers.

We received a number of reports of care staff regularly turning up early or late for visits. Two people we spoke with told us they were unhappy when staff did not turn up on time as this could affect their normal routines. We also received a positive report from a family member who told us they had been impressed by the service when it had worked flexibly to change the support and visit times for their family member at short notice in order to meet their needs.

Safe procedures had been followed in the recruitment of staff. We saw staff had criminal records checks, references and identification in place before they commenced employment. Staff had completed application forms and their suitability for the role also assessed by way of an interview.

People, relatives and staff told us they were always able to get hold of a manager or senior carer, including out of hours. We spoke with several people who told us they had raised complaints, and that they had been dealt with to their satisfaction.

The service used an electronic care management system, and electronic call monitoring that enabled the registered manager to review the services’ performance in a variety of areas, including the time and duration of calls, missed visits and provision of supervision. However, there was no formal record of when such checks had been undertaken, or evidence to show any potential trends or issues had been identified.

Staff told us they enjoyed their jobs and felt valued for the work they did. There were regular team meetings, which helped ensure staff received consistent messages in relation to the managers expectations. They also provided an opportunity for staff to discuss people’s support needs together.

During the course of the inspection we spoke with five staff members, the newly appointed care coordinator and the registered manager.

We spoke with five people who used the service and two relatives. People who used the service all said they found the service to be either 'excellent' or 'very good,' and were very satisfied with the support they received from the carers and the manager. They told us they had no concerns and had no complaints about the service.

We spoke with two relatives of people who used the service. Both said they found the staff to be 'caring' and that they arrived on time and stayed for the allocated length of time.

During the course of the inspection, we spoke with three people who used the service, two relatives and five staff members as well as the Registered Manager.

One person who used the service told us that staff were: "Excellent' and said: 'They have never been late and they are always very polite and respectful." Another person said: 'The manager is excellent she also provides care should the staff go off sick and she communicates with us regularly, I have no complaints.' Another person told us: 'They are very good I would not wish to change.'

We found that care plans and risk assessments were sufficiently detailed for people receiving care and support and that staff completed daily communication records of the care provided.

During our inspection we saw evidence that the agency completed induction training with the staff, that this took place over a two day period but that there were gaps in the training and supervision provided.

We found that the agencies recruitment procedures were lacking in that references although requested, had not been returned prior to commencement of employment. We also found that staff had not received adequate supervision whilst awaiting the return of their Criminal Record Bureau checks.