We carried out a review of the data available to us about Total Care Nursing Limited on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Total Care Nursing Limited, you can give feedback on this service.
Total Care Nursing is a domiciliary care service that was providing personal care to 15 people; mainly older people, but also to younger adults, people with a learning disability or autistic spectrum disorder, people with physical disabilities, mental health, sensory impairment and people living with dementia. Not everyone who used the service received personal care. The Care Quality Commission 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
People were happy with the care and support they received. Relatives said they had confidence in the staff who supported their family member and would recommend the service.
Staff were described as kind and patient. They understood people’s cultural needs and were respectful of this. People were involved in making decisions about their care and staff promoted people’s independence.
People felt safe. Staff protected people from avoidable harm, were knowledgeable about safeguarding and felt able to raise concerns. Systems were in place to recruit staff safely. People were supported by a small team of regular staff which provided continuity.
Staff received appropriate training and support to enable them to carry out their roles effectively and safely. Staff supported people to access healthcare and maintain nutrition and hydration where they provided this support. People’s needs were assessed before they began to use the service.
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.
People had care plans regarding their support needs. Staff knew people's needs, life histories, preferences and routines well. The provider had a system in place for responding to people's concerns and complaints. Any complaints or concerns raised were used as an opportunity to improve the service.
The provider's quality assurance systems were effective. There was a positive culture within the service where people, staff and relatives felt listened to and their feedback was used the improve the service.
For more details, please see the full report which is on the CQC’s website at www.cqc.org.uk.
Rating at last inspection
At the last inspection the service was rated Requires Improvement (report published 16 June 2018) and there were two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.
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.
Although this is the first comprehensive inspection of this location the service was previously registered at a different location where it was rated as good overall with the domain effective rated as requires improvement.
Total Care Nursing Limited is registered with the Care Quality Commission to provide personal care to people in their own homes. This service is a domiciliary care agency. It provides a service to older adults. Not everyone using Total Care Nursing Limited receives a regulated activity; CQC only inspects the service being 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 our inspection, 15 people were supported with their personal care needs by the service. There was 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.
The registered manager was also the registered provider of the service. In the report, we use the term 'provider' for ease but staff and people used the term 'manager' in their conversations with us.
There were no systems in place to assess and monitor the quality of the service so this information could not be used to drive improvements. We could not be assured that all guidance staff needed to keep people safe was available and this demonstrated a lack of leadership within the service.
The provider did not ensure medicines were managed safely, Medicines Administration Records (MARs) were not appropriately completed and contained gaps. Records were not available to confirm staff's competency in this area.
People told us staff had the knowledge and skills to provide care however, staff training records did not show that all staff had completed the required training. Records relating to staff recruitment and supervision were not complete. There were no records to show that annual appraisals had been completed with staff.
We found risk assessments were insufficient and did not inform staff of people's individual support needs. Risks people faced were not always identified. This resulted in a lack of guidance for staff being available to ensure they supported people in a safe way.
People received person centred care however, care records did not always contain up to date and accurate information about people's current care needs.
Staff demonstrated an understanding of the MCA and how they applied its principles in their work. Records relating to the assessment of people's mental capacity were not completed thoroughly. The documents in use at the service required review. The provider took action to address this issue whilst we were on site.
Complaints were documented but records were not available to show they had been investigated as per the provider's complaints policy.
The provider did not have a policy in place regarding the Accessible Information Standard. We have made a recommendation about this.
The provider did not hold staff meetings to give care staff the opportunity to share their views and opinions on the running of the service. We have made a recommendation about this.
Staff told us they knew how to keep people safe and were knowledgeable about safeguarding procedures. People told us they felt safe with staff and had developed positive relationships with them.
We received positive feedback from people and relatives regarding the overall running of the service. Care staff spoke positively of the management team and the support they received. People told us they had not had any missed calls and the office staff always let them know if staff we going to be late.
People were cared for by staff who showed kindness, care and attention. People told us they communicated well with staff and they encouraged them to make their own decisions and remain independent.
People were supported to access healthcare professionals when they needed them.
We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.