Trinity Carestaff Solutions Limited

Trinity Carestaff Solutions is a domiciliary care agency, providing personal care to people living in their own homes. There were 147 people receiving personal care at the time of the inspection. 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 found that improvements had been made. The agency had not only sought to rectify the previous concerns CQC found, but to investigate why these had occurred and implement new systems to thoroughly understand and prevent any slippage in the standard of care for people.

Governance arrangements provided assurance that the service was well-led. The provider had ensured that their systems and processes to monitor the quality and safety of care were effective.

People were safe. Risk management of people’s complex care needs were consistently in place and reviewed. Care records had been reviewed and clearly guided staff. Records relating to daily statements of care provided and administration of medicine were well kept and more centred on the person rather than tasks.

People were satisfied with their care and support. People said that the service had become more reliable. People had the same group of staff to support them. One person told us that they had the same carers for the last three years. People described the care staff as kind, caring and they felt safe being supported by staff from Trinity Carestaff Solutions. One person said, “I’m so lucky to have a good service. Nothing is too much trouble and I’m never let down.”

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 welcomed the support that provided them with independence and choice.

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 Inadequate (published 21 December 2020).

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.

This service has been in Special Measures since 21 December 2020. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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

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

Trinity Carestaff Solutions is a domiciliary care agency, providing personal care to people living in their own homes. There were 153 people receiving personal care at the time of the inspection. 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

Staff were not always recruited safely and the provider did not always follow its recruitment policies and procedures.

It was unclear if staff had received adequate training for their roles. Dates recorded on the provider’s staff training matrix records did not match training certificates. There was a lack of regular, planned supervision, staff meetings, spot checks and competency assessment to ensure staff received support and their performance monitored.

Care records did not always contain sufficient information and guidance to enable staff to support people in a safe way. Risk management was not always in place for falls, dementia care, care of people with diabetes, Parkinson’s disease and risks of choking.

People were not always protected because records did not reflect safe administration and monitoring of medicines errors. Staff competency had not always been assessed prior to staff administering medicines. A lack of medicines audits meant any medicines errors could not identified.

People told us they did not receive prior notice of what staff would support them with the timings of calls. They also told us they were not provided with any care plan to review and confirm their agreement with.

Governance arrangements did not provide assurance that the service was well-led. The provider had not ensured that their systems and processes to monitor the quality and safety of care was effective.

There was a lack of analysis of incidents and it was not clear that lessons were learnt with actions taken to ensure improvements were made when things went wrong. For example, in relation to late or missed calls.

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

The last rating for this service was Good [published 12 September 2018].

Why we inspected

We received concerns in relation to the management of risk, reporting of incidents and staff training and recruitment processes. A decision was made for us to inspect and examine those areas of risk. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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

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

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 have identified continued breaches in relation to safe care and treatment, recruitment, governance and failure to notify. Immediately after the inspection we wrote to the provider and requested they provide us with urgent information telling us what they were going to do regarding safe care, the management of risks, infection control and ineffective government arrangements.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will work alongside the provider and 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.

Special Measures

The overall rating for this service is 'Inadequate' and the service is therefore 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 means 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 of 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.

We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

People’s care plans and risk assessments were reviewed regularly and updated. The staff were aware of the contents of the care plans so that they understood the people’s needs and how to support them to meet their desired goal. One relative explained to us that they liked all the staff and considered the management must have put a lot of time and effort into finding the right caring people.

All of the staff told us that the manager and deputy were approachable and highly supportive, acting as a role model, whenever on duty in the way they approached and supported the people that used the service. Staff also liked the rota being compiled well in advance and the manager or care co-ordinator quickly and effectively dealing with staff requests, particularly annual leave. Staff told us that they were knowledgeable about the people using the service so that they could work with anyone as required. They usually worked with the same small group of people however and were able to discuss the support they provided in supervision with senior staff. A member of staff told us, “As the managers work alongside us sometimes, this makes supervision easier because they know the person and understand what we are doing.”

People who used the service, relatives and staff members had been asked for their opinions of the service and any improvements that they would like were considered and brought into effect as soon as possible. A relative of a person who used the service said, “The service is reliable and that is so important.”

There was an effective quality assurance system in place. Quality audits were completed by the senior staff on a monthly basis were reported to and reviewed by the managers of the service. This information was used to plan the future of the service. The manager explained to us that from their experience they wanted to keep medicines and care plan accuracy under close attention alongside supporting the staff through supervision and training. We saw that audits of these subjects plus supervision and training were in operation and further was planned for the future.

The director told us the aim of the service was to deliver high quality care. This required the care plans of the individuals using the service to be person-centred and for the staff to understand those principles. Staff training in person-centred care and care plan writing was provided at the staff induction and refresher training provided. All the people using the service had a care plan which was person-centred and reviewed each month. People using the service were invited to attend the review of their care as were their relatives. Changes in people's physical health were documented and how they were to be supported. This was important for the maintenance of people’s well-being. A relative informed us that they had the permission of their relative to attend the review with them and considered the reviews to be important for communication.

The service demonstrated a clear commitment to work in a joined up way with other organisations for the benefit of the people using the service. Time had been taken to ensure if ever people were admitted to hospital or had an appointment with a professional appropriate written information was available for that professional. The service sought peoples, relatives and other professionals views about the service in order that information could be learned and shared throughout the organisation to improve the service. We saw that one professional had considered the service was effective and proactive at supporting a person with complex needs.