Archived: Touch of Care Limited

Touch of Care Limited is a domiciliary care service providing support and personal care to people living in their own homes. It is registered to provide personal care to older people and people who are living with dementia and/or other long-term conditions. At the time of our inspection, one person was using the service.

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

People’s experience of using this service:

¿ We met and spoke with one person using the service and their relative. They had no concerns about the staff who provided the care and support. The relative commented, “I think they’re very good”. The registered manager told us, “The girls always take to [named person] and she responds well to them. There are two carers at a time to get her in and out of bed, so I don’t think much can go wrong”.

¿ Despite this, risks to the person had not been identified, assessed or fully documented. There was insufficient guidance to staff on how to support the person safely in relation to their care needs. There was a lack of information about potential risks relating to falls, medicines management and skin integrity. This put the person at risk of unsafe care and treatment.

¿ Recruitment systems were not robust to ensure new staff were recruited safely. There were inaccuracies within the paperwork relating to potential new staff. People were put at possible risk because new staff were not vetted properly. Where new staff had a criminal record or criminal convictions, the registered manager had failed to risk assess them to ensure they were suitable to care for people in their own homes.

¿ Systems had not been established to measure and monitor the service overall or the quality of care delivered. However, surveys had been sent out and one person had responded positively.

¿ Lessons were not learned when things went wrong. The registered manager had not taken sufficient steps to ensure the safety of people receiving a service. The registered manager did not have a good understanding of how to meet the regulatory requirements.

The service continued to meet the characteristics of Inadequate in the areas inspected. More information is in the full report.

Rating at last inspection: The last inspection report was published on 22 February 2019. The overall rating was Inadequate.

Why we inspected:

This was an unannounced, focused inspection which took place following concerns raised by the local authority.

Enforcement:

The inspection checked to see whether the provider/registered manager was meeting the condition imposed in a Notice of Decision issued by CQC on 11 January 2019 and that this Notice of Decision remained appropriate. We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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

For less serious concerns, you can see what action we told the provider to take at the back of the full version of this report.

Follow up:

We will continue to monitor and review the service in line with our methodology for ‘Inadequate’ services.

Touch of Care Limited is a domiciliary care service providing support and personal care to people living in their own homes who are in receipt of the regulated activity of personal care. The service supported older people and people who are living with dementia, mobility issues and other long-term conditions such as Parkinson’s, to enable them to continue living in their own homes.

By the end our inspection, no people received personal care from the service. This was due to recent emergency intervention from the local authority who reduced the number of people who used the service. The local authority had safeguarded people by providing care to people with a team of professionals and providing management support to the service after invoking their emergency policy and protocol. Some people privately funded their care whilst others had their care funded by the local authority. Following the inspection, the local authority coordinated care for people who were still with the service and worked with them to find alternative providers of care.

Before the inspection, we asked the provider for information in response to significant concerns that we received which indicated that not all people had received a safe or consistent service. We also attended strategic meetings held by the local authority involving all related external agencies.

The service is owned by a provider who is also the registered manager. 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.

At the time of this inspection the registered manager was absent from the service due to being unwell. There was no registered person in charge of the day to day management and running of the service.

At the last inspection in March 2017, the overall rating was Good. Areas of improvement were identified because of a lack of formal quality assurance processes and records that related to people’s care were not always complete to reflect peoples' current needs. At this inspection we found that these areas had not improved and the service had deteriorated.

The local authority shared information with the CQC that some people had not received their scheduled care calls in line with assessed needs and visit schedules. This had exposed people to the risk of harm because they depended on the calls to meet their personal care needs and check on their safety and well-being. One person had not received the daily care calls they needed for three days. Four additional people had missed care calls. One person had not received time critical medication and a further two people had not received their medication. The local authority had safeguarded these people by providing care to people after invoking their policy and protocol. The local authority had also raised safeguarding investigations.

Staff were not recruited safely. The service had a small committed group of staff however the service did not employ sufficient numbers of care staff. Care staff were not deployed adequately to arrive at calls on time to meet people’s needs. Rota’s were not managed well, which meant that that calls were missed.

Records were not available to the inspection team to show how people were protected against avoidable harm and abuse. From the records that were available, risks to people were not always assessed. There were no records to show systems for monitoring the quality of care and support.

Care records were not fully completed or up to date. People's personal care needs were not always consistently assessed. People’s care files were either informed by a referral from local authority, that contained the local authority’s’ assessment of the person’s needs or an assessment done by staff of basic personal care needs but these were not always fully completed.

Electronic records and information needed for the day to day running of the service were not accessible to staff.

People’s confidential information was not always kept private. For example, the local authority informed CQC that information about one person who received care from Touch of Care Ltd was found in another person’s home.

We found breaches of Regulations 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 the report.

Touch of care is a domiciliary care service providing support to people living in their own homes who are in receipt of the regulated activity of personal care. The service supports older people and people who are living with dementia or other conditions, to enable them to continue living in their own homes. Some people privately funded their care whilst others had their care funded by the local authority. The service is based in Worthing, West Sussex. .

The service is owned by a provider who is also the registered manager. 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 harm and abuse as they were cared for by staff that had received training in safeguarding adults at risk and knew what to do if there were concerns over peoples’ safety. There were sufficient staff to meet peoples' needs. There was a small staff team of nine, including the registered manager, who worked hard to ensure peoples' visits were covered and no calls were missed.

The registered manager had a good oversight of the systems and processes that were in place and had identified areas in need of improvement. However, there was a lack of formal quality assurance processes and those that were conducted were not documented. The registered manager had recognised this and had taken measures to improve this.

Records were not always completed sufficiently and care plans had not always been updated to reflect peoples’ current needs. It was clear that the registered manager and staff had a good awareness of peoples’ needs, however these had not been documented. This had been recognised and new records had been devised to improve the detail included within records.

People told us that they felt safe. Comments included, “I feel totally safe because they are such a good band of carers and they put me at ease” and “I feel safe as the carers are very nice ladies and do what I want them to do”. Risk assessments had been undertaken, they considered peoples’ physical and cognitive needs as well as hazards in the environment and provided guidance to staff in relation to how to support people safely. There were low incidences of accidents and incidents, those that had occurred had been recorded and were used to inform practice. People received their medicines on time, they were administered by staff that had undertaken relevant training and who had their competence assessed. People had access to relevant health professionals to maintain good health. People were supported with their hydration and nutrition and were offered support according to their needs and preferences.

Staff had undertaken training which the registered manager considered essential. People felt that the staff were well trained and felt confident that they had the right skills to meet their needs. One person told us, “Yes, the carers are always skilled and most helpful”. Another person told us, “I know the owner has 18 years’ experience and on the whole carers are trained”. People told us they were asked for their consent before being supported. For example, when being supported with their personal hygiene or to take medicine. The registered manager and staff understood that people should be supported to make their own decisions. People were involved in their care and decisions that related to this. People were asked their preferences when they first joined the service and these were respected and accommodated. Reviews ensured that peoples’ care was current and appropriate for their needs.

There was a warm and friendly atmosphere within the service. People were complementary about the leadership and management. One member of staff told us, “She is so supportive. I get a lot of advice, she is a pretty good manager, and I can’t fault her”. People told us that staff respected their privacy ad dignity and that they were kind and caring. Comments included, “The carers are nice to talk to and kind” and “They chat and we have a laugh”.

Touch of Care is a domiciliary care service which provides personal care and support services for a range of people living in their own homes. These included older people, people living physical disability and some people experiencing the early stages of dementia. At the time of our inspection 18 people were receiving a care service.

The service had a registered manager. 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 told us that they were happy with the service they receive from Touch of Care. People told us they felt safe with care provided. One person told us “I don’t think you could find better”. Another person said “I definitely feel safe; they are a very pleasant team”.

People were cared for by staff that knew them well and were aware of the risks associated with most of their care needs. However accidents and incidents were not recoded separately and people’s medicines were not always recorded correctly. These are areas that need improvement.

Staff knew to ask for people’s consent when providing care and support and some staff had received training in The Mental Capacity Act. However not all staff had received training in this areas and policies around this had not been implemented. Staff received training but identified that they would benefit from face to face training. Staff told us they met regularly but these meetings were not recorded. These are areas that need improvement.

Although the manager was fully involved in the day to day management of the agency and in regular contact with people who used the service there wasn’t a clear system of auditing in place that assured the manager of the quality of the service being provided. This is an area that needs improvement and we have made a recommendation in relation to this.

Staff were aware of the potential signs of abuse and who to report this to. Staff were knowledgeable about the risks people faced and of the ways to reduce these. There were enough staff to provide consistent safe care.

People were supported to eat and drink enough and maintain a balanced diet. Staff supported people to access health care professionals when needed.

Staff knew people well and were aware of their individual needs, their likes and dislikes. One person said “They know me and what I like”. Staff gave us examples of how they treated people with dignity and respect. Some people received care calls that supported them with activities of daily living. Complaints were responded to in a thorough and timely way.

People and staff told us they thought Touch of Care was well led. They complemented the registered manager on her efficiency and reliability. Everyone we spoke with told us that the registered manager was open and available at all times to discuss any concerns or issues.

We found that people were included in decisions about their care needs and that their consent was sought. People's care was planned and delivered in line with their individual needs and preferences. People had detailed, individualised care plans whichkept up to date.

People told us that they felt safe being supported by Touch of Care. All staff had received training and information related to safeguarding vulnerable adults to ensure they could identify and address any safeguarding concerns. Staff had full employment checks including criminal history checks and references to ensure they were of good character.

Staff were given appropriate training and support to fulfil their roles safely. All staff had access to mandatory training as well as specialised training related to people's needs. Staff received appropriate supervision and support.

The provider had an effective system to regularly assess and monitor the quality of service that people received.