Twilight Health & Homecare Services Ltd

Coventry Twilight Recruitment Limited is a domiciliary care agency which is registered to provide personal care and support to people in their own homes. The service is registered to provide support to younger adults, people living with physical disabilities, people living with sensory disabilities, people with a learning disability, autistic people, people with mental health support needs, older people and people with dementia. At the time of our inspection the service was supporting one person who was receiving 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

People’s needs were assessed before they started using the service. People and relatives were involved in this initial assessment and this formed their plan of care.

The person supported received care and support consistently from one staff member who knew them very well and how to keep them safe from harm, injury and risks of abuse. The provider had identified some risks, and basic risk management was included in the person’s plan of care. However, more detail and greater depth of information was needed in risk management, which the registered manager assured us they would add.

The person felt safe during their care calls and gave us positive feedback about the service. The person and their relatives described the provider and staff member as kind and caring toward them. The staff member followed healthcare professional guidance in supporting the person.

The provider and staff member had completed training. The provider understood the importance of training staff when they recruited them in the future as their business grew.

Some quality checks took place on records, but these were not always recorded and were limited. Further improvement was needed.

There had been no missed care calls. People had no complaints about 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.

Rating at last inspection

This service was rated Requires Improvement and the report was published January 2020.

Why we inspected

At our last inspection we found a breach in the regulations of safe care and treatment and a breach in the regulations of the provider’s quality monitoring systems. This inspection took place so we could monitor the improvements the provider told us they had made.

Follow up

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

Twilight Recruitment Limited is registered to provide personal care to people who live in their own homes. CQC only inspects where people receive personal care. This is to help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. At the time of the inspection four older people were supported by the agency.

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

Since our last inspection, improvements had not been made to the managerial oversight and governance of the service. Whilst people and their relatives continued to be satisfied with the staff and care calls undertaken to them, the provider did not ensure a safe and quality service was provided.

The provider had not consistently ensured staff were recruited in a safe way and required checks were not always completed before staff undertook care calls to people. The provider failed to adhere to their own recruitment policy.

Some systems of checks and audits took place, but these had not identified the gaps in information we found. The provider had not made the required improvements to their policies and procedures to ensure they related to their business. The provider did not always ensure people’s personal information was shared using secure communication systems.

Potential risks to people were identified but risk management plans were not always detailed and did not consistently give staff the information they needed.

Staff had not always received an induction or training to ensure they had the skills they needed to provide a safe service to people. Not all staff had received training on how to protect people from the risks of abuse, which meant they may not understand the importance of reporting any concerns.

People told us their needs had been assessed and they had a plan of care in their home which informed staff of the agreed tasks to be undertaken. However, the provider had not ensured they had an office copy file to refer to as required.

People gave us positive feedback about the staff and had not experienced any missed calls. People felt staff were kind and caring toward them and undertook agreed tasks in an unrushed way. Staff promoted people’s independence and maintained people’s privacy and dignity. People had no complaints.

People were supported with their food and drink where this was part of their agreed care. Staff worked within the principles of the Mental Capacity Act 2005 and understood the importance of gaining consent from people.

We reported that the registered provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were:

Regulation 12 Regulated Activities Regulations 2014 - Safe care and treatment

Regulation 17 Regulated Activities Regulations 2014 - Governance

Following our inspection feedback, the director told us they would impose a self-imposed stop and not take on any further care packages until the required improvements were made.

On 6 December 2019, we sent the provider a letter asking for an immediate response to our concerns and evidence of the action they had taken.

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

Rating at the last inspection

The last rating for this service was Requires improvement (published 11 December 2018).

Why we inspected

This was a planned inspection based on the rating of the last inspection.

Enforcement

We have identified two breaches in relation to the safe care and treatment and the lack of effective monitoring of the service. You can see what action we have asked the provider to take at the end of this full report.

Follow up

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

Twilight Recruitment Limited is registered to provide personal care support to people. At the time of our inspection the agency supported six people and employed three care staff.

This service is a domiciliary care agency. It provides care to older people living in their own homes. This was the first inspection of Twilight Recruitment Limited since their registration with us in January 2018.

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 received their care calls at the times they expected and from staff they knew. There were sufficient staff to cover all the planned calls to people.

The provider shared their complaints policy with people when they started to use the service so they knew how to make a complaint. People and their relatives told us they currently had no complaints about the service.

Overall, people managed their own medicines. Staff supported people with prescribed creams and improvement was needed to ensure a consistent approach and administration records were kept.

People told us they felt safe using the service and staff knew how to protect people from the risks of abuse. Care staff were safely recruited and completed an induction and training so they had the skills and knowledge to meet people’s needs effectively.

Care plans listed most agreed tasks to be undertaken, but there was no detailed plan of care to tell staff how tasks should be completed. Risks assessments did not detail how identified risks should be mitigated by staff.

Overall, people made their own arrangements to access healthcare professionals, though staff said support would be given if needed.

People were supported to maintain their privacy and dignity and staff encouraged people’s independence where possible. People received their care and support in an unrushed way from staff who had the right skills and experience. People’s consent was gained before care was provided to them and staff involved people in making choices about their support.

People and their relatives were involved in planning their care and support. Care staff knew people well and worked alongside the provider when they started working for the service.

Everyone spoken with was satisfied with the service provided and the way the service was managed. The provider had policies and procedures, though some required improvement. The provider had some systems to check the quality of the service, though auditing systems had not been fully implemented.

People and their relatives were encouraged by the provider to share their views about the service during care reviews. Care staff felt supported and valued by the provider.

Further information is in the detailed findings below.