Archived: Total Care at Home

Updated 8 November 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 20, 22 and 28 February and the first day was unannounced. We gave 48 hours’ notice so the provider could inform people of our inspection and we could visit them. It was carried out by an adult social care inspector and an expert by experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. The expert-by-experience was experienced in the care of elderly people, dementia and using domiciliary care services. A specialist pharmacist inspector also contributed their expertise.

Before the inspection, the provider had not been asked to complete a recent Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. The last PIR was completed in August 2016. We looked at the information in the PIR and also looked at other information we held about the service such as notifications, before the inspection visit.

We spoke with four people and one relative during the inspection, and phoned 23 people after the inspection. We also spoke with the registered manager, the deputy manager and two office staff, three members of staff working with people during the inspection, and phoned another six members of staff after the inspection. We spoke with a local authority commissioner and a healthcare professional. We looked at four staff files, eight care plans in the office, four care plans in people’s homes, complaints, quality assurance, policies and procedures, training records, minutes of meetings and management action plans.

Updated 8 November 2017

This inspection took place on 20, 22 and 28 February 2017. The first day was unannounced; the other two days were announced. We gave people 48 hours’ notice so the provider could inform them of our inspection and we could visit them.

Total Care at Home is registered to provide personal care to people who wish to remain living in their own homes. The agency can also provide a 24 hour personalised service to support people at home and in the community. At the time of this inspection, the agency was providing a service to 45 people. The frequency of visits ranged from one visit per week to four visits per day depending on people’s individual needs. There were three teams which operated in different areas; one team covered the Weston-super-Mare area, a second team covered the Clevedon area and a third team covered the Portishead area.

There is 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.

During the last inspection in August 2016 we found the provider had breached five regulations of the Health and Social Care 2008 (Regulated Activities) Regulations (2014):

1. Safe care and treatment (Regulation 12). The required improvements had not been made.

2. Fit and proper persons employed (Regulation 19). The required improvements had not been made.

3. Staffing (Regulation 18). The required improvements had not been made.

4. Good governance (Regulation 17). The required improvements had not been made.

5. Receiving and acting on complaints (Regulation 16). The required improvements had been made.

People were not protected against the risk of harm because risks associated with people’s conditions had not all been assessed. Risk management plans did not contain the information staff needed to be able to provide safe care and treatment. One person had been placed at risk because staff had not visited the person to provide care and support in line with their care plan.

People were supported with their medicines by staff who had not been assessed as competent to do so. Monitoring the safety of medicines had not identified the shortfalls we found. The deputy manager told us medicines audits were the only audit undertaken, no other quality assurance checks were in place.

People benefited from a service where staff understood their safeguarding responsibilities. People told us they felt safe with their care. People said, “I am safe most of the time, I have no reason not to be”. Staff received training in how to recognise and report abuse.

People told us they had not been able to receive sitting services, where these had been booked, because there weren’t enough staff. People told us they were unhappy the times of their visits had been changed. Everyone we spoke with told us their carers were kind and considerate, and gave them choices.

Required employment checks had not been completed before staff began work. Staff were not enabled to complete an induction programme which gave them the skills for the job. Staff had not received training to be able to provide care and support for people with conditions such as diabetes, dementia, strokes, or people who used catheters.

People told us they were happy with the care they received from staff, and staff showed respect for people’s dignity and preferences. People told us staff were polite and said, “She’s more than a carer, she’s a friend” and “We get on well and are able to have a chat and a laugh”.

People and staff told us the deputy manager was accessible and approachable. Staff and relatives felt able to speak with the deputy manager and provided feedback on the service.

We found repeat breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.