Archived: Total Care at Home

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.

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 63 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. We found there were differences in the effectiveness of these different teams.

The service had a registered manager; the registered manager was present during our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. The registered manager was supported by a deputy manager. Additional management support was provided by a care coordinator and senior care specialists. 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 last inspection, we found the provider in breach of Regulation 17 of the Health and Social Care 2008 (Regulated Activities) Regulations (2014) as records had not been maintained appropriately and systems to assess the quality of the service were not effective. The quality assurance systems in place were not effective, because they had not identified the shortfalls we found. Management records and statistics were unreliable because some records contradicted other records and meant the information could not be relied on.

Risks to people had not always been identified and assessed. There was a lack of information and guidance for staff around how to manage people’s risks. Care plans and other information sources did not contain the information needed to be able to provide the care and support people needed.

The provider was not following safe recruitment procedures as necessary checks had not been conducted to ensure the suitability of staff employed.

Complaints were not always recorded or acted on in a timely way. We found conflicting information about the actual number of complaints received. Some people, but not everyone using the service, were given questionnaires to complete to be able to share their views about the service they received.

Most staff had a clear understanding of what might constitute abuse, although only 32% of staff had completed safeguarding training. Not all staff would follow the guidance in the safeguarding policy around reporting their concerns; however staff were confident their concerns would be followed up.

Although some people had regular staff visiting them, most people were concerned about the lack of continuity.

People told us they felt safe with the care they received. Some staff were very highly praised and complimented. We observed good interactions between and saw that people responded well to staff.

During this inspection, we found the provider had breached five regulations of the Health and Social Care 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.

We saw there was flexibility to arrange additional visits to cover occasions when people needed extra support. We were told the staff supported and encouraged people to maintain independence. We heard people felt comfortable with the staff, one person said 'I trust them and that makes me listen to what they are telling me.'

People told us they felt safe using this service and knew what to do if they had any concerns. They had met the manager and were happy to contact them.

We saw there were progress records of the daily visits completed by the care specialists. We read them and saw staff understood the about the care to be provided and took action when there were any concerns about people's safety. Another relative told us 'they are really very good at contacting me if my relative is not so well.'

All the people we spoke with said they would recommend the service because it was reliable and supported them in the way they wished to live.