Archived: Town & Local Care

Town & Local Care is a domiciliary care service that provides personal care to people living in their own houses and flats in the community. 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. At the time of inspection, the service was providing personal care to 39 people

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

People felt safe when care workers visited. Recruitment checks were carried out before staff were employed and there were enough staff to keep people safe. Most people were very happy with the staffing arrangements although some felt the timing of calls could improve. Systems were in place to identify and manage risks associated with people’s care. The provider checked staff were working in a safe environment. People's medicines were well managed. The service followed safe infection, prevention and control procedures.

Systems and processes for monitoring quality and safety were effective. The management team had identified some audits were overdue and had started taking action to address this. The service had a positive culture that was person centred and involved people and their families. Staff were well supported in their role.

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

Rating at last inspection

The last rating for this service was good (published 17 October 2017).

Why we inspected

This was a planned inspection based on the previous rating.

We undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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.

This service is a domiciliary care agency and provides personal care to people living in their own homes in the community. At the time of this inspection they were providing a service to approximately 190 people over the age of 18 in the Calderdale and Kirklees area. It is a condition of registration with the Care Quality Commission that the service has a registered manager in place and there was 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.

Our inspection confirmed staff had received training in how to keep people safe. All the staff we spoke with demonstrated they understood how to ensure people were safeguarded against abuse and they knew the procedure to follow to report any incidents, which included contacting their line manager in the first instance and other statutory organisations if required.

The service practised safe recruitment to ensure people were cared for by staff who had undergone the necessary checks including obtaining evidence of conduct in previous employment, their full employment history, together with a satisfactory written explanation of any gaps in employment and checks with the Disclosure and Barring Service (DBS).

Environmental risks had been assessed to ensure a safe working environment for staff. The service had assessed the risks to people supported, but some of the measures put in place to mitigate risk were very general. The registered provider had recognised this and was in the process of improving these to make them more person-centred.

At our previous inspection we found moving and handling care plans lacked detail. At this inspection, we found improvements had been made in the assessment and records. These detailed the method staff were to follow when moving and positioning people.

We found the management of medicines was not in line with good practice at our previous inspections. We found improvements had been made at this inspection. Improvements were on-going and actions put in place when medicines audits highlighted gaps in medicines administration records.

At our previous inspection, the service was not meeting its responsibilities under the Mental Capacity Act 2005. Improvements had been made and mental capacity assessments and best interest decisions had been recorded. The registered provider was improving how it was recording Lasting Power of Attorney to ensure they had a record of who they needed to consult if the need arose.

Staff received regular training to ensure they developed skills and knowledge to perform their role and received regular on-going supervision and an appraisal to support their development. New staff completed the Care Certificate which included observations in their role and competency checks.

People were cared for by staff who were caring and compassionate and who respected their dignity and privacy. Staff could describe how they ensured they maintained people’s privacy. Equality and diversity was respected by the registered provider in relation to the workforce, and when providing the service.

Care records were person-centred and recorded people’s preferences, views and how they wanted their care to be delivered. Staff had received additional training in record keeping and this was an on-going development area.

The service had a complaints policy in place and complaints were handled appropriately to ensure a satisfactory outcome for people using the service. We saw a high number of compliments had been received. When these related to staff, these were published in the company newsletter to acknowledge staff achievements.

Staff spoke highly of the registered manager and the organisation and told us they were supported in their role. They told us the organisation had a positive culture, where they were supported with training and development.

The registered provider completed a detailed audit which had picked up where improvements were required and action plans were implemented to address these issues. Systems and processes were in place to monitor the service provided and it was clear strong leadership was in place to drive improvements.

Town and Local Care provides a domiciliary care service for approximately 195 people in the Calderdale and Kirklees area. They are registered to provide the regulated activity of personal care. It is a condition of registration with the Care Quality Commission that the service has a registered manager in place and there was 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.

Our inspection confirmed staff had received training in how to keep people safe. All the staff we spoke with demonstrated they understood how to ensure people were safeguarded against abuse and they knew the procedure to follow to report any incidents.

The service practised safe recruitment to ensure people were cared for by staff who had undergone the necessary checks.

Environmental risks had been assessed to ensure a safe working environment for staff. The service had assessed the risks to people supported, but we found the identification of risk and measures put in place to mitigate risk were not specific to the person. As a result not all risks had been identified to ensure they were reduced.

We found people had assistive equipment in place which was not referenced in their moving and handling care plans and there was insufficient detail in the method staff were to follow when moving and positioning people.

We found the management of medicines was not in line with good practice and there were incorrect dosages recorded in care plans when referenced against the medicines administration records, not all medicines recorded in the care plans and gaps in the medicine administration records.

The service was not meeting its responsibilities under the Mental Capacity Act 2005. No capacity assessments or best interest decisions had been recorded and staff did not have a good understanding of the principles of the Act although they could describe how they supported people to make decisions.

Staff received regular training to ensure they developed skills and knowledge to perform in their role and received regular ongoing supervision and an appraisal to support their development. Staff competency was checked through two direct care observations each year.

People were cared for by staff who were caring and compassionate and who respected their dignity and privacy.

Care records were person centred and recorded people’s preferences, views and how they wanted their care to be delivered. However, care plans contained contradictory information and there were gaps in essential information which meant unfamiliar staff might not have sufficient recorded information to care for people appropriately.

The service had a complaints policy in place and complaints were handled appropriately to ensure a satisfactory outcome for people using the service. A record was kept of all compliments received and when these related to staff, these were published in the company newsletter to acknowledge staff achievements.

Staff spoke highly of the registered manager and the organisation and told us they were supported in their role. They enjoyed their caring role and showed great pride in their work and the feedback they received from the people they cared for.

The registered provider had a clear vision in place to develop the service. There was robust monitoring in place in areas such as people management and staff training. However, we found audits to monitor the quality of service provision around for example, the safe administration of medicines, and care plan audits had not been effective in addressing shortfalls in these areas.

We found three breaches in the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were breaches in Regulation 12; Safe Care and Treatment, Regulation 11; Need for consent and Regulation 17 Staffing; Good governance.

You can see what action we told the provider to take at the back of the full version of the report.

We used the information to answer the five key questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

This is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us. If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People received care which met their needs.

There were enough staff on duty to meet the needs of the people who used the service. Staff we spoke with told us they were given enough time during visits to people to provide care as planned.

Is the service effective?

We looked at five people’s care records and saw their individual needs were assessed thoroughly. We also saw care plans had been developed which were clear and provided staff with clear guidance on how to meet people’s needs.

Is the service caring?

We spoke with eight staff members and it was clear they cared for the people they supported.

Staff told us their rounds of calls to people were planned in such a way which ensured they visited the same people as much as possible. This meant people were supported by staff who knew them well. All of the staff we spoke with told us that each person’s care plans were person centred. This showed people’s care planning was individually tailored to meet their needs.

Is the service responsive?

We saw in all five care records that people’s needs had been assessed before they began using the service. Two people we spoke with told us they had required changes to the way care was provided. They had been able to talk to their carer about this and their care plan had been changed to reflect this.

Is the service well-led?

We spoke with the deputy manager of the service. We looked at the systems in place for monitoring the quality of the service provided to people. We found there were systems in place which ensured the service gathered feedback from people who used the service. We saw evidence of where action had been taken in response to feedback received.

We spoke with a selection of office staff and care workers. The office staff told us they had been going through a period of change as the registered manager had recognised there was a problem with the co-ordination of care. One office worker told us, "There's light at the end of the tunnel, we are getting the support we need".

We looked at the recruitment and training files of four care workers and saw they had received sufficient training for their role. However, two care workers we spoke with told us they had new staff shadowing them and they felt they did not have the relevant experience to support them.

We looked at the changes the registered manager was in the process of implementing in order to rectify concerns raised. We saw that progress was being made towards achieving the action plan.