Tipton Home Care Limited

Tipton Home Care Limited is a domiciliary care service providing personal care to older people with a mixture of needs including dementia and physical disabilities. People are supported in their own homes, at the time of the inspection 92 People were receiving personal care.

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

At the last inspection we found the provider’s systems to monitor the quality and safety of the service were not consistently effective. At this inspection we found the required improvements had been made.

Governance systems were now in place that provided oversight of the service. Accidents, incidents and matters of a safeguarding nature, were responded to and acted on appropriately. Analysis of this information was taking place to identify any trends or lessons to be learnt.

At the last inspection we found improvement was required where people were supported with ‘as required’ medication. At this inspection we found this work had been completed and people’s medication care plans had been reviewed and updated. Medication management had improvement and an electronic monitoring system was in place to ensure people received their medication as prescribed.

Improvements had been made to the systems in place that allocated packages of care. An electronic system was in place which enabled office staff to monitor call times and on the whole, people received their calls at the agreed times. In response to unexpected staff absence, the provider and manager worked proactively to ensure people received their calls.

People’s care records had been reviewed and held the most up to date information regarding their care needs. Staff reported they were kept up to date with changes in people’s care needs in a timely manner.

People were complimentary of the staff who supported them and felt safe when supported in their own homes.

Following the last inspection, the manager had focussed on addressing risk and ensuring staff received the training and support they needed. Staff reported improvements in the governance of the service and felt supported and listened to.

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

Rating at last inspection (and update) The last rating for this service was inadequate (published 7 June 2021) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since June 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an announced inspection of this service on 10 February 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve in response to the following breaches; safe care and treatment, person centred care and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Inadequate to Requires Improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Tipton Home Care Limited on our website at www.cqc.org.uk.

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.

Tipton Home Care Limited is a domiciliary care service providing personal care to older people with a mixture of needs including dementia and physical disabilities. People are supported in their own homes, at the time of the inspection 121 people were receiving personal care.

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.

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

At the last inspection we found the provider’s systems to monitor the quality and safety of the service were not consistently effective. At this inspection we found the required improvements had not been made and the service remained in breach of the regulations.

At the last inspection we found improvement was required where people were supported with ‘as required’ medication. At this inspection we found this work had not been done.

People did not consistently receive their care calls at the times agreed on their package of care. The system to allocate packages of care was not effective, staff were rushed and frequently had new calls placed on their rota at last minute, making it difficult to meet people’s care needs.

People’s care records were not consistently reviewed and did not hold the most up to date and accurate information regarding their care needs. Staff were not provided with the most up to date information on how to support people safely and effectively.

Medication management was poor. Staff were not provided with information regarding people’s medication and the risks associated with it. Systems in place could not provide assurances that people received their medication as prescribed.

The provider’s governance systems had failed to identify and address a number of areas of concern that had been identified on inspection.

People praised the staff who supported them, but felt their concerns and complaints weren’t heard or listened and responded to.

Staff felt people did not consistently receive their care as per their wishes, due to an infective call allocation system and poor governance.

The provider had failed to respond to concerns raised and opportunities to learn lessons were lost.

This is the second inspection that THC Ltd has failed to reach an inspection rating of good and the second occasion when a breach of Regulation 17 has been found.

Rating at last inspection and update

The last rating for this service was requires improvement (published 20 January 2020). At this inspection enough improvement had not been made sustained and the provider was still in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about late care visits and medication errors. As a result, 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.

The overall rating for the service has changed from Requires Improvement to Inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Tipton Homecare Limited on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to person centred care, safe care and treatment, staffing and good governance.

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

Follow up

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. This means we will keep the service under review and, if we do not propose to cancel the provider's registration, we will re-inspect within six months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

Tipton Home Care Limited is a domiciliary care service providing personal care to older people with a mixture of needs including, dementia and physical disabilities. People are supported in their own homes, at the time of the inspection 174 people were receiving personal care.

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.

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

Systems were not effective for monitoring medicine records. The registered manager had not told the local authority or CQC about a safeguarding concern. Audits of care plans did not identify people were being restricted of their liberty. Staff told us they received the opportunity for constructive feedback. Staff understood whistleblowing.

People were restricted of their liberty without legal authorisation. There was a lack of understanding of how to restrict people lawfully in their best interest in order to keep them safe, by the registered manager and provider. People were given choices and the right to refuse by staff. Staff understood their responsibilities and what was expected of them.

Staff did not always record people had received their medicines as prescribed. People did not receive their calls at the times they were expecting. People felt regular staff knew them well but often they were supported by staff who did not know them as well. Staff had good knowledge of safeguarding processes.

People were supported to have choice and control of their lives and staff did support them in the least restrictive way possible and in their best interests; the policies and systems in the service did support this practice.

People did not have regular staff and felt their support was not always provided in a consistent way. Some people felt calls were rushed. People’s privacy and dignity was maintained.

People and their relatives knew how to complain but didn’t always feel listened too. People did not always have regular staff, so felt care was not always provided in a personalised way. People’s communication needs were met.

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

Rating at last inspection

This service was registered with us on 21 December 2018 and this is the first inspection.

Why we inspected

This was a planned inspection.

Enforcement

We have identified breaches in relation to safeguarding people and governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.