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Inspection carried out on 12 December 2018

During a routine inspection

Teonfa Care Services is a domiciliary care service. They provide care and support to people living in their own homes so that they can live as independently as possible. Not everyone using this type of service receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the time of the inspection, 43 people were being supported by the service.

This announced comprehensive inspection took place between 12 December 2018 and 11 January 2019.

The service had an overall rating of 'requires improvement' when we inspected it in October 2017. The provider needed to improve the key questions Safe and Well-led to at least good. At this inspection, we found they had improved the areas we had previously been concerned about. The overall rating has improved to 'good'.

However, Well-led was again rated ‘requires improvement’ because further improvements were required to the timeliness of care visits and people’s overall experience of the service. The provider needed to ensure that their systems were effective to enable them to achieve this quickly and in a sustainable way.

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.

People were safe because there were effective risk assessments in place, and systems to keep them safe from harm. There were safe staff recruitment processes and there were enough staff to support people safely. Staff took appropriate precautions to ensure people were protected from the risk of acquired infections. People’s medicines were managed safely, and there was evidence of learning from incidents.

People’s needs had been assessed and they had care plans that took account of their individual needs, preferences, and choices. Staff had regular supervision and they had been trained to meet people’s individual needs effectively. Staff understood their roles and responsibilities to seek people’s consent prior to care and support being provided. Where required, people had been supported to have enough to eat and drink to maintain their health and wellbeing. They were also supported to access healthcare services when urgent care was needed.

People were supported by caring, friendly and respectful staff. They were supported to have maximum choice and control of their lives, and the policies and systems in the service supported this practice.

Staff supported people in a person-centred way. The provider had a system to handle complaints and concerns. Further work was necessary to ensure staff knew how people wanted to be supported at the end of their lives.

Further information is in the detailed findings below.

Inspection carried out on 26 October 2017

During a routine inspection

When we inspected the service in March 2017, we found the provider was in continuing breach of some of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because poor staff deployment had resulted in a number of late and missed care visits. People had not been consistently given their medicines as prescribed and accurate records in relation to people’s medicines were not always kept. Incidents were not always recorded and analysed. Staff recruitment processes were not robust enough to ensure that only suitable staff were employed by the service. Staff had not been trained on the Mental Capacity Act 2005 (MCA), and people’s consent was not always sought in line with legislation. People’s health needs were not always identified in their care plans so that they received appropriate support. People’s care plans were not detailed enough to enable staff to provide person centred care. People had not been consistently involved in planning and reviewing their care plans. The provider did not have an effective system to handle people’s complaints and concerns, and there was no evidence of learning from these to improve the service. Additionally, the overall management, leadership and governance of the service was poor.

The service had an overall rating of 'Inadequate' and was placed in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. We also imposed a condition that the provider could not accept any new care packages without the Care Quality Commission’s authorisation, and we followed up on this during this inspection.

This announced comprehensive inspection was carried out between 26 October and 29 November 2017 to check if sustained improvements had been made. We found the provider had made improvements to most areas where we had previously identified shortfalls. However, people’s concerns about inconsistent care visit times meant that Safe and Well-led were rated ‘requires improvement’. This was because a longer period was required to ensure that systems and processes had been embedded to enable staff to provide consistently safe, effective and good quality care. However, the service demonstrated to us that significant improvements have been made and is no longer rated 'Inadequate' overall or in any of the key questions. Therefore, this service is now out of Special Measures.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to younger and older adults. At the time of this inspection, 41 people were being supported by the service.

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.

People’s medicines were now managed safely and accurate records were kept. The provider had effective recruitment processes in place. More staff had been employed to ensure that people were supported safely and consistently. The provider had effective systems to keep people safe, and staff had been trained on how to safeguard people. There were individual risk assessments that gave guidance to staff on how risks to people could be minimised. Environmental risks were assessed and there was evidence of learning from incidents to reduce the risk of recurrence.

Staff training, support and supervision was now more robust. The requirements of the Mental Capacity Act 2005 were being met and people’s consent was sought in line with guidance. People’s needs had been assessed so that they received effective care. People were supported to have enough to eat an

Inspection carried out on 1 March 2017

During a routine inspection

This inspection took place on the 1, 2, 3, 7, 9 and 10 March 2017 and was announced. We last carried out a comprehensive inspection of the service in March 2016 and it was rated “requires improvement” overall. We carried out a focused inspection in the domains of ‘safe’ and ‘well-led’ in August 2016 but found that insufficient improvement had been made, and the rating remained ‘requires improvement’. We identified concerns in relation to people’s visit times, the management of medicines, staff recruitment, monitoring of care delivery and training to understand the Mental Capacity Act.

This inspection identified further serious issues regarding the management and leadership of the service and the quality of their care delivery. The feedback from people and staff regarding the quality of the care and support was poor and showed that changes were not being implemented or embedded within acceptable timescales.

Teonfa Care Services is a domiciliary care service providing personal care and support to people in their own homes. At the time of our inspection, the service was providing care to 62 people.

The service had a registered manager, although they had applied to de-register from their role. 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 did not always receive their calls on time, and many people reported missed calls or calls frequently cut shorter than the allocated time. This meant that people were placed at risk of neglect, missed medicines and not having their healthcare needs attended to within a reasonable time. The service did not have a system for monitoring their calls and identifying persistent issues that required improvement.

People had care plans in place but these were varied in quality and lacked sufficiently up-to-date, relevant and personalised information to enable staff to carry out their care effectively. There were concerns in relation to people having consented to the care provided and people’s capacity to make and understand decisions about their care was not always assessed. People were asked for their views through surveys and quality monitoring calls but issues identified were not always resolved. People’s needs in relation to health and nutrition were assessed but erratic call times meant these needs were not always being met.

People had mixed views as to whether they felt cared for and were treated with dignity and respect. People received good care from staff who were regular and understood their needs but there were concerns in relation to the aptitude and consistency of less regular staff.

There were not always enough staff to fulfil the number of hours of care commissioned by the agency. Rotas did not always account for adequate travel time between calls and staff were not deployed in a way that enabled them to get to people on time or remain for the scheduled duration of the call. Staff received basic training in medicines and moving and handling, but the service had accepted care packages for people with more specialised needs. The staff had not been trained in how to meet these needs. Staff did not receive training to understand the Mental Capacity Act (2005). Staff recruited to the service did not always have suitable references in place, and there were gaps in employment histories which had not been accounted for.

People did not always feel confident that complaints would be resolved, and expressed concerns that the management were not always responsive. There were missing or incomplete records, and the systems in place to identify this were ineffective. People’s call times, medicines, rotas and care plans were not always available or complete.

Staff received regular supervision and ap

Inspection carried out on 19 August 2016

During an inspection looking at part of the service

This focused inspection took place on the 19 and 23 August 2016. We gave the provider 24 hours’ notice of our inspection as we needed to make sure somebody would be available to meet us in their offices. We carried out the inspection in response to concerns that people were not always receiving care on time, and that rotas were not being managed effectively.

Teonfa Care Services provides personal care and support to people living in their own homes. At the time of our inspection, the service was providing care to 38 people.

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.

While there had been some improvements since our last inspection in March 2016 we identified further breaches of two regulations. You can see the action we’ve asked the provider to take at the end of the report.

People did not always receive their care on time and the systems put in place (to monitor this were not adequate to have proper oversight of this or make improvements) were ineffective. Although the staff rotas now included travel times, the planned visits for people did not always correspond with the times listed and agreed in their care plans. There were enough staff to meet people’s needs safely, but some people reported calls being cut short or staff being persistently late.

People’s medicines were being managed safely, and the auditing systems for the management and administration of medicines had improved. The provider were now following their recruitment policy to make sure that staff had the appropriate skills, character, experience and qualifications to work for the service. Risk assessments were robust and detailed enough to capture the risks to people and staff and suitable control measures were in place to mitigate the risks.

There was a registered manager in post. Staff were positive about the support they received from management, but people told us that the office staff were not always responsive. The service did not submit their action plan from the previous inspection before the deadline, and the Care Quality Commission were not notified of safeguarding incidents in the service.

There had been improvements in quality monitoring and auditing, although the service could not always evidence how they were responding to people’s feedback.

Inspection carried out on 8 March 2016

During a routine inspection

This inspection took place on the 8 and 10 March 2016 and was unannounced.

Teonfa Care Services is a domiciliary care service providing personal care and support to people in their own homes. At the time of our inspection, the service was providing care to 43 people.

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.

During our inspection we found the service was in breach of two regulations. You can see what action we’ve asked the provider to take at the end of the report.

People had risk assessments in place that enabled staff to keep them safe. The service had a safeguarding policy in place which detailed how to report concerns or any risk of harm. Staff were trained to use moving and handling equipment appropriately and safely.

There were enough trained and competent staff to be able to meet people’s needs, but the provider’s systems for deploying staff were insufficient. Rotas did not always include times for calls or take travelling times into account. Call times were sometimes erratic and people weren’t always made aware of changes.

People’s privacy and dignity was observed and they were cared for by staff who understood their needs and showed a caring attitude. Care plans were detailed enough to provide staff with a list of tasks that needed to be completed daily. However these lacked personalisation and were basic in nature. Reviews took place to give people the opportunity to provide their views and make changes to their care plan. People’s relatives were involved in this care planning and the service regularly corresponded with people’s families to ensure that they were satisfied with the care their loved one received.

People’s medicines were administered safely, but the systems in place for recording and auditing these were ineffective. Errors and omissions were not always identified or acted upon and there were inconsistencies in the way that medicines administration records (MAR) were completed. Some medicines, such as people’s creams, were not always accounted for.

Staff received training that was relevant to their role and enabled them to understand people’s needs. Training was regularly refreshed and new starters received an induction which included the care certificate. However, staff were not always trained to understand the mental capacity act and were not consistently able to describe to us what this meant.

Staff received supervisions and performance reviews from management. However these were infrequent and not always completed sufficiently to enable staff to develop.