Teonfa Ltd

About the service

Teonfa Ltd is a domiciliary care agency providing personal care to people in their own homes. The service provides support to older people and people with physical and mental health needs as well as people with a learning disability and autistic people. At the time of our inspection there were 54 people using the service.

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

Right Support: People were at risk of harm because risks were not always fully assessed. Risks in relation to moving and handling, catheter care and falls had not been fully explored. There was limited guidance to staff to keep people safe as risk assessment were missing in some areas.

There were enough staff deployed to meet peoples needs and they were recruited safely. Medicines were managed safely, and people received their medicines as prescribed.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Where required, the provider ensured mental capacity assessments were undertaken and people were supported to be involved in decision making. Staff enabled people to access specialist health and social care support in the community.

Right Culture: Audits were not always effective and did not identify the shortfalls around risk assessment that were found during this inspection. People were involved in decisions about their care and were able to express their views. Feedback about people’s experiences of care was gathered through questionnaires, telephone calls and spot checks. Spot checks of staff were carried out to monitor care standards and identify where improvements were needed. People told us staff were kind, caring and attentive to their needs. Peoples wishes and preferences were respected.

Right Care: Staff understood how to protect people from poor care and abuse. Staff received training on how to recognise and report abuse and they knew how to apply it. People's needs were assessed before they started using the service. When people needed help with eating and drinking, or assistance to prepare meals, this information was recorded in their care plan. The provider worked in partnership with other healthcare professionals to meet people's needs and in response to changes or concerns about people's health. Staff spoke positively about their training.

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 15 March 2023) and there were breaches of regulation. These were in relation to person centred care, need for consent, safe care and treatment, safeguarding, governance, fit and proper persons, and staffing. We issued warning notices in response to these breaches. 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 the provider remained in breach of regulations.

This service has been in Special Measures since 15 March 2023. 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

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

The overall rating for the service has changed from inadequate to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. 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 Teonfa Ltd on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to risk assessments and audit processes at this inspection.

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

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

About the service

Teonfa Ltd is a domiciliary care agency providing care to 99 people in their own homes. The service supports people with various physical and mental health needs as well as autistic people and people with a learning disability. At the time of the inspection the service was supporting 97 people with personal care.

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

Right Support:

People experienced risk of harm because risks were not assessed and staff did not recognise abuse or when people’s rights were not being upheld. Staff did not always ensure that people’s environments were safe and clean.

Risks in relation to moving and handling, medicines, fire, infection prevention and control (IPC), catheter care and self-harm had not been explored. Risk assessments were often missing altogether offering no guidance for staff about how to support people safely in these areas.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Staff did not recognise situations where people needed support to assess if they had the mental capacity to make their own decisions and how they could be supported with those decisions in ways that were in their best interest. This led to cases of self-neglect, fire hazard and unlawful medicine administration going unreported.

People’s wishes for the support they would like in the event of becoming ill or at the end of their life had not always been discussed or recorded. This meant there was a risk people’s wishes and rights in relation to care and treatment would not be known or upheld in the event of a medical emergency.

People chose to live in their own homes and could choose who they lived with. Where people consented, their relatives and friends were involved in planning and agreeing their care but were not supported to review the care. Staff did not always support people to access local health services where required

Right Care:

The service did not have enough suitably trained and skilled staff to meet people’s needs and keep people safe. Staff did not understand how to protect people from poor care or abuse. Safeguarding concerns were not always escalated to the registered manager or reported to the relevant authorities. Staff received training on safeguarding and abuse awareness but not all staff understood this training and did not apply any learning to their practice.

People were not all provided with culturally appropriate care in consideration with their wishes. Some people felt their preferences and needs were not always understood by staff where English was not their first language. Other people requested female only staff and were unable to have this resulting in some personal care not being given as per their care plan due to embarrassment.

Care was not always person centred and co-ordinated. Information in people’s care plans did not reflect their full range of needs or promote their well-being and enjoyment of life. . Guidance for staff was sometimes contradictory or missing and did not therefore enable personalised and accurate support.

People’s experiences of the care provided varied. Some people felt staff treated them well and with care and kindness. Most people told us staff did not talk to them or promote their independence.

Care was not always being delivered at the right times although most people told us this was improving.

Right Culture:

People were supported by staff who did not understand best practice in relation to the wide range of strengths, impairments or sensitivities people may have. This meant people did not always receive compassionate and empowering care that was tailored to their needs.

Staff did not evaluate the quality of support of support provided to people, involving the person, their relatives and other professionals. Systems in place to monitor the quality of care such as audits and competency assessments of staff, were carried out by staff who were not qualified to do so. The registered manager did not conduct any audits and analysis of quality themselves. This meant the quality of care people received was not sufficiently monitored and areas of concern not always identified.

People did not feel that staff were always competent and well trained. Staff training provided was not sufficient to ensure staff fully understood the needs of the people they were supporting, especially in relation to specific conditions such as dementia or autism. This meant staff were not able to provide the right support to people to meet their needs.

Most people felt able to complain to the staff or managers but some people did not feel comfortable and would complain externally or not at all.

The service promoted people’s rights and person centred care in their policies. However, this was not always practiced. People’s quality of life was not enhanced by the service’s culture because the behaviours of the management and staff did not respect or recognise people's rights to choose. Staff did not ensure risks of a closed culture were minimised. People did not receive support based on transparency, respect and inclusivity.

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 requires improvement (published 12 January 2021). 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 the provider remained in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about the quality of care provided, care visit times and staffing. A decision was made for us to inspect and examine those risks.

This inspection was also carried out to follow up on action we told the provider to take at the last inspection. You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

We have identified breaches in relation to medicines, managing risks, safe care, staffing, staff training, quality assurance processes, consent to care and inaccurate records at this inspection.

We have served a warning notice against both the registered manager and the provider for each of the 7 breaches of regulation found at this inspection. We expect the provider to make the required improvements to ensure they are fully complaint with the regulations.

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 from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures:

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 6 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.

Teonfa is a domiciliary care agency providing personal care to people in their own homes. 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 the inspection, the service was supporting 42 people, all of whom were receiving personal care.

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

People did not receive reliable and consistent care. Care visit times were late and this meant some people did not always feel safe due to feeling that staff rushed their care and did not listen to them.

Audits failed to identify concerns about the inconsistent care visit times and missed medicines, which were not managed safely.

Risks were identified but measures to manage the risks were not clear and there was a lack of guidance for staff to follow. Staff did not understand how to keep people safe or how people’s various health conditions impacted them.

People were somewhat protected from the risks of the COVID-19 pandemic but people told us not all staff always wore their masks correctly or washed their hands.

People’s complaints were not always resolved and lessons learnt from concerns did not always result in a practical change or an improved experience of care. People felt communication from office staff could be better.

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 5 February 2019).

Why we inspected

We received concerns in relation to the management of care visit times, medicines, response to complaints and people’s care needs not being met. 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 good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

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 inconsistency of care visit times, clear communication and reporting. We have also found concerns about how staff were guided to keep people safe and staff understanding of their roles. We found there was a failure to effectively monitor and improve the quality of care 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 from 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.

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.

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 and drink, and they had access to healthcare services when required.

Staff were kind and caring towards people they supported. They treated people with respect and as much as possible, they supported people to maintain their independence. People were happy with how their care was provided and they valued staff’s support. People made decisions and choices about how they wanted to be supported and staff respected this.

There had been improvements in the quality of care plans and these now contained personalised information that enabled staff to provide person-centred care. The provider now had an effective system to manage people’s complaints and concerns.

More robust quality audits were now carried out and prompt action taken to make improvements. People were mainly complimentary about the quality of the care provided by staff. Staff felt supported and motivated to carry out their roles. People, relatives, staff and professionals had been enabled to provide feedback in order for them to contribute to the development of the service.

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 appraisal and were subject to a full induction when they joined. The staff were positive about the culture of the provider and felt supported and listened to by management. They were able to contribute to the development of the service through team meetings.

This inspection identified that there had been breaches of a number of the regulations of the Health and Social Care Act 2008 (Regulated Activities) 2014. 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.

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.

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.

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.