Totus Care Ltd

On this page

• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

Caring – this means we looked for evidence that the provider involved people and treated them with compassion, kindness, dignity and respect.

At our last assessment we rated this key question Outstanding. At this assessment the rating has changed to Good.

This meant people were supported and treated with dignity and respect; and involved as partners in their care.

This service scored 65 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider always treated people with kindness, empathy and compassion and respected their privacy and dignity. Staff treated colleagues from other organisations with kindness and respect.

People were treated with kindness, compassion and respect by staff who understood the importance of providing person-centred care. Feedback from relatives was consistently positive regarding the caring nature of staff. Relatives told us staff were kind, compassionate and treated people with dignity. Comments reflected that staff were approachable, supportive and genuinely cared about the wellbeing of the people they supported. One relative said, “[Person] gets on well with the staff, although they prefer some to others.” Another relative told us, “[Person] has a good relationship with staff.”

There was evidence that staff sought to protect people's dignity and promote respectful relationships. The caring interactions observed, alongside the positive feedback received from relatives, demonstrated that people were supported by staff who treated them with compassion and kindness.

The provider treated people as individuals and made sure people’s care, support and treatment met people’s needs and preferences. They took account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

People received care and support that reflected their individual preferences, wishes and personal circumstances. Care plans contained information about people's likes, dislikes and routines, helping staff to understand how people preferred to receive their care and support. One staff member told us, “I follow the care plan, and you can tell [that people like the way they are supported] by their disposition, demeanour and communication.”

Records showed that care was tailored to individual needs rather than delivered through a one-size-fits-all approach. Information within care plans guided staff on people's preferences, including aspects of their daily lives that were important to them. This helped to ensure people received support in a way that was meaningful and appropriate to their individual circumstances. One person liked to attend church on a regular basis and their care plan reflected this and they received support from staff to attend safely.

Staff demonstrated an understanding of the people they supported and used the information within care plans to provide personalised care. The care people received was reflective of their identified preferences and choices, helping to promote their independence and wellbeing.

The evidence reviewed showed that people's individuality was recognised and respected, and that care was delivered in line with their known likes, dislikes and preferences.

The provider did not always promote people’s independence, so people did not always know their rights and have choice and control over their own care, treatment and wellbeing.

People were encouraged to maintain their independence wherever possible. Care records contained information about people's preferences, and staff described how they offered people options and involved them in decisions about their care and support. We saw evidence that people were encouraged to do as much for themselves as they could, helping to promote autonomy and independence. However, one relative told us, “[Person’s choice and control over their life] is limited.”

Where people may have lacked the mental capacity to make specific decisions, records did not always demonstrate that decision-making processes were being followed in line with the Mental Capacity Act 2005 (MCA) and its Code of Practice. We found inconsistencies in mental capacity assessments and limited evidence to show how people had been supported to make their own decisions before others became involved. In some cases, it was unclear how decisions had been reached or whether the least restrictive options had been considered.

Although we saw no evidence that these issues had resulted in people being unnecessarily restricted or had negatively affected their day-to-day independence, they posed a risk that people's rights may not always be fully protected. The lack of robust MCA processes meant the provider could not fully demonstrate that decisions made on behalf of people who lacked capacity were always lawful, person-centred and made in their best interests.

The provider did not always listen to and understand people’s needs, views and wishes. Staff did not always respond to people’s needs in the moment or act to minimise any discomfort, concern or distress.

People's care plans contained information about signs that may indicate they were becoming distressed. However, records did not consistently provide sufficient guidance for staff on the potential triggers for distress or the proactive interventions that could be used to prevent situations from escalating. This meant staff may not always have access to detailed information about how to respond at the earliest opportunity to meet people's immediate emotional and behavioural support needs.

Staff told us they monitored people's emotional wellbeing and said they had time to provide reassurance and emotional support when required. They demonstrated an awareness of the importance of responding to changes in people's moods and behaviours and described how they would support people who appeared upset or anxious. One staff member told us, “[People’s] behaviour indicates when they are upset.”

We also reviewed the care records of a person who was known to display behaviours in the community which could cause disruption to other people. Staff were able to clearly describe the person's needs, the factors that could influence their behaviour, and the strategies they used to support them safely and effectively. However, this information was not reflected within the person's care plan. This omission had also been identified during an audit earlier in the year, but the additional information had not been added to the person’s care plan. The lack of documented guidance meant there was a risk that staff may not have a consistent understanding of the support required, particularly for new or less familiar staff. It also reduced assurance that the person's immediate needs and risks had been fully assessed and planned for.

Records relating to a recent safeguarding incident identified gaps in the provider's evaluation of how people's immediate needs were responded to. The incident involved a person leaving their home without the staff member supporting them. The provider's analysis focused primarily on how the staff member responded after the person had left the property. There was limited consideration of whether the person's needs had been recognised and appropriately responded to beforehand, or whether there had been opportunities to identify and address any factors that may have contributed to the incident.

The lack of detailed guidance in care plans, combined with limited reflection on preventative support following incidents, reduced assurance that people's immediate needs were always anticipated and responded to in a proactive manner. Although staff demonstrated a caring approach and an awareness of people's wellbeing, systems and records did not consistently support effective planning and evaluation of responses to people's changing needs.

The provider cared about and promoted the wellbeing of their staff and supported and enabled staff to always deliver person-centred care.

Staff spoke positively about their roles and described feeling supported by the management team. The staff member we spoke with told us they enjoyed their work and felt able to raise concerns, seek advice and access support when needed. They described management as approachable and said they received guidance to help them carry out their role effectively.

The staff member was able to speak confidently about the people they supported and demonstrated an understanding of their individual needs and preferences. This indicated they had the knowledge and support necessary to provide person-centred care.

Although we only received feedback from one member of staff during the assessment, the feedback provided was positive and there was no direct evidence to indicate concerns regarding staff wellbeing or support arrangements. However, records relating to staff support were not always comprehensive. We saw limited documentation of team meetings and supervision sessions. Staff and leaders told us these were taking place, but records did not consistently demonstrate their frequency or content. This reduced our ability to fully verify the support arrangements described, although the evidence available did not indicate that this was having a negative impact on staff wellbeing or their ability to carry out their roles effectively.

Overall, the evidence available demonstrated that staff felt valued and supported to carry out their roles, which helped to promote positive outcomes for people using the service.