Background to this inspection
Updated
27 April 2015
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
The inspection took place on 3 March 2015 and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service; we needed to be sure that someone would be in. This inspection was undertaken by two inspectors.
Prior to this inspection we reviewed information we held about the service including statutory notifications that had been submitted. Statutory notifications include information about important events which the provider is required to send us by law. We also gathered information from Local Authority Commissioners.
We spoke with five people using the service and relatives. We also spoke with the area manager, the company quality, compliance and safeguarding director, two care coordinators and eight care staff.
We reviewed the care records relating to five people who used the service and 10 staff files that contained information about recruitment, training, supervision and appraisals. We also looked at other records relating to the management of the service including care quality audits.
Updated
27 April 2015
Total Home Care Solutions – Northampton provides a domiciliary support service within Northamptonshire and surrounding areas. The service enables people to live independently in their own home. At the time of our inspection there were 52 people using the service.
The inspection was announced and took place on 3 March 2015. The service did not have 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 and associated Regulations about how the service is run. The Care Quality Commission had been informed of the interim management arrangements following the resignation of the registered manager in August 2014. However the arrangements for appointing another registered manager remained unresolved.
People felt safe and confident in the care provided by permanent staff, who they felt understood they needs and meet them in the way they wanted. However they did not feel as confident or safe when care was provided by agency staff. The recent recruitment difficulties and the reliance on agency staff had impacted on the quality and safety of care provided and the provider had voluntarily taken a range of actions to drive the improvements required.
Staff understood their role and responsibilities to safeguard people and to report any concerns. The provider was working closely with the Local Authority in relation to recent concerns about missed or late calls to people. They had notified CQC and the Local Authority of all relevant matters.
The risk assessments were created using a ‘generic’ standard template and were not sufficiently personalised to address the specific risks to each individual and on how the risks were to be safely managed. Systems were in place to manage people’s medicines when they were not able to, manage them themselves. However missed calls and staffing difficulties meant that people had not consistently benefited from the proper and safe management of medicines.
The staff recruitment practices were robust and the staff received appropriate training, however the reliance on agency staff meant that people did not always receive a consistent quality of care. Staff support systems were in place, however staff did not always benefit from receiving one to one supervision meetings at the frequency set out within the company staff supervision policy.
A range of assessment processes were in place and these were used to develop focused and individualised care plans. These set out the care and support that people needed and were in the main used to guide the way in which care was provided. However agency staff did not always show the same attention to detail and at times missed important elements of care.
Peoples were involved in making decisions about their care and where they lacked the mental capacity to make their own decisions, consent had been obtained in line with the Mental Capacity Act (MCA) 2005.
People were encouraged to have their say about how the quality of services could be improved and knew how to raise a concern if they needed to do so. A system of quality audits, surveys and reviews were used to monitor performance and manage risks and the provider was open and transparent about the services development needs.