Tigheaven Ltd

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

People had care assessments that identified their needs. Risks associated with people’s health and well-being needs were identified and managed well to mitigate risks found. The provider’s safeguarding policy and training guided staff on how to identify abuse and to report any allegations of abuse appropriately.

People had staff support with the administration of their medicines in a safe way. Medicine administration records were reviewed to ensure these were completed accurately.

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.

People identified their own social activities and participated in these as they chose. People had meals that met their preferences, choices and cultural needs when this was arranged as part of their package of care.

People and their relatives told us they were satisfied with the care and support received and with the management of the service. People understood how to make a complaint about the service if they were unhappy with aspects of their care.

Rating at last inspection and update:

The last rating for this service was requires improvement (published 11 October 2018) and there was one breach 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.

Why we inspected:

This was a planned inspection based on the previous rating.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

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

This inspection took place on 17 December 2017 and was announced. At the last inspection on 30 October 2015, the service was rated Good. However, we found that at this inspection the service did not meet all the regulations we inspected and it has therefore been rated Requires Improvement.

The service has 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.

There were systems in place for the safe management of medicines. There was a medicines policy that provided staff with guidance for the administration, ordering and storage of people’s medicines. However, one person told us they had not always received their medicines as prescribed.

The registered provider had a safeguarding process in place on how to report an allegation of abuse. However, we found people were at risk from financial abuse due to poor management and monitoring of people's money when staff supported them with their shopping.

People had their needs and choices assessed before receiving care. However we found that people’s choices were not always respected because staff often arrived late and changed the time of their visits without discussing it with people first.

Staff did not always care for people in a way that demonstrated dignity and respect. People’s dignity was not always respected by staff. This was because some staff spoke in a language people did not understand while delivering care. Staff were kind, compassionate and helpful to people.

Staff received training, supervision and an appraisal to support them effectively in their roles. Staff were supported by the registered manager to assist them with their professional and development needs.

.

Staff identified risks to people’s health and well-being. Risks were recorded in a risk management plan that and contained guidance for staff to follow.

The registered manager had systems in place to record accidents and incidents that occurred and the provider learnt lessons from these. People had support from staff who understood their wishes at the end of their lives.

The registered manager had a rota that showed enough staff were available to care for people. Staff were safely recruited and pre-employment checks were carried out before they were employed at the service.

People were supported by staff to eat and drink enough and their preferences were met. Staff supported people with shopping and provided meals that helped people maintain their nutritional and health needs.

Staff followed safe infection control procedures to reduce the risk of infection. Personal protective equipment was available for staff to use.

The registered provider had developed relationships with health and social care professionals to deliver effective care for people. Staff supported people to attend health appointments when needed.

People gave their consent to care and support. Staff cared for people and had an understanding of the Mental Capacity act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Feedback about the service was sought from people by the provider. People were confident about being able to use the complaints system. People knew how to make a complaint about the care and support they received.

The registered manager demonstrated leadership in the service. Staff told us they enjoyed their job and explained that the registered manager was kind and understanding.

The registered provider completed reviews and monitored the service to improve the delivery of care. There were quality assurance systems in place to check the quality of care people received. The registered manager understood their responsibilities to the CQC in regards to their registration.

We have made two recommendations in relation to safe medicines management and quality monitoring and we found a breach of regulation in relation to safeguarding people from abuse. You can see what action we told the provider to take at the back of the full version of this report.

Is the service safe?

People told us they were treated with kindness and in a respectful manner by staff and the managers at the office. We looked at five care records and saw the provider ensured that people understood the care which was to be provided. Staff supported people to consent to care and support, by providing people with information and choices for their care.

Staff demonstrated that they were aware of how to report, manage and respond to concerns raised by people and staff. There were systems in place so staff were able to learn from events such as incidents, compliments, complaints and safeguarding alerts. This helped to reduce the risk to people and improved the quality of the care they received. Procedures for dealing with emergencies were in place and staff were able to describe these to us.

The provider and staff understood their responsibilities under the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS).

Is the service effective?

People had an assessment of their needs before receiving care and support; from this information individual care plans were developed. Assessments included needs for any equipment, mobility aids and specialist dietary requirements. Risks associated with people's conditions were assessed and a management plan to minimise them.

We saw care plans were made available to people and their relatives. Care plans identified people's wishes, concerns, risk assessment and a management plan to minimise risks identified. Peoples' needs were assessed and appropriate support provided for people to meet those needs and reduce risks.

Is the service caring?

People told us that staff were kind and supportive. Staff were aware of the individual needs and preferences of the people they provided care for. We saw that people were supported to be independent within their local community and were encouraged to attend social activities outside the home, with support if required. For example, people were escorted by care staff, to a range of health care appointments when required.

Is the service responsive?

People told us that they were able to choose when they wanted to make changes regarding their care. For example when a person required the carer to visit them early than at their normal visit time, because they had to attend a social activity. We saw where staff had accommodated this person's request.

Staff supported people with their decisions and made arrangements with the person so that they were able to have their needs and wishes listened to. We saw that the service made arrangements with people for additional health and social care support when required. We saw that referrals had been made to a social worker for people, meeting their changing care needs. People told us they were involved in reviewing their plans of care when their needs changed and we saw that following the review appropriate support recommended was implemented. For example a change in carer.

Is the service well led?

People told us that they felt able to raise and discuss concerns with staff or the manager as appropriate. There were quality assurance systems in place to improve the lives for people. We saw that staff had regular team meetings, care plan reviews with people living.

People knew how to make a complaint if they were unhappy with any aspect of the service. There was a complaint form for people which was available in a format that people would be able to understand and use, with support if required. People, relatives and staff were asked for their views of their care provided.