Archived: inTouch Home Care

InTouch Home Care is a domiciliary care agency providing personal care to people in their own homes. The service was supporting 68 people with personal care at the time of our inspection.

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

The provider had not learned lessons since our last inspection and their governance systems to monitor the service remained inadequate. In addition, the quality and safety of the service had deteriorated further over the last 14 months which demonstrated the provider was unable to make and sustain improvements. Information we received from the management team following our inspection visits informed us action was being taken to make improvements.

The provider’s systems to keep people safe were ineffective. We found action had not always been taken to protect people from the risk of ongoing abuse. The provider told us they planned to strengthen their safeguarding systems to improve safety. People did not always know their care workers which made them feel unsafe. Staff had completed safeguarding training and described the types of abuse people could experience.

The information staff needed to help them manage some risks and provide safe care was not always in place. Auditing processes had not identified when risks associated with people’s care had not been assessed. Action was taken in response to our feedback to drive forward improvement in this area.

The management of medicines was not safe, and the unsafe administration of medicines had placed people at risk of significant harm. Action had not always been taken to mitigate known medicine management associated risks and prevent reoccurrence. The provider was not working in line with their medicines policy or national medicines guidance and their audits of medicines were not effective. Some action was taken following our inspection to improve medicines safety. Staff had completed COVID-19 testing in line with national guidance, but individual risks to people and staff who were at increased risk from Coronavirus had not been assessed.

Staff were recruited safely, and the provider was open and honest about their challenges in relation to the recruitment and retention of staff. Prior to our inspection they had been unable to provide safe care to people due to low staffing levels. At the time of our inspection people had received their planned care, but people and their relatives were dissatisfied because their care was not always provided on time. In addition, care was not always provided by staff people knew and trusted.

An open culture was not embedded at the service. Complaints continued not been managed in accordance with the provider's policy and people and their relatives did not always feel well treated and listened to. Staff provided mixed feedback when we asked them if they felt valued and listened to by their managers. The management team were open and honest during the inspection and recognised good outcomes for people had not always been achieved.

Staff continued not to receive all of the training they needed to carry out their roles and meet people’s specific needs. Feedback gathered demonstrated how the lack of training impacted negatively on people’s lives. Checks to ensure staff were competent and skilled to carry out their roles did not always take place.

Responsive action took place following our inspection to start to address this. Staff told us the induction they had completed when they had started work at the service had helped then understand how to support people.

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 did not support this practice.

People’s dietary requirements and preferences were documented and overall, positive feedback was provided about the support people received to eat and drink. When required, referrals had been made to health professionals such as district nurses to access the support people needed to remain healthy and well.

Whilst assessments of people's needs had been completed before they started using the service, care and support was not personalised. Some people felt respected whilst others did not. Staff told us how they supported people to remain independent, but people’s dignity was not always maintained.

More information needed to be added to some care records to help staff provide care in line with people’s wishes. Care records contained some information to help staff understand how people preferred to communicate and information about the service was available to people in a variety of formats including large text.

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

The last rating for this service was requires improvement (published 19 October 2020). At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection and was also prompted due to the provider informing us they could not provide safe care to people.

The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well-led sections 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 providing safe care and treatment, staffing, consent, dignity and respect, person centred care, complaints and governance 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 until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner. We will work alongside the provider and local authority to monitor actions taken to address the concerns we identified.

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.

in Touch is a domiciliary care agency providing personal care to people in their own homes. The service was supporting 88 people with personal care in their own homes at the time of our inspection.

People's experience of using this service

Systems for identifying and managing organisational risk were not effective and information to support performance monitoring was not always reliable. Staffing issues meant senior staff had been delivering care calls and were unable to effectively carry out their roles and responsibilities to manage service delivery. Whilst some people were positive about the care provided, over half the people spoken with raised concerns about missed and late calls and inconsistent staff who lacked the knowledge and understanding to meet their needs. Not everyone had confidence in the complaints process because issues of concern continued despite complaints being raised.

Safeguarding systems were not sufficient to ensure risks associated with people’s care were promptly identified and managed to reduce the risk of people coming to harm. Systems in place for the oversight of safeguarding incidents did not demonstrate they had been managed effectively and risks to people had been mitigated.

Some areas for improvement of the service had been identified but actions to implement changes were still in progress at the time of our visit.

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

Why we inspected

The inspection was prompted by concerns we had received about missed and late care calls, inconsistency in standards of care due to high staff turnover, failure to address concerns and complaints and the overall governance of the service. As a result, a decision was made for us to inspect and examine those risks. We undertook a focused inspection to review the key questions of safe and well-led only.

The overall rating for the service has deteriorated to requires improvement. This is based on the findings at this inspection.

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 two breaches of the regulations in relation to the safety of people’s care and governance.

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 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People’s experience of using this service:

People were supported by staff who knew how to recognise potential abuse and who they should report any concerns to.

People’s care considered their risks and reduced the risk of harm. Staff met people’s social and care needs when expected.

Staff were trained to meet people’s needs and acted promptly to refer people to healthcare professionals when required.

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.

People enjoyed positive relationships with the staff team and were treated with kindness and respect. People’s independence was promoted by staff who encouraged them.

People’s needs and routines were know and supported by staff who ensured these were met and respected. People knew how to complain if needed, and were confident any comments or concerns were listened and acted on.

People and staff were happy with the way the service was led and managed and the provider worked well with external professionals to ensure people’s needs were met.

Service management and leadership was consistent and areas for improvements were identified. The registered manager gathered people’s views and experiences and made any necessary improvements.

We found the service met the characteristics of a “Good” rating.

Rating at last inspection: Good (Report published on 16 November 2016)

Why we inspected: This inspection was a scheduled inspection based on previous rating.

Follow up: We will continue to monitor the service and will inspect within 30 months of the report being published.

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

We inspected this service on 18 October 2016. We told the provider before the visit we were coming so they could arrange to be there and for care workers to be available to talk with us about the service.

This service was last inspected on 14 November 2013; we found the provider was compliant with the essential standards described in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

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.

Staff understood their responsibility to protect people from abuse and people felt safe with care workers that provided their care. There were processes to minimise risks to people’s safety, these included procedures to manage identified risks with people’s care and for managing people’s medicines safely. Care workers were properly checked during recruitment to make sure they were suitable to work with people who used the service.

People told us they were supported by care workers who they knew and who had the right skills to provide the care and support they required. Care workers understood people’s needs and abilities as they visited the same people regularly and had time to get to know people and read their care plans.

People felt involved in their care and care plans provided guidance for staff about how people liked their care delivered. Plans were regularly reviewed to make sure people continued to have the support they needed.

There were enough care workers to deliver the care and support people required. Care workers received the training and support they needed to meet people’s needs effectively. People told us care workers were kind and respected their privacy, dignity and independence.

The registered manager understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA). People made their own decisions about their care and had given agreement for the care to be provided. Care workers respected people’s decisions and gained people’s consent before they provided personal care.

People knew how to complain and information about making a complaint was available for people. Care workers said they could raise any concerns or issues with the management team, knowing they would be listened to and acted on.

The management team checked people received the care they needed by monitoring the time care workers arrived at people’s homes, reviewing daily records and through feedback from people and staff.

The provider’s quality monitoring system included asking people for their views about the quality of the service through telephone conversations, visits to review their care and questionnaires. There was a programme of other checks and audits which the provider used to monitor and improve the service.

Records and discussions with people who used the service showed that Personnel and Care Bank provided a service that met people's needs in ways they were satisfied with. Comments we had from people we contacted included:

'Good'do the job properly. Nothing to complain about ' if there was a problem I'd tell them.'

'Can't grumble at all.'

'Always clean, always particular, always polite.'

'I have the same person call ' I insisted on that.'

We saw that medicines were administered and recorded safely, that complaints were recorded and responded to, and that staff were properly recruited and trained.

We saw the service operating efficiently, with issues being responded to and resolved in a calm and positive manner.

People we spoke with who used the service were generally positive about it. 'Fine', 'polite and friendly' were typical comments from the majority of people who had 'regular' staff to visit. 'Different faces, don't know them' was a comment from one person who felt they didn't have a regular team of staff to support them.

Staff that we spoke with told us they were happy and well supported in their work. Staff told us they mostly supported people they were familiar with. Some staff told us they sometimes supported people they were not familiar with when they covered staff who were off sick or on holiday.