Archived: TLC Private Home Care Services Ltd

TLC Private Home Care Services Ltd is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to older adults and younger disabled adults. On the day of our inspection there were 49 people receiving the regulated activity of personal care.

At the last inspection in June 2017 we identified two breaches of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to systems not being in place to fully assess and the provider had failed to ensure information required to demonstrate staff employed were of suitable character was in place.

During this inspection on 6, 7 and 15 August 2018, we found improvements had been made towards meeting the requirements to help ensure that people received an improved quality of service and there were no longer any breaches of regulation.

The service had a registered manager who had been registered with the Care Quality Commission (CQC) since July 2014. 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.

The management of medicines had improved. New systems were in place to ensure that medicine administration records were accurate and up to date. This included regular auditing of medicines and the associated documentation.

Staff recruitment processes had improved. Comprehensive pre-employment checks were now in place to ensure new staff were suitable to work with people who required social care. New staff had received a robust induction. Staff training was up to date. Records showed and staff confirmed that they now received regular supervision sessions. Staff told us they felt very valued by the management team.

We have made one recommendation that all key documents are readily available to ensure the day to day running of the service is maintained in the absence of the registered manager. During the inspection we found a number of key documents such as accident and incidents, and quality assurance records were not available as the registered manager had these stored on his laptop. The registered manager at the time was not available for two weeks, which meant the deputy manager had no access to these keys records.

People we spoke with said they were involved in care planning and were confident that their comments and concerns would be acted upon. The provider took account of any complaints and comments to improve the service.

Feedback received from people who used the service and their relatives was overwhelmingly positive and people were encouraged to contribute their views. People were positive about the staff who supported them and told us they liked the staff and were treated with dignity and kindness.

Where people lacked the mental capacity to make decisions the home was guided by the principles of the Mental Capacity Act 2005 (MCA) to ensure any decisions were made in the person's best interests. Staff we spoke with were able to explain how they considered capacity and consent when they supported people.

There were arrangements in place to ensure staff attended care visits on time. Staff told us they had time to provide person centred care and the service had enough staff to support people.

People were protected from abuse and avoidable harm. People and relatives we spoke with told us they were happy with the support received from the service and they felt safe with staff. Staff knew how to identify abuse, the different types of abuse and how to report abuse.

People had a comprehensive assessment of their health and social care needs before they used the service. Care plans contained detailed information to enable people to receive appropriate care and support with their needs. People's care needs were regularly reviewed.

Although the provider was aware of the Accessible Information Standard (AIS) they had not yet taken action to implement this further into people's care plans. The registered manager confirmed they would introduce a policy relating to the AIS and would review elements of their care plans to ensure people's communication needs were accurately recorded in a format that was accessible to the person.

Complaints had been investigated and appropriate action taken. People were aware of how to make complaints and staff knew how to respond to complaints.

Quality assurance procedures were used to monitor and improve the service for people and people were included them in developing their care and support. Feedback from people and their relatives was provided via the NHS Choices website to improve the service when their views were sought annually.

TLC Private Home Care Services Ltd is a domiciliary care service which is registered to provide personal care to people in their own homes including people living in Extra Care housing. Extra Care housing is a type of supported housing for older people that helps them to live independently for as long as possible and to access services that are responsive to their needs. The service also offered services such as shopping, help with paying bills and collecting pensions, escorting people to appointments, housework, laundry and ironing.

TLC Private Home Care Services Ltd provides support for younger and older adults with a range of needs such as learning disabilities, mental health issues and dementia. At the time of our inspection the service was supporting 79 people. The service supported a number of additional people with a service that did not include personal care.

At the last inspection in January 2016 we identified two breaches of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to systems not being in place to fully assess and monitor the quality of the service and staff had not received appropriate necessary support, training, professional development, supervision to enable them to carry out their role effectively.

The service had a registered manager who had been registered with the Care Quality Commission (CQC) since July 2014. 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.

We found breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulation 2014. You can see what action we have told the provider to take at the back of the full version of the report.

The provider had not always recruited staff following robust procedures to ensure they were of suitable character for the roles in which they were employed. We found gaps in one staff members employment history had not been captured or discussed.

Medication administration records (MARs) were not easy to navigate and understand. During the inspection we discussed the MARs with the registered manager who was not aware the current records were not sufficient to ensure people’s medicines were clearly recorded. We made a recommendation that the registered provider reviews current guidance in relation to the management of medicines in domiciliary care services.

People’s preferences, likes, dislikes and social histories were recorded in their care plans, although the level of detail recorded varied. People told us they had been involved in developing and reviewing their care plans. We saw people had signed to show they agreed with the proposed plan of care. However, information in relation to a person’s capacity to provide their consent was not always clear.

The service undertook risk assessments for all aspects of the care and support people received in their homes. Care workers had been trained in infection control and used personal protective equipment when they supported people with personal care.

Staff understood how to provide care to people in line with the Mental Capacity Act 2005 (MCA). Any restrictions on people had been taken in line with the MCA and took a least restrictive approach to ensure people's safety.

Staff received regular training and support from the provider to ensure they had the required skills and knowledge to meet people’s needs. New staff benefitted from a comprehensive induction and all staff received on-going training and refresher sessions. Staff received regular supervisions to help them discuss their roles and performance and to support their development.

People told us they felt safe when using the service; their relatives also said they felt people were safe. Staff we spoke with understood about safeguarding vulnerable people, they had received safeguarding training and said they would report any concerns appropriately.

The service had enough staff to attend the care visits scheduled. People receiving support and their relatives said care workers arrived on time and stayed for the duration of their allotted visits.

The service had an effective system in place for logging and following up accidents and incidents.

Management systems were in place and people's opinions about the service provided were sought. These enabled the manager to look at where improvements were needed to the service. The manager was aware of improvements needed in the monitoring and auditing of people's medicines administrating records.

People told us they were supported to access other health care professionals and we saw that the service contacted GPs or occupational therapists, with the person’s consent, if they felt it was necessary.

People said they were treated with dignity and respect and that care workers were very caring. The service had been awarded the Dignity in Care Award in May 2016.

The service had procedures in place to help people access advocates if they needed them. This showed the service had a proactive approach to ensuring that people’s rights were always represented.

The service had a complaints policy which encouraged people to raise concerns. Few complaints had been received and those that were, were investigated and dealt with quickly. Feedback about the management of the service was positive and the registered manager planned to make further improvements to their existing customer feedback mechanisms.

The registered manager maintained good working relationships with key organisations in the community, such as the local authority, a local college, health care professionals and a housing trust.