25 October 2018
During a routine inspection
A registered manager was not present during the inspection, however at the time of writing the manager has now become registered with the CQC. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.
At the time of the inspection, Tailor Maid Care Solutions Limited supported 39 people who received some element of support with their personal care. This was the service’s third inspection under its current registration. During our previous inspection on 25 and 29 January 2018, we rated this service as ‘Inadequate’. However, found during this inspection that some improvements had been made and we have changed the overall rating to ‘Requires Improvement’.
During this inspection, we found staff punctuality had improved, but further work was needed to ensure all calls were carried out time. However, people’s medicine administration records were not always appropriately completed. The manager was aware of this and was taking action against the staff concerned. However, the action taken was not always carried it out an appropriate timeframe. Some improvements had been made to the process for assessing the risk to people’s health; however, there was still further work needed to ensure these assessments reflected people’s needs.
Accidents and incidents were now investigated and recorded appropriately; however, analysis of any trends or themes to reduce to the risk of reoccurrence was not always completed. There were now enough sufficiently skilled and experienced staff to meet people’s needs. Effective processes were now in place to ensure any allegations of abuse were actively investigated and reported to the relevant bodies such as the CQC or the local authority. People felt staff understood how to reduce the risk of the spread of infection in their home. People told us they felt safe when staff supported them in their homes.
Some improvements had been made to ensure that the principles of the Mental Capacity Act 2005 were applied when decisions were made for people. However, further work was needed to ensure people were always supported to have maximum choice and control of their lives and for staff to support them in the least restrictive way possible. The policies and systems in the service do not currently fully support this practice, and clearer documentation is required to ensure all decisions made clearly evidenced that they were in each person’s best interest.
Staff training was now up to date and staff received supervision of their role. People’s physical, mental health and social care needs were assessed prior to commencing using the service; however professional guidance was not always used to inform care planning. People were happy with the support they received with their meals. People were supported to access health or social care agencies.
Most people felt staff provided care and support that was kind, caring and respectful and they were treated with dignity. Staff spoke confidently about how they supported people living with dementia. People contributed to decisions about their care.
Improvements had been made to people’s care records. They now included more detailed reference to people’s personal choices and preferences. Care plans were reviewed and people contributed to the process. Steps had been taken to provide information for people with a sensory impairment in a way they could understand, however further development in this area was needed. People’s diverse needs were discussed with them and support offered where needed. Most people understood how to make a complaint. End of life care was not currently provided by the service.
People’s care records were now handled and stored securely, although we did find one example where they were not. The manager had ensured the CQC were notified of incidents that had or could have an impact on people’s health and safety.
At the last inspection, the manager had been in post for one week. Over the past nine months since our last inspection, they have focused on improving the main areas of risk at the service. This has reduced the risk to people’s safety. However, further improvements were needed to ensure that the risks identified at the last inspection and those that remain after this inspection, are reduced further. We were unable to judge the sustainability of these improvements, but we will be able to report on this in our next inspection.
We have made two recommendations for the provider to address, which will assist them in making improvements to the care and support people received.
This service has been in Special Measures following our inspection on 25 and 29 January 2018. Services that are in Special Measures are kept under review and inspected again within six months of the publication of the report. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements had been made and it is no longer rated as Inadequate overall or in any of the key questions. However, further improvements were needed to achieve an overall rating of Good.