4 November 2019
During a routine inspection
Tiger Lily Care is a domiciliary care service providing personal care to people living in their own homes. 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. The service provided care and support to adults and children. The service was providing personal care to approximately 29 people at the time of the inspection.
People’s experience of using this service and what we found
Medicines were not always managed safely. Medicines administration records (MAR) were not completed in a safe way to make sure people received their medicines as prescribed as they were missing essential information.
There were systems in place to check the quality of the service. However, the systems to review and check the quality of the service were not always robust, they had not identified the concerns we raised in relation to medicines management. This was an area for improvement.
Improvements had been seen across the service since our last inspection. The provider and staff had worked hard to make sure people received quality care and support, however further improvements were still required.
People's needs were assessed, monitored and reviewed to ensure their needs were met. People were supported by competent, knowledgeable staff. Some staff had not undertaken all of their basic training. This was an area for improvement. Staff were supported by the provider.
People's care records contained in depth risk assessments to keep people safe. Risks to the environment had been considered as well as risks associated with people's health and care needs. The provider had systems in place to monitor accidents and incidents, learning lessons from these to reduce the risks of issues occurring again. The records of the action taken were not always clear. This was an area for improvement.
Staff were recruited safely. There were enough staff deployed to keep people safe. Staff told us that most of the time they had adequate time between care visits to travel between their calls. Some remote areas had not been allocated enough travel time. This was an area for improvement.
People were protected from the risk of abuse. The provider promoted an open culture to encourage staff to raise any concerns.
Where required, people were supported to ensure their dietary needs and preferences were met. Staff worked closely with occupational therapists and other agencies to assess people’s needs and ensure people were supported with their changing needs.
People and their relatives told us their choices and decisions were listened to and they were in control of their support. On a day to day basis people directed their care. People and their relatives told us they were asked how they liked things to be done. People said staff treated them with dignity and their privacy was respected. People were supported to be as independent as possible.
People gave us positive feedback about their care and support. They told us, “I believe I get all the care I need”; “They are good all of them”; “They are very friendly, we have a laugh really, very kind” and “The [staff member] is my favourite, I think the world of her.”
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.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The service was rated Requires improvement at the last inspection on 04 September 2018 (the report was published on 20 November 2018). There were four breaches of regulation. The provider had failed to operate effective quality monitoring systems. The provider had failed to effectively deploy staff to enable them to carry out their duties. The provider had failed to manage care and treatment in a safe way through assessment and mitigation of risks. The provider had failed to operate effective recruitment procedures. The provider completed an action plan after the last inspection to show what they would do and by when to improve. We also met with the provider after the last inspection to discuss the improvements required.
At this inspection we found improvements had been made. However, the provider was still in breach of one regulation. The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.
Why we inspected
This was a planned inspection based on the previous rating.
Follow up
We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.