Tehy Care Group Limited is a domiciliary care service, supporting people living in their own houses and flats with personal care. At the time of the inspection, the service was supporting 15 people 13 of whom received help with personal care.
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 and what we found
Although staff knew people well changes in their needs were not always clearly documented in their plans. We saw no evidence of any negative impact on people, but this is not in line with best practice guidelines. We discussed this with the management team who assured us this would be addressed.
The providers website had a link to the to the latest inspection report rating, but it did not display the services CQC rating in line with CQC guidance and their regulatory responsibility. The provider was in the process of amending this and we will continue to monitor them to ensure they do so.
Medicines were managed safely. Systems were in place to monitor staff competencies to administer medication and identify and address concerns.
Staff had been recruited safely. There was enough staff to support people and missed and late calls were no longer a concern.
Staff were provided with appropriate PPE and people told us staff used this when supporting them.
Incidents and accidents were monitored and reviewed to ensure that actions had been taken and lessons were learnt.
People using the service and their relatives were happy with the care they received and were cared for by the same familiar staff with whom they had developed good relationships. People who had raised concerns felt these had been dealt with by the management team and they were happy with the outcome.
Since the last inspection the management team had been restructured. Effective quality monitoring systems were now in place to ensure the management team had oversight of the service.
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 last rating for this service was inadequate (4 June 2020).
We carried out an announced comprehensive inspection of this service on 26 February 2020. Multiple breaches of regulations were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.
This service has been in Special Measures since 10 September 2019. During this inspection the provider demonstrated improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.
Why we inspected
This was a planned inspection based on the previous rating.
We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.
The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Tehy Care Group Ltd on our website at www.cqc.org.uk.
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 monitor the service.
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.
Tehy Care Limited is a domiciliary care service. It provides personal care to people living in their own houses and flats.
At the time of the inspection, the service was supporting 12 people 11 of whom received help with 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 and what we found
This was the second inspection during which we found people were placed at risk by the provider failing to identify and address breaches of regulatory requirements. The provider had not made sufficient improvements to the safety and governance of the service and had not taken appropriate steps to support the management team. This lack of managerial oversight had impacted on the quality of care provided.
The management and provider continued to lack understanding of governance systems. This meant they did not have oversight of the service to ensure people received safe care. Systems that were in place were not implemented effectively and audits did not identify ongoing concerns with the service.
Risk assessments had been reviewed. Some included clear guidance for staff about concerns found during the previous inspection however, not all new risks had been identified and some areas lacked detail.
Medicines were not managed safely. Medicine administration records were not always complete. Some lacked information about people's medicines such as what they took and what the medicines were for. Medication audits had failed to identify areas of concern found during the inspection.
Staff recruitment processes were not robust. This meant people were potentially at risk of staff being employed to work with them who were not suitable.
A system was in place to record incidents and accidents. However, there was no evidence of how lessons learnt had been used to facilitate improvement in service delivery.
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.
There was an improvement in staff’s access to training but there continued to be areas where not all staff members had completed the necessary training to ensure the needs of people were met.
Staff were supported by the management team through supervision sessions and regular staff meetings.
People knew how to raise complaints and concerns. People and their relatives were given the opportunity to provide feedback about the service via questionnaires and weekly telephone review calls.
Staff were kind and caring and knew people well. Staff understood their roles and responsibilities to safeguard people from the risk of harm.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was Inadequate (published 10 September 2019). The service remains rated inadequate. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not enough improvement had been made and the provider was still in breach of regulations.
Why we inspected
This was a planned inspection based on the previous rating.
Enforcement
We have identified multiple breaches in relation to risk assessments, person centred care, the management of medicines, staff recruitment, recording of consent and the providers continued lack of governance and oversight to ensure people received safe care and treatment.
Please see the action we have told the provider to take at the end of this report.
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.
Special Measures
The overall rating for this service is ‘Inadequate’ and the service remains 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 of 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.
Tehy Care Group Limited is a domiciliary care agency. It provides a range of services, including personal care and medication support to people living in their own homes.
Not everyone using Tehy Care Group Limited received a regulated activity; CQC only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. At the time of the inspection,10 people using the service received the regulated activity of personal care.
People’s experience of using this service and what we found
Staff had not completed up to date practical manual handling training. Risk assessments had been reviewed but did not provide adequate guidance for staff to support people and mitigate the risk of harm. Although we found no evidence people had been harmed, systems were not robust enough to demonstrate safety was effectively managed. This meant people were not protected from the risk of harm.
Staff had completed medication training and competencies were reviewed through spot checks. Whilst we found no evidence to suggest medicines were not administered safely, medication audits were not robust, and the medication policy needed to be updated.
Accidents and incidents were recorded. However, there was no evidence of lessons learned or action taken to reduce the risk of reoccurrence.
Staff had not completed training to provide them with the skills and knowledge to care for people and move them safely. There was no formal induction programme in place and staff did not have access to annual appraisals or formal supervision sessions.
Although people reported they felt safe with the staff who supported them, they did not always receive visits on time and were not informed when staff were running late or had been replaced.
People told us staff were caring and they were treated with dignity and respect. However, the wording used in some of the care plans did not always reflect this.
The provider did not have processes in place to effectively monitor the quality of the service and drive improvements. Suitable measures had not been considered and put in place to mitigate the risk or potential risk of harm for people using the service. This meant the registered manager had not identified the shortfalls we found during this inspection.
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. However, the recording of mental capacity assessments was not detailed and required reviewing.
Staff were recruited safely and underwent all the necessary checks.
People, their relatives and staff were all complimentary about support provided by the registered manager and staff who supported them. However, we found an overall lack of governance.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was requires improvement (published 23 March 2019).
At the previous inspection we found the domain of well-led to be inadequate and there were multiple breaches of regulations. The provider completed an action plan to show what they would do and by when to improve; safe care and treatment; good governance; fit and proper persons employed and staffing.
At this inspection, a system was in place to ensure staff were suitable to work with adults and children and the service was no longer in breach of regulation 19 relating to fit and proper persons employed. However, we identified continued shortfalls in other areas and the provider was still in breach of regulations relating to safe care and treatment, staffing and leadership. We also made two recommendations; for the service to follow current legislation to maintain people’s information confidentially in relation to Accessible Information Standard (AIS) and for the service to record information about people’s preferences for end of life care.
Why we inspected
This was a planned inspection based on the previous rating.
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.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Tehy Care Limited on our website at www.cqc.org.uk.
Enforcement
At this inspection we have identified breaches in relation to the safe care and treatment of people, the training, support and professional development of staff and the leadership and quality monitoring of the service.
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.
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.
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:
There was no registered manager in post at the time of our inspection. A registered manager is a person who has registered with the 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. In the absence of a registered manager, the service was being managed by a care review officer who was acting as the registered provider’s representative.
There was a lack of managerial oversight and scrutiny of the service. Significant improvements were required to ensure effective quality assurance systems and processes were in place and embedded to assess, monitor and improve the quality of the service.
Recruitment procedures were unsafe. Staff had been recruited without thorough checks being completed. Staff had not completed formal training since starting work at the service or had received regular supervision.
We found significant issues with the management of people’s medicines; this included staff not undertaking medication training and receiving formal observation to check their competency to administer medicines. We have made a recommendation about the safe management of medicines.
Risk management plans were in place. However, some of these contained basic information and primarily covered identified risks within people’s home environment. We have made a recommendation about the management of risks to people and staff.
Improvements were required to the registered provider’s pre-assessment process and involvement of people in the development and review of their care and support. This included obtaining people’s written consent to their planned care.
We checked whether the service was working within the principles of the Mental Capacity Act 2005 (MCA). Staff had not completed MCA training but understood the importance of choice and gaining people’s consent before supporting them with care. No one currently using the service lacked capacity to make decisions.
People told us they felt safe using the service, staff were kind and caring and they were happy with the service they received. People’s independence was promoted and, where possible, they were encouraged to do as much as they could for themselves.
Rating at last inspection: This is the first inspection of the service since registration with CQC.
Why we inspected: This was a planned comprehensive inspection of the service.
Follow up: We identified four breaches of regulations. You can see what action we told the provider to take at the back of the full version of this report. 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.