Archived: Tabitha Homecare Ltd

Tabitha Homecare Limited is a domiciliary care service providing personal care to people living in their own homes. At the time of our inspection there were 7 people using the service.

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

Governance systems in place were not effective. At the last inspection we found the provider's oversight of the service had not identified the shortfalls we found. At this inspection this continued to be the same, and these were repeated concerns over the 4 previous inspections.

Care plans and risk assessments continued to lack robust and clear guidance, with incorrect or conflicting information. Risks to people were not thoroughly assessed and failed to inform staff on the actions they should take to keep people safe.

There were unsafe recruitment at the last inspection, because no new staff had been employed, at this inspection we were unable to ascertain if robust systems were now established.

Some improvements to staff training had taken place. Staff we spoke with were aware of their responsibilities to keep people safe. Most people told us staff were caring and kind.

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.

At the last inspection we found the provider's oversight of the service had not identified the shortfalls we found during the inspection process as part of their audits and checks. At this inspection this continued to be the same.

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 (published 24 November 2022) and there were breaches of the regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations and they had either not implemented or maintained the improvements they said they had made.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. The overall rating for the service has remained Inadequate. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvements. Please see 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 Tabitha Homecare on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified repeated breaches in relation to; Regulation 12 – Safe care and treatment, and Regulation 17 – Good governance at this inspection.

We issued a notice of proposal to cancel the providers registration.

Please see the action we have taken detailed at the back of the report.

Follow up

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. The provider's oversight of the service had not identified some of the shortfalls we found during the inspection process as part of their audits and checks.

Tabitha Homecare Limited is a domiciliary care service providing personal care to people living in their own homes. At the time of our inspection there were 24 people using the service.

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

Governance systems were in place but were not effective. The provider’s governance systems had failed to identify the concerns and shortfalls we found during our inspection. The concerns about ineffective systems, were repeated concerns over the three previous inspections.

Risks to people's safety had not been assessed accurately. Infection prevention and control (IPC) measures were not consistently followed. Medicines were not always managed safely, and recruitment procedures did not ensure staff were safe to work with people.

Staff we spoke with were aware of their responsibilities to keep people safe. Most people told us staff were caring and kind.

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 last rating for this service was inadequate (published 15 March 2022) and there were breaches of the regulations. The provider completed an action plan and sent monthly reports to show what they would do and by when to improve.

At this inspection we found improvements had been made to meet the previous breach of regulation 13, safeguarding service users from improper treatment. However, enough improvement had not been made on the breach of safe care, employment of staff, and the governance of the service. The provider had failed to achieve a good rating over the last three inspections.

Why we inspected

We undertook this comprehensive inspection to check they had followed their action plan and to confirm they now met legal requirements.

We found evidence during this inspection that the provider needs to make improvements to ensure the risk of harm to people is identified, and action taken to reduce these risks. Please see the safe, effective, caring, responsive and well-led key questions of this full report.

The overall rating for the service remains as inadequate, based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Tabitha Homebased Care Limited on our website at www.cqc.org.uk.

Enforcement and Recommendations

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 and will take further action if needed.

We have identified breaches in relation to; Regulation 12 – Safe care and treatment, Regulation 17 – Good governance, Regulation 19 – Fit and proper persons employed, at this inspection.

We issued a notice of proposal to cancel the providers registration.

Please see the action we have taken at the end of this report.

Follow up

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. The provider's oversight of the service had not identified some of the shortfalls we found during the inspection process as part of their audits and checks.

Tabitha Homecare Ltd is a home care agency providing personal care to 42 people at the time of the inspection. 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

The provider did not always identify safeguarding concerns or share safeguarding information with external agencies. Risks to people’s safety had not been assessed accurately. Infection prevention and control (IPC) measures were not effectively managed. Medicine records showed medicines were not always given as prescribed. Recruitment procedures did not consistently ensure staff were safe to work.

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 last rating for this service was inadequate (Published 02 June 2021) and there were multiple breaches of regulation. After the last inspection, we varied the conditions of the providers registration, requiring the provider to send a monthly report to the CQC setting out the results of their quality assurance activities and any actions taken to improve the service. At this inspection enough improvement had not been made/sustained and the provider was still in breach of regulations.

Why we inspected

This was an ‘inspection using remote technology’. This means we did not visit the office location and instead used technology such as electronic file sharing to gather information, and video and phone calls to engage with people using the service as part of this performance review and assessment.

We carried out an announced focused inspection of this service on 20 April 2021. Breaches of legal requirements were found. Following that inspection, we received concerns in relation to infection prevention and control (IPC) and staff recruitment processes and practices.

We undertook this focused inspection to look at the concerns raised and to check the provider now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective 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 to calculate the overall rating on this inspection. The overall rating for the service has remained Inadequate. 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 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 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 risk assessments, IPC, recruitment, medicines, oversight of the service and acting on safeguarding concerns.

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.

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.

About the service

Tabitha Homecare Ltd is a home care agency providing personal care to 65 people at the time of the inspection. 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

Where safeguarding incidents had occurred, the provider had not always shared this information with external agencies. Risks to people’s safety had not always been assessed accurately. Recruitment procedures did not consistently ensure staff were safe to work. Medicine records showed medicines were not always given as prescribed. There were sufficient numbers of staff to support people.

The providers systems to monitor and improve the quality of care provided were ineffective and did not identify where improvements were needed. Where improvements had been identified, these were not consistently acted upon. People and staff were given opportunity to feedback on the quality of the care provided.

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 (Report published 01 April 2021) and there were four breaches of regulation. At this inspection enough improvement had not been made/ sustained and the provider was still in breach of regulations.

Why we inspected

We carried out an announced comprehensive inspection of this service on 06 January 2021. Breaches of legal requirements were found. The provider failed to complete an action plan after the last inspection to show what they would do and by when to improve.

We undertook this focused inspection to check 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 remains Inadequate. 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 Tabitha Homecare 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 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 recruitment, risk assessments, acting on safeguarding concerns and oversight of the service 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.

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 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.

Tabitha Homecare Ltd is a domiciliary care service providing personal care to people living in their own homes. At the time of the inspection the service supported 74 people. 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.

Peoples experience of using this service

There was a lack of provider oversight which meant risks to people’s safety had not been responded to appropriately. Risk management plans were not always in place to guide staff on how risks should be managed and minimised. The provider’s monitoring systems were not effective as internal audits did not identify the issues we found on inspection. Following the inspection, the provider told us they had employed a quality monitoring person to support them in addressing the concerns we found at this inspection.

People we spoke with did not always feel their care was provided by trained staff. People and their relatives had been consulted about their care and support but felt that when concerns were reported to the provider actions were not always taken to resolve the concerns they raised.

The provider did not always complete full employment checks to ensure staff were suitable to work with vulnerable people.

Infection control systems were in place but needed to be consistent throughout the service and required strengthening to limit the risk of infection in the office environment. Staff confirmed that they had enough personal protective equipment (PPE) to support people’s safely when providing personal care

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.

Rating at last inspection-

This service was registered with us on 24 January 2020 and this is the first inspection.

Why we inspected

The inspection was prompted due to concerns about the service in relation to allegations of unsafe practice, not reporting incidents, staff conduct issues, poor staff culture and not following infection prevention and control guidelines.

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 Regulation 17 good governance due to the lack of provider systems and process' in place to assess, monitor and improve the quality and safety of the services provided. Regulation 12 safe care and treatment because people were exposed to the risk of harm as their care needs and risks associated with their care were not clearly identified and recorded. Regulation 19 fit and proper persons employed due to failing to follow safe recruitment processes at this inspection and Regulation 13 safeguarding service users from abuse and improper treatment, for failing to notify the appropriate authority and take the appropriate action when required to safeguarding people from potential harm.

You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme we will check the providers progress against the action they have told us they will take at our next inspection.