Archived: Total Home Care Solutions Limited Lincoln

We considered our inspection findings to answer questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

This is a summary of what we found-

Is the service safe?

In general safeguarding procedures were robust and staff understood their role in safeguarding people the people they supported. Staff had a good understanding of the providers whistle blowing policy and had raised concerns with us when they believed people were put at risk with late and missed calls.

Records showed that the provider had not taken people's care needs into account when making decisions about the number of staff the agency required or the particular qualifications, skills and experience staff would need. Travelling times and the size of the geographical area care workers needed to cover was not included when planning rotas.

Systems in place to review accidents incidents and concerns did not ensure staff learned from these events.

Recruitment practice was safe and thorough. However, there had been a high turnover of staff and the provider had trouble maintaining appropriate staffing levels.

Is the service effective?

People's health needs had been assessed and person centred care plans were in place. Care plans were reviewed regularly or when people's needs changed. Risks to people's welfare such as their mobility, environment and skin care were taken into account in the care planning process. However, care workers were unable to meet the demands of their rotas and care calls were late or missed. This impacted on the care people received. A relative told us, 'I just despair; twice this week I have had sheets to wash as they (care workers) have been late (and the person receiving care needed the toilet).' They added, 'They have not been on time once, we changed the call time by 45 minutes to make it better and they are still not on time.'

Staff received appropriate induction training. However, three people commented that at times staff had not had the skills needed to provide specific areas of the care needed. This meant people were left to self-care of if able to explain to staff what needed to be done.

Business continuity plans to ensure people received safe care in an emergency such as a staff shortage were not fully effective. Lack of detail about who was responsible for agreeing terms and conditions with other agencies prevented contracts being signed and support being given.

Is the service caring?

Six people told us about the staff who supported them. People commented that staff were often late for their care calls. A relative told us, 'Care has been appalling. XXX has three visits a day and when XXX sees them they are ok but they don't come on time and sometimes they don't come at all. Sometimes it's very late 12:30am. XXX needs help getting to bed and falls asleep waiting for the carers."

Records showed and people told us the care staff did not always leave their home as clean and tidy as they would like. We saw someone had left a message to the carers requesting that they ensure the back door was locked when they left the property. They also asked that care workers cleaned up after preparing meals as this was not being done.

Is the service responsive?

People told us they knew how to make a complaint, however they said that the provider was unable to sustain any improvements about the complaints they made. The local authority told us they had stopped placing new people who needed care in their own home with the provider in March 2014 as they had identified concerns with the delivery of the service. While the provider had initially made improvements these had not been maintained.

Is the service well-led?

In this report the name of two registered managers appears who were not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time.

The service had a quality assurance system in place, However, it did not always ensure shortfalls were identified. Accidents and incidents were recorded and investigated, but actions were not always taken to decrease the risk of the incident re-occurring in the future.

Overall we found improvements in service delivery were not embedded in care and could not be sustained.