Tigerlily Healthcare Limited

Updated 20 July 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

Inspection team

One inspector carried out this inspection.

Service and service type

This service is a domiciliary care agency. It provides personal care to people living in their own homes.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was a registered manager in post. However, the registered manager only had oversight of four people, only one of whom received personal care. The provider had not informed the registered manager about the second person they supported with personal care.

Notice of inspection

We attended the service unannounced on 7 April 2022. However, there was no-one at the office to facilitate the inspection.

We therefore gave the service 24 hours’ notice of our next site visit which took place on 25 April 2022. This was because we wanted to ensure there would be someone in the office.

Inspection activity started on 7 April 2022 and ended on 30 May 2022. We visited the location’s office on 7 April 2022 and 25 April 2022.

What we did before the inspection

We reviewed information we had received about the service. We sought feedback from the local authority and professionals who work with the service. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make.

During the inspection

We corresponded with one person who used the service, and we spoke with one relative about their experience of the care provided. We spoke with nine members of staff including the director, the registered manager, the business manager, five support workers and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. However, the nominated individual confirmed to us they had not acted in this role for approximately 12 months.

We reviewed a range of records. These included two people’s care records and medicine records. We looked at recruitment information for 13 members of staff. We spoke with three professionals who regularly worked with the service. We liaised with relevant local authorities and commissioning teams in respect of the concerns we identified.

The director did not provide us with all of the requested documents in relation to the second person they supported, or in relation to staff recruitment. We therefore served a formal letter under section 64 of the Health and Social Care Act 2008 requiring the director to provide the requested information. Not all of the information requested has been provided, and we are dealing with this outside the inspection process.

Updated 20 July 2022

About the service

Tigerlily Healthcare Limited is a domiciliary care agency which provides personal care and support to people living in their own homes. The service supports people with mental health needs, physical disabilities and people living with a learning disability or autism. At the time of the inspection, the service supported five people in total.

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. At the time of the inspection, personal care was provided to two people.

People’s experience of using this service and what we found

There were two people who received a regulated activity at the time of the inspection. The registered manager only had oversight of one person’s care, as the provider had not informed the registered manager about the second person who received a regulated activity. The two people’s experience of care was very different.

There were not always enough staff to support the second person who received a regulated activity. Safe recruitment procedures were not in place. The provider did not carry out appropriate pre-employment checks. The second person had experienced, and was at risk of experiencing, unsafe care. Safeguarding concerns were not appropriately investigated. Risk was not appropriately assessed, monitored or managed for this person. Medicines were not safely managed.

There were enough staff to support the first person who received a regulated activity, although safe recruitment procedures were not in place. Risk for this person was assessed, and medicines were safely managed. Lessons were learnt when things went wrong, and improvements made in response to feedback for this person. Infection control was managed in line with guidance.

The second person was not always appropriately supported to eat and drink enough to maintain a balanced diet. The provider had not looked into anomalies in staff training. This person’s needs were not fully assessed, and the care plan was task orientated. The provider did not always work well with other agencies.

The first person was supported to maintain a balanced diet. Most staff had received training which was specific to this person’s needs. This person’s needs were assessed, and the care plans were developed around those needs. The registered manager worked well with other agencies.

The first person was supported to have maximum choice and control of their lives and the second person was not. Staff supported the first person in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. The second person was not always supported in their best interests.

The second person was not always treated with kindness and respect. They were not supported to take part in hobbies or meaningful activities. The first person was treated with compassion and was encouraged to be as independent as they could be. This person was empowered to take part in activities they enjoyed.

The provider did not understand their regulatory requirements. Roles within the service were not clear. The provider had not informed the registered manager about the second person’s care package. Required recruitment information was not in place. There was no evidence of learning and service improvement around the second person. Audits were limited and did not identify the issues found on inspection. The director and the business manager failed to provide some requested information to CQC.

The registered manager engaged with the inspection process. The registered manager involved relatives where appropriate, sought feedback from staff and implemented suggestions put forward by the staff team in respect of the first person supported.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service supported one autistic person. In respect of this person, the service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. This person was supported to have choice, control and independence. This person was encouraged and supported to do activities they wanted to do. They were supported to have choice and make their own decisions where possible. The service recognised when this person needed interactions and when they needed their own time and space alone. This was respected and understood by staff. This person was supported to be as independent as possible and encouraged to undertake appropriate daily tasks themselves.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

This service was registered with us at this address on 28 September 2021. The service was first registered with us at a previous address on 3 March 2020. This is the first inspection of this service.

Why we inspected

The inspection was prompted in part due to concerns received about staff recruitment and the quality of care. When we tried to investigate the concerns, we had difficulty in contacting the provider. This raised further concerns about the role of the provider and the level of provider oversight. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements.

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

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 safe care and treatment, safeguarding, person-centred care, staffing, recruitment and good governance.

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 and request an action plan 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

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.