Tigerlily Healthcare Limited

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.