Total Community Care

Updated 23 September 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 Care Act 2014.

Inspection team

The inspection was carried out by one inspector and a specialist advisor. A specialist advisor has knowledge in relation to the area the service provides care to. The specialist advisor looked at the care and support of three people who used the service and reviewed relevant documents and records.

We were also supported by an Expert by Experience. The Expert by Experience made telephone calls to people who used the service and spoke to some people's relatives. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

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

The service had a manager registered with the Care Quality Commission. 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.

Notice of inspection

We gave the service 24 hours' notice of the inspection. This was because we needed to be sure that the provider or registered manager would be in the office to support the inspection.

What we did before the inspection

We reviewed information we had received about the service since the last inspection including the provider’s action plan telling us how improvements would be made in response to the warning notice. We asked the local authority and Healthwatch for any information they had which would aid our inspection. Local authorities, together with other agencies may have responsibility for funding people who used the service and monitoring its quality. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. We used all this information to plan our inspection.

The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.

During the inspection

We spoke with the registered manager and the head of nursing to understand the structure of the service and how it was organised. They also told us of improvements and changes that had been made to the service to improve quality and support.

We reviewed a range of records. This included five people's care records and medication records.

We looked at three staff files in relation to recruitment and staff support. We also looked at a variety of records relating to the management of the service, including policies, procedures and audits and checks to monitor the quality of the service provided.

We spoke with 14 people who used the service and/or their relatives about their experience of the care provided. We spoke with 12 members of staff including support staff and care managers.

We also received feedback from a health or social care professional.

Updated 23 September 2022

About the service

Total Community Care is a domiciliary care agency providing support to people living with spinal injuries and neurological conditions in their own homes.

At the time of inspection, the service was providing support to 47 people across the country.

The last rating for this service was requires improvement (published 16 September 2021) and there were breaches of regulation resulting in a warning notice being served. The provider completed an action plan to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

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

The management of medicines had improved since the time of the last inspection. Records were being kept of medicines administered and there were systems in place to check they were being administered safely. When people took control of managing their own medicines, records did not always reflect prescribing guidelines. This was actively being reviewed and addressed to protect the person and the staff supporting them. Staff were knowledgeable of medicines administration processes and supported people to lead their support making the process person centred.

Staff were committed to provide person centred care and records reflected people’s needs and wishes. Risks were assessed and managed appropriately.

Staffing problems challenged the provider when aiming to provide consistency. The provider was actively recruiting and reviewing staffing terms and conditions to assist with retaining staff.

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.

The service was well-led. Staff felt supported by their managers. The structure of management provided layers of leadership and at all levels immediate managers were supportive and approachable.

The registered manager had quality assurance processes in place to monitor the quality of the service provided and audits identified areas where improvements were required. The provider listened to feedback and produced action plans for change.

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 requires improvement.

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. There were concerns about medicines management and leadership and governance. The overall rating for the service was requires improvement.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from requires improvement to good. 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 Total Community Care on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.