Tamworth Home Care Limited

Updated 23 August 2023

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

This inspection was carried out by 2 inspectors and 2 Experts by Experience. 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 is a domiciliary care agency. It provides personal care to people living in their own homes.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

The provider (owner of the business) was the nominated individual. They had registered with us as a (second) manager but had delegated day-to-day management of the service to their employed manager who was also registered with us. It is this person, within our report, we refer to them as registered manager.

During our inspection, we were informed the nominated individual intended to de-register as manager with us. They would retain their role as nominated individual. The nominated individual is responsible for the oversight of the regulated activity and service management.

Notice of inspection

This inspection was announced. We gave short notice on 5 July 2023 to the registered manager. This was so they would be available to support the inspection process. We sought feedback through telephone calls to people, relatives and staff on 7, 10 and 11 July 2023 and also visited a 24hour supported living service on 11 July 2023. We undertook a visit to the provider’s office location on 12 July 2023.

Inspection activity started on 5 July 2023 and ended on 12 July 2023.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and Healthwatch. The local authority purchase packages of care when people do not purchase their own care and support. 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 the information to plan our inspection

During the inspection

We had telephone conversations to gain feedback on the service from 9 people and 18 relatives. We visited 1 person and gained their feedback. We also spoke with 7 care staff, 2 care coordinators, 1 field supervisor, 1 senior carer and the training coordinator and registered manager.

We reviewed a range of records. This included 11 people’s care plans, risk management records and medication administration records. We looked at a variety of documents relating to the management of the service, including quality monitoring checks. We reviewed 5 staff employment records.

Updated 23 August 2023

About the service

Tamworth Homecare Limited is a domiciliary care agency which is registered to provide personal care and support to people in their own homes. The service is registered to provide support to children aged 4 years to 18 years, to people with a learning disability or autistic spectrum disorder, to people with a sensory impairment or physical disability and to people with dementia and to younger and older adults.

People had individual packages of care ranging from 15-minute care calls to 24-hour supported living. At the time of our inspection the service was supporting 97 people; younger and older adults who were receiving 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.

We assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.

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

Right Support: The service did not always follow a Model of Care that maximises people's choice, control and independence.

Risks associated with people’s care were not always assessed and staff did not always have important information available to them to prevent risks of potential avoidable harm. Where risks had been identified, the management of those risks were not always sufficiently recorded to demonstrate people had received the right support.

Staff had received training, and some had the right skills enabling them to provide the right support. However, some staff lacked skills and knowledge or had not always completed the training they needed.

Overall, staff supported people with their medicines in a way that promoted their independence and achieved the best possible health outcome.

Overall, people were supported by staff who understood and were trained in recognising the signs of abuse. However, people had not always been protected from abuse.

Some people experienced consistency in their care staff and were happy with their care and support. However, other people experienced inconsistencies with their care staff and were not always satisfied with the care received. People’s preferred communication needs had been assessed, but systems were not always in place to ensure people and / or their relatives could access plans of care or notes made by staff in an accessible format. Not everyone knew they could request access to the electronic ‘app’ for their care plan.

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; overall the policies and systems in the service supported this practice.

Right Care: Care was not always person-centred. The service did promote people's dignity, privacy and human rights

People’s needs were assessed, and everyone had a plan of care. Overall, these were personalised, but a few people’s plans of care contained information that was either not relevant to them or was contradictory because information had not yet been updated. Some areas of risk management needed improvement.

Staff supported people’s privacy, dignity, and cultures. Training was available to staff on human rights and protected characteristics under the Equality Act.

Overall, staff were aware of people’s nutritional needs and supported people to eat and drink where this was required.

Right Culture: The ethos, values, attitudes and behaviours of leaders and care staff did not always ensure people using services led confident, inclusive and empowered lives.

The provider had not always had effective oversight of the service. Whilst the registered manager had some systems and processes in place to make checks on the quality of the service, these had not identified issues we found where improvements were needed.

Records across the service were not always clear to demonstrate effective systems were in place to capture people’s feedback and demonstrate any issues for improvement had been acted upon. Staff recruitment checks had not been fully completed and / or recorded before they started to work for the service to confirm they were safe and suitable to work with people.

People and relatives felt some staff demonstrated a positive, caring attitude but this was not everyone’s experience.

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

Rating at last inspection

The last rating for this service was requires improvement (published 15 March 2023).

Why we inspected

This inspection was prompted by a review of the information we held about this service. This included concerns shared with us from staff and complaints about poor care services from relatives. Two local authorities had shared recent reports with us where they found improvements were needed.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, repsonsive and well-led sections of this full 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.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, fit and proper persons employed and good governance at this inspection. You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will request an action plan from the provider 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.