Tamworth Home Care Limited

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.

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. At the time of our inspection the service was supporting 116 people; younger and older adults who were receiving personal care. People had individual packages of care ranging from 15 minute care calls to 24hour care and support. 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.

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

Quality checks were in place, but some were not always effective in identifying where improvements were needed.

Staff did not always follow the company policy in infection prevention and control, which posed potential risks of cross infection. Personal protective equipment was made available to staff, but some staff did not use it as directed.

Staff did not always apply transdermal (skin) patch medicines in line with the manufacturer’s instructions. This posed potential risks of harm to people.

Risks of harm or injury were assessed, and care plans gave detailed information to staff on how to reduce risks. Care plans were reviewed regularly and updated when people’s needs changed. People were protected from the risks of abuse.

Staff were recruited in a safe way and received a comprehensive induction and training. Their skills and knowledge were assessed, and people felt staff had the skills they needed to complete care tasks.

There were enough staff to carry out care calls to people and there was a care call monitoring system in place.

People felt staff were kind and caring toward them. The service had a caring culture which was demonstrated by staff.

Staff felt supported in their job roles and able to raise any concerns with the registered manager.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

At the time of the inspection, the location did not care or support for anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.

Right Support: Model of Care and setting that maximises people’s choice, control and independence

People were supported to have maximum choice and control of their lives and staff did support them in the least restrictive way possible and in their best interests; the policies and systems in the service did support least restrictive practices.

Right Care: Care was person-centred and did promote people’s dignity, privacy and human rights

Right Culture: The ethos, values, attitudes and behaviours of leaders and care staff did ensure people using services led confident, inclusive and empowered lives.

People had detailed, personalised plans of care and were involved in agreeing their support with Tamworth Homecare Limited. Systems were in place to gather people’s feedback on the service and this was analysed by the registered manager. Complaints were acted on and used to improve services.

Important information about specific incidents had been shared with us as legally required.

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 good (published 12 June 2018).

Why we inspected

This performance review and assessment was prompted by a review of the information we held about this service.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

On our last inspection in February 2016 the service was rated as Good; on this inspection we found the service remained Good. However, we found the service needed to make improvements to how they supported people to make decisions which meant, ‘Is this service effective?’ was now ‘requires improvement’. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. However, improvements were needed to ensure decisions were only made in people’s best interests.

The service had a manager in place at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons.’ Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People continued to receive safe care. Risks to people’s health and wellbeing were assessed and this was reviewed to ensure people continued to be assisted in a safe manner. The staff understood how to protect people from harm and the registered manager had reflected on how safeguarding concerns were addressed to ensure these were reported promptly. Some people received assistance to take medicines and records were kept to ensure that this was done safely. There were safe recruitment procedures in place to ensure new staff were suitable to work with people.

Staff were supported and trained to ensure that they had the skills to support people effectively. When people required assistance to eat and drink, the provider ensured that this was planned to meet their preferences and assessed need. People were able to make decisions about how they wanted to receive support to ensure their health needs were met.

The care people received remained good. Care was planned and reviewed with people and the provider ensured that people’s choices were followed. People’s privacy and dignity were respected and upheld by the staff who supported them. People felt comfortable with staff who they knew and satisfied with the support provided.

The service remained responsive. The support plans reflected people’s specific needs and preferences for how they wished to be supported and this was reviewed. People felt comfortable raising any issues or concerns directly with staff and there were arrangements in place to deal with any complaints. Information was being reviewed to ensure it this was accessible to all people who used the service.

The service remained well led. Staff felt supported by the registered manager. Regular quality checks were completed and people could comment on the quality of service provision. People and staff were encouraged to raise any views about the service to consider how improvements could be made.

The service provides care and domiciliary support for older people and people with a learning disability who live in their own home in and around Tamworth.

There was a registered manager in the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The provider had systems in place to assess and monitor the quality of care. People were encouraged to give their feedback and this was used to drive improvements. Quality audits within the registered office had not been carried out to ensure the premises were safe.

Staff knew how to recognise the signs of abuse and knew what actions to take if they felt people were at risk. People’s risks were assessed and support plans included measures to reduce or prevent potential harm.

People received care and support from staff who were well trained and knew how people liked things done. People’s care records included information about how they wanted to be supported and this was reviewed to ensure it reflected any changes.

People received an agreed level of staff support at a time they wanted it and were happy with how the staff supported them. People had a regular team of staff who had the skills to meet their needs. People knew who was providing their support in advance and the provider was flexible and responsive to changes. People received their medicine and were supported to apply any cream they needed to keep well.

People consented to any care. Where concerns were identified about whether people had capacity to make decisions, action was taken to ensure decisions were being made in people’s best interests.

People were treated with care and kindness and staff were friendly and respectful. People benefitted from having support from staff who had a good understanding of their individual needs. People were positive about the way staff treated them. Staff listened to people’s views and they knew how to make a complaint or raise concerns.

People benefitted from receiving a service from staff who worked in an open and friendly culture and were happy in their work. Checks were carried out prior to staff starting work to ensure their suitability to work with people.

People felt the service was well managed and they were asked to express their views and be involved in decisions related to the planning of their care. People chose how support was provided and they were involved in the review of their care.

The provider had systems in place to assess and monitor the quality of care and encouraged people and their relatives to give their feedback and used this to drive improvements.