Total Care Nursing Limited

Updated 17 July 2019

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 completed by one inspector.

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 48 hours’ notice of the inspection. This was because it is a small service and we needed to be sure that the provider or registered manager would be in the office to support the inspection.

Inspection activity started on 14 June 2019 and ended on 17 June 2019. We visited the office location on 14 June 2019.

What we did before inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

We spoke with three people who used the service and two relatives about their experience of the care provided. We spoke with seven members of staff including the registered manager, office staff and care workers.

We reviewed a range of records. This included three people’s care records and multiple medication records. We looked at three staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures, were reviewed.

Updated 17 July 2019

About the service

Total Care Nursing is a domiciliary care service that was providing personal care to 15 people; mainly older people, but also to younger adults, people with a learning disability or autistic spectrum disorder, people with physical disabilities, mental health, sensory impairment and people living with dementia. Not everyone who used the service received personal care. The Care Quality Commission 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

People were happy with the care and support they received. Relatives said they had confidence in the staff who supported their family member and would recommend the service.

Staff were described as kind and patient. They understood people’s cultural needs and were respectful of this. People were involved in making decisions about their care and staff promoted people’s independence.

People felt safe. Staff protected people from avoidable harm, were knowledgeable about safeguarding and felt able to raise concerns. Systems were in place to recruit staff safely. People were supported by a small team of regular staff which provided continuity.

Staff received appropriate training and support to enable them to carry out their roles effectively and safely. Staff supported people to access healthcare and maintain nutrition and hydration where they provided this support. People’s needs were assessed before they began to use the service.

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.

People had care plans regarding their support needs. Staff knew people's needs, life histories, preferences and routines well. The provider had a system in place for responding to people's concerns and complaints. Any complaints or concerns raised were used as an opportunity to improve the service.

The provider's quality assurance systems were effective. There was a positive culture within the service where people, staff and relatives felt listened to and their feedback was used the improve the service.

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

Rating at last inspection

At the last inspection the service was rated Requires Improvement (report published 16 June 2018) and there were two breaches of regulation. The provider completed an action plan after the last inspection 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.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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