Triangular Care Services Limited

Updated 10 June 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

The inspection was carried out by 1 inspector and an Expert 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 service 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.

Notice of inspection

This inspection was announced.

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 17 April 2023 and ended on 20 April 2023. We visited the location's office on 17 and 18 April 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 from professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 2 people who used the service and 4 family members or their representative about their experience of the care provided. We spoke with the registered manager when we visited the office. We spoke with 4 care assistants by telephone.

We reviewed a range of records. This included 3 people's care records. We looked at 3 staff files in relation to recruitment. A variety of records relating to the management of the service were also reviewed. This included quality monitoring tools, minutes of meetings, policies and procedures, and the staff training matrix.

Updated 10 June 2023

About the service

Triangular Care Services Limited is a domiciliary care service providing the regulated activity personal care, which is help with tasks related to personal hygiene and eating, in people's own homes. At the time of our inspection 10 people were receiving personal care.

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

Systems to support the governance and performance management of the service continued to be ineffective. There was little evidence of learning, reflective practice and service improvement. The provider and registered manager had failed to identify improvements were needed. Audits had failed to identify poor record keeping, which included incomplete documentation. Records were not stored in an accessible and organised manner to enable effective oversight of the service.

There continued to be limited analysis of feedback provided by those using the service and their relatives, which included an analysis of questionnaires, concerns and complaints. Continued poor governance and oversight had impacted on the provider’s ability to identify shortfalls and in their ability to develop plans to improve the management of the service.

People’s needs were assessed. However, improvements were needed to ensure the assessment process was sufficiently recorded and assessment records completed in full. People’s capacity to make informed decisions was documented. However, records had not been completed in accordance with the Mental Capacity Act (MCA), which demonstrated a lack of staff’s understanding and knowledge of the MCA. We found no evidence this had impacted on people’s choices.

People’s care and support needs were detailed within multiple paper based documents, which made it difficult for staff to easily access information. This left people vulnerable to inconsistent care being delivered. People were aware of how to raise concerns. However, multiple paper based records and how they were stored made it difficult to determine if all concerns had been responded to.

People were supported by staff who had undergone a recruitment process. There were sufficient staff to meet people’s needs. People and their family members spoke positively of the reliability and good time keeping of the staff. Systems to record the management of people’s medicine had recently been transferred to an electronic monitoring system, which had improved the systems and practices of medicines management. Staff worked consistently within the provider’s policy and procedure for infection prevention and control.

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 and family members contributed to the assessment process. People's health care needs were documented, and staff liaised with family members regarding people's health and wellbeing where required. People were supported with their dietary needs. Staff had the required experience, knowledge and training to meet people's needs.

People and their relatives spoke of the kind and caring approach of staff. They told us their privacy and dignity was respected and their views were respected by staff. New staff were introduced to people and their family members before they started providing support and care.

People and family members were involved in the development and reviewing of their care needs. People were supported to take part in activities and engage in social events where support had been identified as part of their assessed package of care. People and their relatives were aware of how to raise concerns.

People and their relatives spoke positively of the management of the service, which included good communication between themselves, the registered manager and staff. Staff and an external professional were positive about the day to day management of the service, and of the commitment of the registered manager in the support of people and the staff team.

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 (published 8 August 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve safe medicines management and quality monitoring of the service provided. At this inspection we found the provider remained in breach of regulation 17.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

Enforcement

We have identified a continued breach in relation to the leadership and governance of the service.

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 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.