Background to this inspection
Updated
16 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, an assistant inspector who made calls to staff and an Expert by Experience who made calls to people who used the service and their relatives. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of 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.
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
We gave the service 24 hours’ notice of the inspection. This was because the service is small and people are often out and we wanted to be sure there would be people at home to speak with us.
Inspection activity started on 21 April 2023 and ended on 15 May 2023. We visited the location’s office on 24 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 professionals who work with the service and Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. The provider had completed a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does 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 7 relatives about their experience of the care provided. We spoke with 7 members of staff including the registered manager and the deputy manager. We reviewed a range of records. This included 7 people’s care records and multiple medication records. We reviewed a variety of records relating to the management of the service, including policies and procedures.
Updated
16 June 2023
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 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.
About the service
Total Homecare (Yorkshire) Limited is a domiciliary care service providing personal care to people living in their own houses and flats. At the time of our inspection there were 70 people using the service.
People’s experience of using this service and what we found
Right Support:
Although the provider had systems in place for call monitoring, there was no overview of this, and we identified a number of issues with call times and length of calls which had not been picked up by the provider. Care documentation lacked evidence of assessment of people’s needs. People's choices were generally promoted by staff who had a good understanding of how to promote people’s independence.
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.
Right Care:
Care documentation did not always give staff good information about what to do to promote people’s safety and protect them from avoidable harm. Records did not demonstrate medicines were managed safely. Care records needed additional information to help staff get to know and understand the person they were supporting. People did not always feel as though they had been supported in making decisions about their care or being involved in the care planning process. Staff knew what to do to make sure people’s privacy and dignity needs were met and some people gave us examples of the good care they, or their relative had received.
Right Culture:
The provider did not have a system in place to monitor safety and quality within the service. This meant they were unaware of issues happening in the service and therefore were unable to take learning from them. We identified issues in relation to staff recruitment, call monitoring and medicines management. People who used the service and staff felt supported by the registered manager.
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 good (published 2 October 2018). The rating for this inspection has now changed to requires improvement.
Why we inspected
This inspection was prompted by a review of the information we held about this service and the date of the last inspection.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement. 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 Homecare (Yorkshire) Limited on our website at www.cqc.org.uk.
Enforcement
We have identified breaches in relation to safe care and treatment and governance at this inspection.
Please see the action we have told the provider to take at the end of this report.
Special Measures
The overall rating for this service is ‘Requires improvement’. However, we are placing the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any Key Question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.
For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures
Follow up
We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect