TerraBlu Homecare

Updated 23 April 2022

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 two inspectors and an Experts by Experience spoke with people and relatives. 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 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

This inspection was unannounced. We visited the office location on 09 February 2022. Calls with people and relatives were made on 11 February 2022. Calls with staff were made on 16 and 18 February 2022.

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 who commission the service. We also sought feedback from Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. Healthwatch told us they had not visited the service or received any comments or concerns since the last inspection. A local authority commissioner told us they had not received any concerns about 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 seven people who used the service and six relatives about their experience of the care provided. We received written feedback from two people/relatives through our website. We spoke with 11 members of staff including care staff, senior care staff, the deputy manager, the operations manager, the registered manager and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

We reviewed a range of records. This included six people’s care records and multiple medicines 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 audits, risk assessments, complaints records, surveys and procedures were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records.

Updated 23 April 2022

About the service

TerraBlu Homecare is a domiciliary care service providing personal care to people living in their own homes. Not everyone who used the service received personal care. The Care Quality Commission (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. The service was providing personal care to approximately 40 people at the time of the inspection. Most people receiving care were older people and people with physical disabilities. The service was providing care for one person with a learning disability and autism.

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

Most people and relatives gave us positive feedback about their care and support. They told us, “They are very careful with me, I’ve never had an accident and I feel very safe with them”; “From the first phone call they have been brilliant”; “I know all my carers now and they are extremely good”; “We have a regular carer who is well trained and extremely good at her job and likes it. She takes great care and does all the things [person] likes even down to turning his trouser legs up for him because she knows he likes it that way”; “They have kept me very safe, they wear masks even now so they are very good” and “Our main carer seems to know exactly what she’s doing and has suggested things that will help too.”

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The management team were not aware of Right support, right care and right culture. Based on our review of safe and well-led, the service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right support

Staff supported people to complete personal care tasks and activities to meet their assessed needs set out in the care plan. However, care plans for people with a learning disability and or autism were not structured to support people to achieve their goals and aspirations.

Right Care

The provider did not have effective safeguarding systems in place to protect people from the risk of abuse. Safeguarding concerns related to older people had not always been reported to the local authority. Staff understood how to protect people from poor care and abuse. Staff had training on how to recognise and report abuse and they knew how to apply it.

Right culture

People and those important to them, including advocates, were involved in planning their care.

Individual risks were not always assessed and managed to keep people safe. Care plans were in place. However, care plans and risk assessments were inconsistent and did not always detail the relevant information staff would need to meet people's assessed care and health needs. People could not be sure their prescribed medicines were always managed in a safe way. When people had accidents and incidents, appropriate reports had not been completed.

People could not be assured new staff were adequately checked and had received training to ensure they were suitable to work with people to keep them safe. We found no evidence that people had been harmed however, systems were either not robust enough to demonstrate staff recruitment was effectively managed.

The systems in place to audit the quality of the service were not robust or sufficient to alert the provider of the concerns and issues within the service. Audits had not picked up areas which were identified during the inspection. Registered persons had failed to notify CQC of incidents and events such as abuse and serious injuries.

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 (report published 30 December 2017).

Why we inspected

We received concerns in relation to recruitment practice, staff training and the management of medicines. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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 based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for TerraBlu Homecare on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to medicines management, risk management, safeguarding people from abuse, recruitment practice, quality monitoring and notifying CQC of events and incidents.

Please see the action we have told the provider to take at the end of this 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.

Follow up

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