TerraBlu Homecare

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.

At the time of our inspection there was a registered manager at 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.

People were being protected against risks but the risk assessments we saw on people’s files failed to mitigate the potential hazards. The risk assessments we saw were not robust and merely described potential harm to people. We made a recommendation about this.

People’s needs and choices had been assessed when they started using the service, but changes to their needs had not consistently been identified or planned for. This meant that people were at risk of not receiving the care, treatment and support they needed. We made a recommendation about this.

Care plans did not always fully reflect people’s preferences. There was insufficient information recorded for staff to know how the person preferred to be supported, or their likes or dislikes. We made a recommendation about this. There was a system in place to review care plans, and reviews took place every 6 months. People and their relatives were involved in the reviews. The service took people’s communication needs into account when planning for and providing support. People’s complaints and concerns were responded to appropriately.

People were protected against potential abuse. The service had safeguarding and whistleblowing policies in place and staff we spoke to told us these were clear and easily accessible in the office. There were sufficient numbers of staff on duty to ensure the needs of people were being met. Recruitment systems were robust and made sure that the right staff were recruited to support people to stay safe. People were protected by the prevention and control of infection where possible. Staff were aware of the importance of using Personal Protective Equipment (PPE) when supporting people. Staff received infection control training. People received their medicines safely. The service had a medication policy which gave guidance to staff on how to support people with their medicines. Accidents, incidents and near misses were reported to management in line with the provider’s policy and procedure.

Staff were trained and competency checked by the registered manager. Staff at Terrablu worked with other organisations and professionals to deliver effective care. People had access to health and social care professionals. Records confirmed people had access to a GP, dentist and an optician and could attend appointments when required.

People’s rights had been protected and staff were acting in accordance with the Mental Capacity Act 2005. Staff demonstrated a good understanding of the MCA.

Staff were seen to be kind and compassionate towards people. Staff were encouraged to develop positive, caring relationships with the people they support. Staff told us they were able to spend time with people to get to know them, and wherever possible were matched with people in order to develop close working relationships. People’s dignity and independence was respected at all times.

People and staff spoke positively about the management of the service. Discussions with staff and people showed there was an open and inclusive culture at the service.

The service took steps to promote equality and inclusion within its workforce. The registered manager kept up-to-date with best practice and guidance in order to ensure she was able to lead the service effectively.

The registered manager understood the legal requirements of their role. They had ensured that all notifications required as per the Health and Social Care Act 2008 were being made to the Care Quality Commission.

People felt they were able to make their own decisions and choices regarding their day to day care and support. People confirmed that they had given their consent and been involved in discussions about their care, sometimes with a family member, when the service had first started.

People said they were satisfied with the care and support they received. One person said, 'As an agency I would give them top marks'. Another person said, 'I am quite satisfied at the moment'. People knew about their care plans or said they had discussed their care and support with staff.

People felt they received safe and coordinated care and support where more than one provider was involved.

People were complimentary about the staff and felt the service recruited the right calibre staff to meet their needs. One person said, 'They vet them'. Another person said, 'They are very fussy who they have, they want to make sure they get the right people'.

The majority of people said they had been asked for their views and feedback on the service provided. People told us they felt confident that any concerns would be addressed. There were systems in place to monitor the quality of the service.

People purchased the service privately and were protected by a contract that clearly stated all the terms and conditions.

There were appropriate processes in place that monitored the quality of the service provided.

People we spoke with were overall happy with the service provided. People felt that care staff treated them with dignity and respect and listened to what they had to say.

The majority of people felt that they were visited by regular members of care staff at times that suited them. One person however felt that there were some ongoing problems with times and continuity of care staff that the agency had not yet managed to fully resolve, although they did tell us that the agency was, 'Trying to sort this out for them'.

People were visited by care staff who were appropriately trained and supervised in order that their individual care needs could be met.

Each person had an individualised plan of care that gave care staff the information they needed.

Senior staff and care staff were aware of the importance of safeguarding people from the risk of abuse. The policy however did not link with local authority protocols.