Totally Living Care provides a domiciliary care service supporting people with individual needs in their own homes. At the time of our inspection 59 people were being supported by this service. This inspection took place on 10 and 11 January 2017. This was an announced inspection which meant the provider was given short notice of the inspection. This was because the location provides a domiciliary care service. We wanted to make sure the manager would be available to support our inspection, or someone who could act on their behalf.There was a registered manager in post at the service and a co-director at the time of our inspection who were jointly managing 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.
Risks to people’s personal safety had not always been assessed or plans put in place to manage these risks effectively and safely. The service had identified potential concerns in people’s initial assessments upon joining the service; however risk assessments had not been developed from these concerns. This included risks around falls, medicines and specific dietary needs.
People’s medicines were managed and administered safely but had not always been recorded appropriately. For example, one person who was prescribed a medicine patch for pain relief, did not have a rotational chart in place to show where the patch had previously been placed and should be put at the next administration. Another person had been prescribed medicine for use when required (PRN). The medicine administration record (MAR) had been handwritten and not signed by the member of staff who had added this addition to the person’s medicine record.
Staff had a good understanding of safeguarding and whistleblowing procedures. They knew how to report concerns and had confidence in both managers that these would be fully investigated to ensure people were protected.
People had on occasion experienced a late or missed call but spoke positively about the response to this from the service. We fed these concerns back to the management. One relative commented “There have occasionally been instances, although not recently as far as I am aware, of them not sending in a carer; I have then contacted them and the registered manager has then gone in, in place of the carer. But generally they are reliable”.
Safe recruitment procedures were followed. Staff said they undertook an induction programme which included shadowing one of the two managers, and meeting the people they would support. The provider had undertaken recruitment checks on prospective new staff to ensure they were suitable to care for and support vulnerable adults. Staff were appropriately trained in the core subjects relevant to their role.
We saw that consent forms agreeing to the service providing people’s care had been put into people’s care plans. However these forms were not always dated, completed or signed by the person to show they had agreed with the content. Reasons why some people were unable to sign their consent, were not stated.
Concerns were raised to us by people and their relatives about the skills and experience of staff. Comments included “Some staff need a little bit more training” and “There is a lack of experience of some carers, they have put clothes on back to front before. They don’t give me the confidence that they could deal with the unexpected, however in lots of ways they have been very good”.
People and relatives were very complimentary about the caring nature of staff. Comments included “I have got to know them and they are always helpful and friendly”, “If I want something staff are very good, they do it if I ask”, “They are caring and that’s the big importance” and “All the staff I have met have been friendly, helpful and informative”. People's privacy and dignity was respected. Staff explained the importance of supporting people to make choices about their daily lives.
People’s needs were reviewed regularly and as required. Where necessary, health and social care professionals were involved. We saw where people had wanted to discuss an aspect of their care, a review form was in place to record what had been discussed and any outcomes from this. One person told us “They are excellent, someone came out and did a review and everything was fine”. Another person said “I have a care plan in my house, the carers ask and I update them if there are any changes”.
Although the service had quality monitoring systems in place, they had not picked up all of the shortfalls identified in this inspection or addressed them before this inspection had taken place.
People praised the management for the service they provided commenting “I find the office very pleasant, the management are always available and respond. It provides what it says it’s going to provide”, “I can speak to the managers easily, they are very helpful, nothing is too much trouble and they are always very respectful”. Staff told us they felt well supported by the management and were able to raise any concerns or ideas they had to improve the service.
We found one breach of the regulations. You can see what action we told the provider to take at the back of the full version of the report.