17 April 2023
During a routine inspection
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.