Background to this inspection
Updated
25 December 2021
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 Care Act 2014.
Inspection team
The inspection was carried out by one inspector.
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 specialises in the care and support of people with acquired brain injuries. Each person using the service has a direct relationship with a case manager who coordinates peoples care, support and rehabilitation.
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
We gave the service 48 hours’ notice of the inspection. This was because it is a small service and we needed to be sure that the provider or registered manager would be in the office to support the inspection.
Inspection activity started on 11 November 2021 and ended on 26 November 2021. We visited the office location on 11 November 2021 and 19 November 2021.
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. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.
During the inspection
We spoke with five relatives about their experience of the care provided. We spoke with twelve members of staff including the provider, registered manager, office manager, case managers and care workers.
We reviewed a range of records. This included five people’s care records and multiple medication records. We looked at two staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies 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. We spoke with four professionals who regularly work with the service.
Updated
25 December 2021
About the service
Total Case Management is a domiciliary care agency providing personal care and treatment of disease, disorder and injury to 11 people at the time of the inspection.
Not everyone who used the service received personal care. 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.
People’s experience of using this service and what we found
People were supported to have maximum choice and control of their lives and staff supported the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
Relatives and staff told us that people had been involved with decision making however, records did not always reflect the principles of the Mental Capacity Act (MCA) 2005. We have made a recommendation about improving records relating to the MCA.
Care plans and risk assessments were thorough and gave staff detailed guidance on how to keep people safe from avoidable harm. Relatives told us that their loved ones were kept safe. Comments included, “I feel [person] is safe in their care, I feel comfortable going out and leaving [person] with staff.”
Staff were safely recruited, and people were fully involved with the selection of their staff teams. Staff received training and competency checks to ensure they administered medicines in line with best practice standards. Staff received training in infection control and used personal protective equipment (PPE) to help prevent the spread of infections.
Care plans showed detailed information around people's eating and drinking needs and included people's preferences. Innovative methods had been introduced to encourage people to be more independent with food and drink. Staff followed the advice of healthcare professionals and people achieved positive outcomes because the relationships between organisations were effective.
People were treated with kindness and respect. Relatives told us, “The care [staff] give is outstanding.” People's communication needs were recorded in their care plan. Where people had limited verbal communication, assistive technologies were used effectively to allow them to express their views and be involved in decision making.
Relatives felt that the service was helping to meet their loved ones needs, preferences and outcomes. The views of people using the service were at the core of quality monitoring and assurance arrangements and governance was well-embedded into the running of the service. People told us they had not had to raise a complaint but felt they would be listened to and felt confident any issues would be resolved.
The service had a systematic approach to working with other professionals to improve care outcomes and to ensure people met their goals. Visiting professionals spoke positively about the person centred care provided.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
This is the first inspection for this newly registered service.
Why we inspected
This was a planned inspection.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.