Town and Country Care Services Limited

Updated 12 April 2023

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 an inspector and an Expert by Experience. 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.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

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

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 someone would be in the office to support the inspection.

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. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make.

During the inspection

We visited the service office and met with the deputy manager, office manager and administration assistant. We reviewed a range of records including 2 people's care records, 3 recruitment files, training records, medication records and audits of the service. We spoke with 5 people who used the service and 5 relatives about their experience of the care and support provided. We received feedback from 5 members of staff and two external healthcare professionals.

Updated 12 April 2023

About the service

Town and Country Care Services Limited is a domiciliary care service providing personal care to people living in their own homes. The service provides support to older people, people with dementia, people with physical disabilities and younger adults.

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. At the time of our inspection there were 43 people using the service. 38 of these received personal care.

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

Systems in place for recording the administration of medicines were not robust. We identified gaps in the records. Action taken to address the issue had not been effective.

Risks associated with people’s health were documented and staff had clear guidance on how to mitigate known risks. They had received appropriate training to provide them with the skills and knowledge required to support people safely.

There were enough staff to support people in line with their identified package of care. Staff had been recruited safely. Before starting work independently, new staff completed shadow shifts to help ensure they understood people’s needs.

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.

There were systems in place to gather people’s views of the service. People and staff told us their opinions were sought out and taken into account.

The management team were described as “open and available.” People were highly complimentary of managers and the wider 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 2 November 2022). At this inspection we found the provider remained in breach of regulations.

At our last inspection we recommended that improvements were made to the way in which the administration of medicines was recorded. At this inspection we found actions to make improvements had not been effective.

Why we inspected

We carried out an announced comprehensive inspection of this service on 29 September 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve recruitment processes, staff training and oversight of the service.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

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 remained requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Town and Country Care Services on our website at www.cqc.org.uk.

Enforcement and recommendations

We have identified a breach of regulations in relation to the recording of the administration of medicines.

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

We have made a recommendation about monitoring and auditing systems.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. 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.