Total Health Support and Training Services Limited

Updated 7 June 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 homes.

This service also provides care and support to people living in 5 ‘supported living’ settings, so that they can live as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

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 24 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 April 2023 with calls to people using the service and their relatives. Inspection activity ended on 2 May 2023. We visited the location’s office on 18 and 19 April 2023 and visited people in their homes on 2 May 2023.

What we did before the inspection

We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We liaised with safeguarding and care quality representatives from the relevant local authorities. We reviewed notifications and information we held about the service. We used all this information to plan our inspection.

During the inspection

We spoke with 11 people who used the service and 7 relatives about their experience of care and support provided. We spoke with the registered manager, human resources manager and administrator. We spoke with 4 members of care staff. We sought written feedback from 36 members of care staff. We received feedback from 10 staff members. We sought written feedback from 4 professionals from health and social care. We received feedback from 1 professional.

We reviewed a range of records. This included 8 people's care and support plans, 3 people's medicines administration records (MARs), staff competency checks, 5 staff recruitment files, supervision records for 5 staff, staff spot checks, the provider’s business continuity plan, the staff training matrix and the provider's policies for safeguarding and duty of candour. A variety of records relating to the management of the service were also reviewed.

Updated 7 June 2023

About the service

Total Health Support and Training Services Limited is a domiciliary care agency. It provides personal care to people living in their own homes in the community. It provides a service to older and younger people, some of whom may be living with dementia. This service also provides care and support to younger adults who have learning disabilities or autistic spectrum disorder living in 'supported living' settings. This is so that they can live in their own homes as independently as possible. In supported living, people's care and housing are provided under separate contractual agreements. The Care Quality Commission (CQC) does not regulate premises used for supported living; this inspection only looked at people's personal care and support. At the time of our inspection there were 73 people receiving a service. Of those 73 people, 13 were living in supported living settings in five different houses.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support:

Systems in place to protect people from the risk of harm or abuse were not always effective. Medicines were not managed safely.

Staff training was not up to date. Records indicated a number of staff had not completed training. People’s care plans did not always contain sufficiently detailed information to support staff to protect people from identified risks.

There were sufficient numbers of staff to provide consistent care to people. Staff reflected on practice when incidents occurred to prevent recurrences. People were protected from the risk of acquiring an infection.

People received individualised support which promoted their independence and upheld their human rights.

Staff worked within the principles of the Mental Capacity Act and demonstrated the appropriate legal requirements had been met where people had been deprived of their liberty.

People were always 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.

Recruitment processes and were in place to support consistent teams of staff to deliver person-centred care and support. There was evidence of effective partnership working with external professionals to promote people’s safety.

Right Care:

Most people received care which met their individual needs and preferences. People, their legally appointed representatives and relevant professionals were involved in developing their care plans which were regularly reviewed.

People’s care and support needs were assessed using a structured process. People were supported to maintain a healthy diet. Staff worked with professionals from health and social care to help meet people’s needs.

People experienced continuity of care from a core team of staff. Staff demonstrated compassion, sensitivity and respect in their interactions with people who they knew well.

Right Culture:

Governance and leadership at the service were not adequate. Systems and processes were not used effectively to monitor quality and improve safety in the service. Audits of people’s medicines records were not always effective in identifying and analysing shortfalls to improve safety. Audits were not used effectively to monitor themes and trends to drive service improvements.

The registered manager sought feedback from people and staff about how the service was run. Staff worked with professionals from different disciplines to promote people’s health and wellbeing needs.

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 good (report published 23 April 2018)

Why we inspected

The inspection was prompted in part by notification of an incident following which a person using the service sustained a serious injury. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk of skin damage, moving and handling and mental capacity. This inspection examined those risks.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this report.

The overall rating for the service has changed from good to 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 Total Health Care and Support Services Limited on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, staff training, and good governance.

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

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.