18 April 2023
During an inspection looking at part of 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.