Total Care

Updated 30 January 2019

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 10 and 11 December 2018 and was announced. We gave the service 48 hours' notice of the inspection visit. The inspection was carried out by two inspectors 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.

Before the inspection, the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We looked at the information in the PIR and also looked at other information we held about the service, which included notifications they had sent us. A notification is information about important events, which the provider is required to send us by law.

During this inspection we visited the provider's office. We spoke with the provider, financial and legal manager, training manager, office manager, administration staff, six care staff and two health professionals. We visited and spoke with seven people and three relatives in their own homes. We spoke with 30 people and relatives on the telephone. We looked at a range of records during the inspection. These included seven people’s care plans, medicine administration records, staff rotas, five staff recruitment files, staff training records and quality monitoring records.

Updated 30 January 2019

The inspection was announced and took place on 10 and 11 December 2018. This was because this service provides care to people in their own homes and we needed to ensure senior staff were available to speak with us.

Total Care is a domiciliary care agency providing personal care to people living in their own homes. At the time of the inspection, the service was providing support for 88 people.

The service was run by a sole provider, Mrs Deborah Clarke. A sole provider is not required to employ a registered manager. Instead they can opt to manage the service themselves. Registered persons have legal responsibility for meeting the requirements in the Health and social care Act 2008 and associated regulations about how the service is run.

Total Care is registered for the regulated activity of personal care. It is a domiciliary agency which provides care and support to people living in their own home. This included people receiving packages of care at the end of their life.

Total Care was previously inspected on 16 and 17 March 2016. The overall rating for the service was good.

At our last inspection we identified concerns in relation to the agency's recruitment procedures. Recruitment procedures did not fully protect people. Staff files seen did not always give information about staff conduct in their previous employment which could possibly place people at risk of receiving care from staff who were not suitable to work with vulnerable people.

At this inspection we found improvements had been made. All necessary checks were being carried out examining at least two employment references and employment history. Staff had been recruited safely

Care records had been reviewed and updated where necessary. Staff had travelling time built into their rotas. Staff had received one-to-one supervision, which provided them with opportunities to discuss their professional development and training needs. Spot checks had been carried out to check that staff were providing care safely and in the way people preferred.

People's records provided information about the medicine they were prescribed and who was responsible for its administration, such as family members or staff. Staff signed records, where they had the responsibility for administering medicines or applying prescribed creams.

Staff attended safeguarding training and understood how to recognise and report abuse. Staff understood risks involved in people's care and managed these well. The provider had developed a contingency plan, which prioritised the delivery of care to people most at risk in the event of an emergency. Staff helped people keep their homes clean and maintained appropriate standards of infection control.

Staff had access to the training they needed to carry out their roles. People's care was provided in accordance with the Mental Capacity Act 2005 (MCA. Staff had received training on the MCA and understood its principles.

People's nutritional needs were assessed during their initial assessment and any dietary needs recorded in their care plans. Staff understood people's healthcare needs and supported them to maintain good health.

Staff were kind and caring. People had developed positive relationships with staff members and enjoyed their company. Relatives said staff treated their family members with respect and maintained their dignity when providing care. Staff supported people to maintain their independence wherever possible. Care plans provided guidance for staff about people's needs and the way they preferred their care to be provided.

The agency was providing end-of-life care at the time of our inspection. The provider had an end of life care policy, which gave guidance to staff if they had to provide care to a person now. Care records also contained peoples end of life wishes.

Staff worked in partnership with healthcare professionals, such as community nurses, to provide people's care. People had opportunities to contribute their views about the service they received. People knew how to complain if they were dissatisfied. People who had complained told us action had been taken as a result of the concerns they raised.

A range of audits were undertaken to monitor the quality of the care and the accuracy of records used to record people's care and support. This information was not always shared with people to ensure they were aware of what action had been taken to improve the service.

Notifications were being made to the CQC as required. Accidents and incidents were recorded, investigated and lessons learnt were shared with staff and the relevant people involved.