About the serviceDementia Care TLC is a domiciliary care agency registered to provide personal care to people in their own homes. The service provides care and support to people which include personal care, food preparation and medication support. At the time of this inspection, the provider informed us that they were providing care and support to 50 people who used the service.
Not everyone using Dementia Care TLC receives a regulated activity. CQC only inspects the service received by people provided with 'personal care'; 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 and relatives were happy with the care workers who supported them. Each person benefited from regular staff who knew them well. Comments included, “I couldn’t wish for better staff. They are respectful and helpful” and “The carers have been wonderful and understand her dementia. They know her likes and dislikes and really work well with us.”
People felt safe and comfortable when staff were in their home. People's records identified risks but there were not always clear plans in place to tell staff how these risks should be managed or reduced. Despite this, staff knew the risks and told us how they would respond. The provider had systems and processes in place for the safe administration and use of medicines. However, these processes were not always followed. The provider’s records for medicines administration did not give assurance about the safe administration of medicines. Staff recruitment practices were safe. Staff understood their responsibilities in relation to infection control.
People and relatives told us people were asked for their consent and permission before receiving care. People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Where some people lacked capacity to make decisions, the care plan did not contain evidence to show decisions had been made in the person’s best interests.
People received a personalised service to meet their specific needs, preferences and wishes. People were involved in making decisions about their care and supported to maintain their independence. However, care plans did not always contain enough detail for staff to know how to deliver care effectively and consistently. Despite the lack of information in care plans, staff knew people well and people spoke positively about the service they received which met their needs and preferences.
People told us the service was well managed. Comments included, “I think it is extremely well organised and (name of provider) is a good leader” and “On the whole I think it seems a well-managed company.” There were systems in place to assess and monitor the quality of the service provided. However, monitoring systems had not identified the issues found at this inspection. When we identified issues during the inspection, the provider immediately started work on making improvements.
Rating at last inspection
The last rating for this service was Good (published 6 June 2018).
Why we inspected
This inspection was initially carried out as part of a pilot exploring virtual approaches to inspection. However, during the inspection we identified concerns with risk assessments, care planning, medicines management and governance. This meant that under the terms of the pilot we needed to convert the inspection to one that included a site visit.
This inspection considered the key questions of safe and well-led and provide a rating for those key questions. Only parts of the effective, caring and responsive key questions were considered, and therefore the ratings for these key questions are those awarded at the last inspection.
The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified breaches in relation to records such as risk assessments, the safe management of medicines, consent, and the governance of the service at this inspection.
You can see what action we have told the provider to take at the end of this report.
Follow up
We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk