This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to older adults and younger disabled adults. Not everyone using Tigheaven Limited receives a regulated activity; The Care Quality Commission (CQC) only inspects the service being received by people provided with ‘personal care’ such as help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the time of the inspection eight people were using the service. This inspection took place on 17 December 2017 and was announced. At the last inspection on 30 October 2015, the service was rated Good. However, we found that at this inspection the service did not meet all the regulations we inspected and it has therefore been rated Requires Improvement.
The service has a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. 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.
There were systems in place for the safe management of medicines. There was a medicines policy that provided staff with guidance for the administration, ordering and storage of people’s medicines. However, one person told us they had not always received their medicines as prescribed.
The registered provider had a safeguarding process in place on how to report an allegation of abuse. However, we found people were at risk from financial abuse due to poor management and monitoring of people's money when staff supported them with their shopping.
People had their needs and choices assessed before receiving care. However we found that people’s choices were not always respected because staff often arrived late and changed the time of their visits without discussing it with people first.
Staff did not always care for people in a way that demonstrated dignity and respect. People’s dignity was not always respected by staff. This was because some staff spoke in a language people did not understand while delivering care. Staff were kind, compassionate and helpful to people.
Staff received training, supervision and an appraisal to support them effectively in their roles. Staff were supported by the registered manager to assist them with their professional and development needs.
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Staff identified risks to people’s health and well-being. Risks were recorded in a risk management plan that and contained guidance for staff to follow.
The registered manager had systems in place to record accidents and incidents that occurred and the provider learnt lessons from these. People had support from staff who understood their wishes at the end of their lives.
The registered manager had a rota that showed enough staff were available to care for people. Staff were safely recruited and pre-employment checks were carried out before they were employed at the service.
People were supported by staff to eat and drink enough and their preferences were met. Staff supported people with shopping and provided meals that helped people maintain their nutritional and health needs.
Staff followed safe infection control procedures to reduce the risk of infection. Personal protective equipment was available for staff to use.
The registered provider had developed relationships with health and social care professionals to deliver effective care for people. Staff supported people to attend health appointments when needed.
People gave their consent to care and support. Staff cared for people and had an understanding of the Mental Capacity act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.
Feedback about the service was sought from people by the provider. People were confident about being able to use the complaints system. People knew how to make a complaint about the care and support they received.
The registered manager demonstrated leadership in the service. Staff told us they enjoyed their job and explained that the registered manager was kind and understanding.
The registered provider completed reviews and monitored the service to improve the delivery of care. There were quality assurance systems in place to check the quality of care people received. The registered manager understood their responsibilities to the CQC in regards to their registration.
We have made two recommendations in relation to safe medicines management and quality monitoring and we found a breach of regulation in relation to safeguarding people from abuse. You can see what action we told the provider to take at the back of the full version of this report.