TLC Community Services Limited

TLC Community Services Limited is a domiciliary care service providing personal care to people in their own home. At the time of our inspection there were 32 people using the service.

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

The content and accuracy of care records, risk assessments and medicines records were not always sufficient. We have made a recommendation about improving risk assessments. Management audits had not always identified errors and omissions in records and as a result people were placed at risk of harm.

People were happy with the way care was delivered and told us they felt safe. The provider had effective safeguarding systems in place. Staff received regular safeguarding training and felt confident to report concerns. There were enough staff to care for people safely. People said staff spent the right amount of time with them during visits and no missed calls were reported. The provider completed pre-employment checks on new staff prior to employment and new staff completed a comprehensive induction. The provider had a robust infection prevention and control system in place and staff had training in this area.

People were 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.

Staff delivered care in a person-centred way. People were supported by the same regular team of staff wherever possible. People told us communication with the provider was good. Staff were happy in their work and understood the importance of their role. The provider sought the opinions of people using the service and staff. People felt confident in the management of the service and staff felt well supported.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 4 September 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for TLC Community Services Limited on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified a breach in relation to the management oversight at the service, including quality checks and accurate record keeping at this inspection.

We have made a recommendation about improving risk assessment details.

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.

TLC Community Services provides personal care to people in their own homes. At the time of our inspection 32 people were supported by the service.

At our last inspection in February 2016 we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People’s medicines were administered in a safe manner.

Staff were given a health and safety handbook which included information risks and what action they were to take. People’s risks were individually assessed and documented. Staff were given guidance on how to manage these risks and prevent any accidents.

Pre-employment checks were carried out by the registered manager to ensure staff were suitable to work with people in their own homes. Staff were supported through a programme of induction, training and supervision.

Staff reduced the risks of cross infection between people who used the service by the wearing of protective items such as gloves and aprons.

Before a person began using the service the registered manager carried out a detailed assessment of their needs and preferences and sought their consent to provide the service. When necessary the provider worked with other professionals to agree decisions made in the best interests of people receiving the service.

Professionals we spoke with were complimentary about the service working with them to meet people’s needs. They told us about the good partnership working they had with the service.

Relatives and people who used the service told us staff showed them kindness and respected their homes, as well as preserving their dignity when meeting their personal care needs. They showed us how they were involved in planning the service. They had developed an order to tasks at the instigation of the registered manager so people could have their care delivered in their preferred routine.

The provider had a complaints process. People told us they had not needed to make a complaint.

Care plans had been drawn up by the provider to reflect people’s individual needs. These were reviewed on an annual basis or if the person’s needs changed.

At the time of our inspection no one was on end of life care. The service had received thank-you cards from relatives of people who had been supported towards the end of their life.

The service was well-led by a registered manager who staff described as caring. Systems were in place to assess and monitor the quality of the service. Members of the management team worked directly with staff to ensure people were receiving appropriate care.

The registered manager had contracts in place with organisations to support them with, for example, human resources advice.

Further information is in the detailed findings below.

TLC Community Services Limited is registered with the Care Quality Commission to provide personal care to people who wish to remain independent in their own homes. The agency covers the County Durham area and provides a range of home care and support services.

50 people were using this service when we visited and there were 30 staff. Two teams of staff were based around the Chester le Street and Stanley areas of County Durham.

There was a registered manager in place who was also the provider and had been in their present post at the service for over thirteen years. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

People’s care plans were person centred, detailed and written in a way that accurately described their individual care, treatment and support needs. This meant that everyone was clear about how people were to be supported and their personal objectives met. These were regularly evaluated, reviewed and updated. People using the service and those who were important to them were actively involved in deciding how they wanted their care, treatment and support to be delivered.

The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who used the service. We saw risk assessments were carried out and these were updated if new situations or needs arose.

Feedback from people using the service indicated that staff and the registered manager were friendly, open, caring and diligent; people using the service trusted them.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA.

We found the registered manager had a good understanding about how the service was required to uphold the principles of the MCA, people’s capacity and ensure decisions about their best interests were robust and their legal rights protected.

The registered manager and staff that we spoke with showed genuine concern for peoples’ wellbeing and it was evident that everyone knew people who used the service very well. This included their personal preferences, likes and dislikes and staff had used this knowledge to form very strong caring and therapeutic relationships.

People were supported by staff who had received appropriate training. The provider had a training programme in place run by a specialist training company which supported staff to gain the skills and knowledge they needed to meet the needs of people who used the service.

People were protected from the risk of abuse. Staff and managers understood the procedures they needed to follow to ensure that people were safe. They had undertaken training and were able to describe the different ways that people might experience abuse. When asked they were able to describe what actions they would take if they witnessed or suspected abuse was taking place and what they expected of service colleagues and statutory agencies.

We saw the provider had policies and procedures for dealing with medicines and these were followed by all staff. Medicines were securely stored and there were checks and safeguards in place to make sure people received the correct treatment.

The service had a complaints policy which provided people who used the service and their representatives with clear information about how to raise any concerns and how they would be managed. Staff we spoke with understood how important it was to act upon people’s concerns and complaints and would report any issues that were raised, to the registered manager. People using the service and those who were important to them knew about the complaints process and had confidence that these would be handled appropriately by the provider.

We found that the registered manager had systems in place for monitoring the quality of the service. This included audits of key aspects of the service, such as medication and learning and development, which were used to critically review the service. We also saw the views of the people using the service and those who were important to them, were sought. The registered manager produced action plans, which showed when developments were planned or had taken place.

We found care and treatment was planned and delivered in a way which ensured people's safety and welfare. People we spoke with were positive about the care and support they received. Comments included 'They (the staff) are lovely' and 'The main carer is wonderful.' People told us their care and welfare needs were met and that they were treated with dignity and respect.

Appropriate procedures were not in place to make sure staff could safely support each person with their medicines.

We found staff were appropriately trained and supported and that there was an effective complaints procedure.