Background to this inspection
Updated
21 January 2020
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
The inspection was carried out by one inspector.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.
Notice of inspection
We gave the service 24 hours’ notice of the inspection. This was because it is a small service and we needed to be sure that the provider would be in the office to support the inspection. Inspection activity started on 7 November 2019 and ended on 13 November 2019. We visited the office location on 7 November 2019.
What we did before the inspection
We reviewed the information we had received since the last inspection. We sought feedback from the local authority. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
We used all of this information to plan our inspection.
During the inspection
We spoke with four people who used the service and two relatives. We received a letter from a third relative. We also spoke with four care staff, the manager and the nominated individual, both of whom also carry out regular care shifts. We observed staff carrying out some of their duties in people’s homes.
We reviewed a range of records. These included six people’s care plans, daily records in detail for two people and six people's medication records. We also viewed four staff recruitment folders and other documents relating to the quality and safety of the service.
After the inspection
We continued to seek clarification from the provider to validate the evidence we found. We requested to see additional recruitment records including disclosure and barring service checks, business insurance records for care staff, rotas and policies and procedures.
Updated
21 January 2020
About the service
Total Care Norfolk is a domiciliary care agency which provides care and support to people in their own homes in the Downham Market area.
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 service was not well-led, and this had a negative impact on people’s care and support. The nominated individual, who is legally responsible for the service, had not fully assessed and reduced risks to people’s health and welfare. Systems designed to report significant information, such as accidents and incidents were not effective. The provider did not have oversight of the service and issues or poor care and neglectful practice had not been appropriately reported, investigated and addressed.
Recruitment procedures were not robust and did not fully protect people. Staff training was not delivered as soon as staff were first employed. This meant some staff did not have all the skills and knowledge they needed to carry out their roles safely. Staffing levels were not always well monitored and rotas did not easily enable staff to ensure all calls were timely.
Medicines were not always well managed. Records relating to medicines needed to be clearer to ensure staff had the guidance they needed.
Although some people who used the service were very happy with their care and we observed good care being provided, we are not confident in the provider. The provider failed to ensure all the people who used the service had safe care and treatment.
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 (report published 10 April 2018.)
Why we inspected
We received concerns in relation to untrained and unskilled staff, poor recruitment practices and poor management of falls. As a result, we undertook a focused inspection to review the Key Questions of Safe and Well-led only.
We reviewed the information we held about the service. No areas of concern were identified in the other Key Questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those Key Questions were used in calculating the overall rating at this inspection.
The overall rating for the service has changed from good to inadequate. This is based on the findings at this inspection.
We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.
Since our inspection the provider has told us that they have taken action to implement new reporting systems. These have been designed to ensure key information about risks to people’s health and welfare is monitored more effectively.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Total Care Norfolk on our website at www.cqc.org.uk.
Enforcement
We have identified breaches in relation to the management of risk, management of medicines, leadership, staffing and recruitment at this inspection.
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 and will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
The overall rating for this service is ‘Inadequate’ and the service is in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe, and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.
For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it, and it is no longer rated as inadequate for any of the five key questions, it will no longer be in special measures.