This inspection took place on 07 December 2018 and was announced as this is a domiciliary care company and we needed to be sure there was someone in to see us.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community and it provides a service to adults. This service also provides care and support to people living in a supported living setting so that they can live in their own home as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

T.L. Care (NW) Limited provides a domiciliary service on the Wirral and at the time of our visit, the service was providing support to 30 people. There were 26 staff employed including the registered manager, a deputy manager, a senior carer. During our inspection visit, the provider was also in attendance.

Not everyone using T.L. Care (NW) Limited receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

The service requires 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. The service had a registered manager in post.

We had previously carried out an inspection on 16 August 2017 where we had identified breaches of Regulation 9 and 17. Some staff had started work prior to their references being received and the provider had not ensured records were systematically audited. This meant they had not ensured there was an effective system in place to monitor the service provided identify shortfalls in the records and drive improvement.

At this inspection we found that the service was ‘good’ and was no longer in breach of regulations. This was because improvements had been made regarding recruitment and quality assurance processes.

Audits had been introduced and had been useful in ensuring the quality of the service. Quality monitoring systems were subject to ongoing development and review to enable improved oversight and scrutiny of the service.

Robust recruitment procedures had also been established to ensure the suitability of prospective staff was checked prior to employment. For instance, previous employment references that were verified by the service had been sought and a criminal conviction check undertaken.

A programme of staff training and development had been developed which was subject to ongoing review. Staff had received access to a range of induction, service specific training and qualification level training in addition to formal supervision and informal spot checks. This helped to equip staff with the necessary knowledge and skills to ensure people received appropriate care.

There was an infection control policy in place to minimise the spread of infection, all staff had attended infection control training and were provided with appropriate personal protective equipment such as gloves and aprons.

We found that people’s needs had been assessed and planned for and that a range of risk assessments had been completed to ensure staff were aware of how to keep both them and people using the service, safe. The provider had developed a policy and obtained guidance for staff relating to the Mental Capacity Act 2005. The registered manager understood the diverse needs of people they cared for and the action that should be taken in the event a person lacked capacity. People told us that they were empowered to exercise choice and control over their lives a

T L Care (NW) Limited is registered to provide personal care to people living in their own homes. At the time of the inspection there were 32 people using the service. The majority of the people receiving a service were older people, some were living with dementia and some needed support from staff with their mobility. Younger people who used the service included people with learning disabilities and complex health care needs. The provider employed 27 staff to deliver care.

We carried out an unannounced comprehensive inspection of this service on 6 April 2016 at which breaches of legal requirements were found. We identified concerns in relation to the recruitment of staff and lack of quality assurance systems. Following the inspection the provider developed an action stating the steps they would take to ensure they were meeting the requirements of the Health and Social Care Act. At the comprehensive inspection on the 16 August 2017 we found that although some improvements had been made the provider was still in breach of legal requirements.

The service had 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.

The provider had not ensured records were systematically audited. Therefore the provider had missed the opportunity to identify missing entries on medication records, the lack of dates on care plans and risk assessments and the fact that accidents and incidents were not always being recorded appropriately. This is an area of practice that requires improvement.

Improvements had been made in relation to the recruitment of staff. The employment history of staff now contained an explanation for gaps in employment, original documents had been seen and staff files now contained a form of photo identity such as a copy of a passport or driving licence. However some staff had started work prior to their references being received. This is an area of practice that requires improvement.

There were sufficient numbers of qualified and experienced staff employed to meet people’s needs. Staff felt supported within their roles, describing an ‘open door’ management approach, where the management team were available to discuss problems or concerns.

People's needs had been assessed and care plans were in place detailing how people wished to be supported. People and or their representatives were involved in making decisions about their care. One person told us “I’ve got a care plan and they do come and check with me from time to time to see if I need anything changed”.

Staff knew the people well and were aware of their personal preferences, likes and dislikes. People and their relatives were happy with the care provided, their comments included; “The girls are so nice, they help me in and out of the shower and look after me” and “Oh it’s marvellous; I am very pleased with it. I cannot fault them”.

People received their medicines as prescribed and were supported with their healthcare needs. Staff liaised with people’s GP’s and other health and social care professionals as required. Staff worked in accordance with the principles of the MCA and sought people’s consent before delivering care.

People’s privacy and dignity was respected. Staff had a firm understanding of respecting people within their own home and providing them with choice and control. People said the service met their needs and encouraged them to be as independent as possible.

There were systems in place to gain people’s views of the service and these had been acted on. People knew how to make a complaint and had confidence in the management of the service.

People confirmed they felt safe with the staff. Systems were in place to protect people from abuse and harm and

We visited T L Care (NW) Limited on the 20 and 21 July 2016. T L Care (NW) Limited provides care and support to people in their own homes. At the time of our visit, the service was providing 33 people with domiciliary care services and 28 people with support. There were 28 care and support staff employed with ongoing recruitment.

The service had 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.

At this inspection we found a breach relating to the governance of the service. Systems were not in place to effectively monitor the service. You can see what action we told the provider to take at the back of the full version of the report.

We also found concerns relating to the robustness of recruitment procedures and the management of the care records.

There was a safeguarding policy in place and staff were aware of the safeguarding procedure in relation to safeguarding adults and all were aware of the need to inform the manager or office manager immediately.

Staff were recruited correctly using safe checks such as criminal records (DBS). There was an induction programme in place which included training staff to ensure they were competent in the role they were doing in the community. Staff received on-going and regular training to enable them to work safely and effectively.

Staff knew what to do if any difficulties arose whilst supporting somebody, or if an accident happened. Incidents and accidents were recorded and learned from.

The opinions of people who spoke with us were that the service was good. People told us they were happy with the staff and felt that the staff understood their care needs. People confirmed that staff mostly stayed for the length of time allocated, however there were issues with staff arriving on time and with no consistency of staff providing their care. People confirmed that calls were rarely missed and that an on-call system was always available. All of the people we spoke with had no complaints about the service.

The staff employed by T L Care (NW) Limited knew the people they were supporting and the care they needed. People who used the domiciliary service and staff told us that T L Care (NW) Limited was well led and staff told us that they felt well supported in their roles. We saw that the registered manager, office manager and senior staff had a visible presence and it was obvious that they knew the people who they supported really well.

A ‘service user guide’ gave information about the agency, including the range of services available. We saw evidence that the service was flexible to meet people’s needs and preferences. One person told us: “They are very, very good. There is good communication, I can ring them anytime to discuss anything.” Another person said: “I haven’t had any reason to complain. I can ring the office any time and generally speaking I’m very satisfied.”

We saw documents to show that before people received a service from the agency, an assessment of their needs was carried out by a senior member of the agency’s staff. A copy of the assessment, and the plans drawn up for their care, was kept in the person’s house and in the office. The plans included detailed work instructions for the care staff to follow.

People who lived in their own homes had an emergency contact number that they could call at any time of day or night.

The registered manager had a management qualification and considerable previous experience. 75% of the care staff had a national vocational qualification at level 2, and 50% at level 3. New staff attended ‘Health and Social Care Induction Training’ which was provided over four days by a training company and covered all relevant subjects. One day refresher training for all staff took place annually.

People who used the service knew how to make a complaint and records we looked at showed that complaints were investigated and responded to appropriately.

We spoke with one person who used the service and two carers of people who used the service. All three people told us that they were consulted regarding the care arrangements and activities. One relative told us that there was a "loose" plan for the activities for their relative to be involved with; however this could change on the day depending on their wishes. They also told us "I would not have anything negative to say about TL Care".

We inspected the staff training records and spoke with three members of care staff and the office staff. We found that staff had access to e-learning training and training from the Local Authority. All staff had completed safeguarding training and some staff had attended training in respect of Deprivation of Liberty. We found that the agency operated a consistent approach to recruiting staff.

One relative told us that occasionally staff could be a bit late but they were marvellous really. The agency had a complaints procedure and we spoke to relatives who were aware of how and to whom they should complain if the need arose.