About the service:

Teasdale Healthcare Ltd is a domiciliary care service that was providing personal care to 133 people living in their own homes at the time of the inspection. People had a range of support needs such as people living with dementia, older and younger adults, people with a learning disability and a physical and/or sensory impairment.

People’s experience of using this service:

Systems needing improving to ensure all incidents were identified and that staff recruitment information was readily available. The registered manager and provider needed to ensure notifications to the CQC were submitted as required.

People felt safe and risks were mitigated. There were enough staff to ensure people received timely support. People received their medicines. Lessons were learned when things went wrong. People were protected from cross infection as appropriate measures were in place.

People had their needs assessed and had access to other healthcare professionals when needed. People were supported to have food and drinks appropriate for their needs. The principles of the Mental Capacity Act (2005) were being followed.

People were supported by kind and caring staff. People had a choice and were able to make decisions about their care whilst being supported to remain independent.

People received personalised care that met their needs. People could complain when they needed to and complaints were investigated and dealt with. When people were nearing the end of the lives they were supported appropriately however care plans would benefit from more detail about people’s wishes.

People, relatives and staff found the registered manager and provider approachable and supportive. The provider worked in partnership with organisations and sought feedback from people who used the service to make improvements.

Rating at last inspection:

At the last inspection carried out in March 2017 we found the service was rated as requires improvement overall and there was one breach of a regulation of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Why we inspected:

We planned the inspection based on the previous rating.

Recommendations:

• We recommend staff improve their knowledge of the Mental Capacity Act (2005).

• We recommend people’s care plans reflect their end of life wishes, when necessary.

Follow up:

We will continue to monitor the service and check improvements have been made at our next inspection.

This inspection took place on 10 and 30 March 2017 and was announced on both days.

Teasdale Healthcare Limited is registered to provide personal care to people over 18 living in their own homes, and provided personal care to 95 people at the time of our inspection.

The service had a registered manager in post. ‘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.’

People’s complaints were not responded to in accordance with the company’s own complaints procedures. People were not always confident to complain.

People did not always receive their care visits at the time they needed them. People sometimes received care visits which were late and not as they wished.

People did not always receive kind and caring support. People were not always involved in the planning of their own care and support. Some relatives of people were consulted about care decisions. However, the records did not always show what legal authority they had to represent people's views.

We found quality assurance systems were in place but these were not always effective in identifying the areas of improvement required in the service. Where some issues and concerns were identified these were not investigated and resolved in a timely way in order to ensure people were receiving the care they required.

People who used the service told us they felt safe. Care staff knew how to recognise and report abuse. The provider had a safe system for recruitment and made sure that required checks were carried out before new staff started work.

People were supported to eat and drink enough to help keep them healthy. Staff understood people's food preferences and acted in accordance with their wishes. People had access to health and social care professionals when required.

We found that although there were systems and processes in place to monitor the quality and safety of the service they had not been working effectively. This was because people's concerns about late and missed calls were not identified and dealt with in a timely manner.

During the inspection we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the back of this report.

This inspection took place on 11 March 2015 and was announced. This was the first inspection of the service. The service provides personal care to people in their own homes.

A registered manager was in post. 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.

People were supported to be as independent as possible. Assistance was offered to prompt people to take their prescribed medicines safely.

People’s risks were assessed. Staff carried out support in a safe way whilst they ensured that people’s independence was promoted.

We found that there were enough suitably qualified staff available to meet peoples assessed needs. Staff received an induction and regular training which ensured they had the knowledge and skills required to meet people’s needs. Staff felt supported by the registered manager.

People were involved in their care and consented to their plans of care and their treatment. The principles of the Mental Capacity Act 2005 were followed. The Mental Capacity Act 2005 sets out requirements to ensure that decisions are made in people’s best interests when they lack sufficient capacity to be able to do this for themselves.

People’s health and welfare needs were met and any concerns acted upon.

People told us staff treated them in a caring and kind way and respected their dignity. Staff listened to people wishes and supported them to make choices about their care.

People told us that staff knew how they liked there care provided. The provider considered people’s individual needs and made changes which ensured they received their care in a way they preferred.

People told us they knew how to complain and the provider had an effective system in place to record and respond to complaints.

The provider promoted an open culture. People felt the management were approachable and that they listened to them. People were encouraged to feedback their experiences and these were acted on to improve the quality of care provided.

We found that the provider was developing systems to monitor the quality of the service provided to ensure the service was effectively delivering the standards of care and treatment people needed.