About the service:

Top Class Quality Services Ltd is a domiciliary care agency based in Reading, providing personal care to people living in their own homes. At the time of inspection, the service was supporting three in their own homes. Care packages ranged from one hour a day to a 24 hour live in service.

People's experience and our findings:

Staff were not always trained or regularly assessed as competent to administer medicines in line with the provider’s policy, clinical guidance and best practice.

Where people were prescribed ‘as required’ (PRN) medication, the service did not always have protocols or guidance in place to ensure that staff knew when to administer PRN medicine.

Audits had not always been undertaken. Those that had, did not always identify gaps or highlight trends, themes or lessons learnt.

Care records did not always clearly reflect people’s care needs or how staff were supporting people with these needs.

Records of best interest discussions had not always been kept in relation to care and treatment of people.

Safe recruitment practices were not always followed to make sure, as far as possible, that people were protected from staff being employed who were not suitable.

People and their relatives told us they felt safe with the staff who supported them.

People and their relatives said staff were caring and respected their privacy and dignity.

People felt the service they received helped to maintain their independence where possible.

People knew how to complain and knew the process to follow if they had concerns.

Staff felt the management was supportive and approachable. Staff were happy in their role which had a positive effect on people's wellbeing.

Rating at last inspection:

The service was inspected on 6 March 2019 (report published 17 April 2019). We found the provider was in breach of Regulations 12 (Safe care and treatment), 17 (Good governance) and 19 (Fit and proper persons employed) of the Health and Social Care Act, (Regulated Activity) Regulations 2014. The service was rated as Requires Improvement.

Why we inspected:

This was a planned comprehensive inspection.

Enforcement:

At this inspection we found the provider continued to be in breach of Regulations 12 (Safe care and treatment), 17 (Good governance) and 19 (Fit and proper persons employed) of the Health and Social Care Act, (Regulated Activity) Regulations 2014. The service remains Requires Improvement.

Full information about CQC’s regulatory response can be found in the full report which can be found on our website at www.cqc.org.uk.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

This was an announced inspection which took place on 06 March 2018.

Top Class Quality Care Services is a domiciliary care agency. It provides personal care to people living in their own homes. It currently, provides a service to older adults and younger adults. At the time of the visit the agency was supporting three people. Care packages ranged from one hour a day to a 24 hour live in service.

This was the first inspection of the service which was registered in February 2016 but was dormant in December 2016. It was formally dormant until August 2017.The service was rated as good in three domains and requires improvement in two domains. This means the service is overall requires improvement. This is the first time the service has been rated as requires improvement.

There was a registered manager running the service. 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 not supported with their medicines as safely as they could be. Medicines were not always recorded accurately. The support people needed with medicines was not clear and when particular types of medicines should be administered was not clear. This breached the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People were not always supported by care staff who had been safely recruited. The service did not always complete all the necessary checks to make sure candidates were safe to work with people. This breached the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People, staff and visitors were protected from harm and safety was maintained by staff who had been trained in safeguarding vulnerable adults and health and safety policies and procedures. Staff understood how to protect the people in their care and knew what action to take if they identified any concerns. General risks and risks to individuals were identified and action was taken to reduce them, as far as possible.

People benefitted from adequate staffing because needs were identified and a person centred package of care was developed. The required number of staff was provided to ensure people’s needs could be met safely and effectively.

People were supported by staff who had been trained and supported to make sure they could meet people’s complex and varied needs. We recommended that the service look at how often they refresh staff training, in particular area. Care staff were effective in meeting people’s needs as described in plans of care. The service was worked closely with health and other professionals to ensure they were able to meet people’s specific needs.

People were supported to have maximum choice and control of their lives and care staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

People were supported by a caring staff team. Care staff built caring relationships with people and knew their needs. The service and care staff were aware of people’s equality and diversity needs which were noted on plans of care. People were supported to be as independent as they were able to be.

The service was person centred and flexible. It was responsive to individual’s current and changing needs. We recommended that the service look at how they write their plans of care. People’s needs were reviewed to ensure the care provided was up-to-date. Care plans included information to ensure people’s individual communication needs were understood.

The registered manager was described as open, approachable and supportive. The registered manager and his team were committed to ensuring there was no discrimination relating to staff or people in the service. However, the service did not ha