Triangular Care Services Limited is registered to provide personal care for adults in their own homes and when out in the local community. They currently provide support for older people with a range of needs, including people who may be living with dementia. On the day of our visit the service provided support for 45 people in their own homes.

The inspection was announced and took place on 18. 19 and 21 October 2016.

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 and associated Regulations about how the service is run.

People felt safe and were protected from harm or abuse by staff that were aware of the principles of safeguarding and reporting procedures. Systems were in place to identify and manage risks within people’s homes and to empower them to be as independent as possible. Staffing levels were sufficient to meet people’s needs and keep them safe. Safe recruitment processes were in place. Safe arrangements were in place for the administration, recording and management of medicines.

Staff had received training and demonstrated an understanding of people’s individual needs and how to meet them appropriately. The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) Deprivation of Liberty Safeguards (DoLS) and to report on what we find. We found that people who used the service had capacity to make day-to-day decisions. However staff and the registered manager understood their responsibilities in line with the MCA requirements. Staff understood the importance of treating people with dignity and respect and people confirmed this.

People were provided with nutritional support if this was an assessed part of their package of care. Systems were in place to respond to people’s healthcare needs.

People were happy with the care they received from staff and felt they had forged meaningful relationships with them. They told us they were treated with kindness and compassion. Staff were respectful of the decisions people made.

People had their support needs assessed and reviewed on a regular basis, so that staff knew how to support them to maintain their independence. Care plans contained person centred information. Staff understood the importance of meeting people’s individual needs and provided the care and support they required. The service had systems to obtain people’s feedback and provide them with opportunities to raise concerns.

There was an open and positive culture at the service, with a clear set of values which people, staff and the management all worked towards. Quality control systems were in place to ensure care was delivered to a high standard and identify areas for development. Staff were keen to drive further improvement and to make the service the best that it could be.

We carried out an announced comprehensive inspection of this service on 04 November 2015. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to systems for medication administration and recording, and management and quality assurance procedures at the service.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Triangular Care Services Limited on our website at www.cqc.org.uk

During our previous inspection on 4 November 2016, we found that one of the regulations relating to care, welfare and records, was not being met.

Systems for medication administration were not effective in ensuring people received their medication safely and appropriately. Records did not always show what medication or dosage people were prescribed, and the administration of medication was not always recorded correctly. This was a breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) 2014.

During that inspection we also found that the provider had failed to implement and operate sufficient quality assurance procedures, to maintain the quality of the care being delivered. There was a lack of effective audit and quality assurance processes, and policies and procedures were not available to all members of staff. This was a breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We asked the provider to submit an action plan to tell us how they would meet these regulations in the future, they stated that they would be meeting them by February 2016. During this inspection we returned to see if the service had made the improvements they stated in their action plan. We found that the provider was now meeting this regulation.

Triangular Care Services Limited is registered to provide personal care for adults in their own homes and when out in the local community. They currently provide support for older people with a range of needs, including people who may be living with dementia. On the day of our visit the service provided support for 47 people in their own homes.

Improvements had been made to the systems in place for medication management. Medication records were completed in full and cross referenced with people’s care plans. Checks of staff and completion of records had been introduced, to ensure medication was being given correctly.

There had also been improvements to the systems for quality assurance and managerial oversight at the service. New checks and audits had been implemented which were based upon the most up-to-date regulations, and forms and policies were available for staff members to use and refer to.

Triangular Care Services Limited is registered to provide personal care for adults in their own homes and when out in the local community. They currently provide support for older people with a range of needs, including people who may be living with dementia. On the day of our visit the service provided support for 42 people in their own homes.

This inspection was announced and took place on 04 and 05 November 2015.

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.

People’s medication was not managed safely. Recording systems did not provide sufficient information or evidence of the medication being given.

Quality assurance systems and processes failed to identify areas for development within the care being provided.

People had individual and specific risk assessments in place, however the provider had not implemented an overall assessment of risks to the service, or an emergency contingency plan in case of emergency situations.

Staff asked people for consent before providing care and followed the principles of the Mental Capacity Act 2005, however care plans did not always reflect this.

People felt safe when receiving care and support from the service. Staff were aware of abuse and potential indicators of it. They were also aware of their responsibilities in terms of recording and report abuse.

Staffing levels were sufficient to meet people’s needs so that care visits were not missed. Staff had been recruited following safe and robust procedures.

Staff received sufficient training, supervision and support to perform their roles.

If required, staff supported people to have sufficient food and drink of their choice and encouraged them to have a balanced and healthy diet, whilst respecting their wishes.

Staff also supported people to make and attend appointments with healthcare professionals if necessary.

People received care from kind and compassionate staff who spent time establishing and building strong relationships with them.

Care plans were produced with input from people and their families. These were used to guide staff on people’s care needs and wishes and were regularly reviewed to ensure they were up-to-date.

People’s privacy and dignity were promoted and respected by members of staff.

Feedback was encouraged by the service and people were happy to talk to staff or management if they had any concern. Complaints were dealt with effectively and, along with feedback, used to drive improvements in the service.

There was a registered manager in post who people and staff were familiar with. They worked with the staff team to produce a positive and open culture at the service.

We identified that the provider was not meeting regulatory requirements and was in breach of a number of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

This was a follow up inspection. We did not need to speak to any people who used the service to see whether the service had followed up the issues not met at the last inspection.

This inspection showed that the manager had taken steps to arrange appropriate training for staff. We saw evidence that staff had been generally rotered properly so that they could meet the needs of people who use the service.

This was a follow up inspection. We did not need to speak to any people who used the service to see whether the agency had followed up the regulations not met at the last inspection.

This was a mixed positive inspection. The manager said that he had not received the previous inspection report so had not been able to act on the issues identified. He said that there had been a problem with the internet provider and a registered e-mail address had needed to be changed. However, we had not been formally notified of this change. The provider had therefore not been sent a copy of the last inspection report. This meant that some issues had not been fully followed up.

The essential standard we inspected with regard to providing comprehensive staff training had therefore not being met. The manager has provided us with information as to how relevant training will be organised.

We will undertake another follow-up inspection to check that this is in place.

We spoke with six people who used the service. They all told us they were satisfied, or mainly satisfied, with the care they received.

A person told us that staff were good at their jobs. She said; ‘’staff are there to help if I need them’’.

We spoke with the relatives of three people. They all told us that care was good, staff seemed to be well trained and they knew how to provide proper care.

One relative said; ‘’I have never had any concerns. Staff are marvellous. Nothing is too much for them ’’.

This was a mixed inspection. People we spoke with told us they were satisfied, or mainly satisfied, with the care they received. All their relatives we spoke with said that care was good. However, the essential standards we inspected with regard to comprehensive staff training and support, and dealing with complaints were not met. We are concerned with the history of non compliance with essential standards. If non complain continues we will seriously consider enforcement action.

There were some suggestions made; for better communication from head office to inform people that staff were running late, for head office to be more immediately contactable so that decisions regarding care could be made as soon as possible and for head office to always support staff. And to ensure that staff rotas are drawn up so that they are not expected to deal with a number of clients at the same times. The manager stated he would follow up these issues.