Town and Country Homecare improved from Requires Improvement to Good across all five key questions, having remediated previous breaches of Regulations 9, 12 and 17. The service demonstrated sustained improvements in risk management, medicines safety, care planning, staff training and governance since the February 2023 inspection.
Strengths
· Robust risk assessments implemented covering falls, diabetes, bed rails, pressure care and skin integrity using national tools such as Waterlow.
· Medicines management improved with no gaps in MAR records, controlled drug recording implemented and topical cream signing addressed.
· Care plans reviewed, updated and made person-centred with real-time online system introduced; staff found them helpful and up to date.
· New online training system well-received by staff; specific training matched to individuals' complex needs such as motor neurone disease.
· Regular supervisions, appraisals and spot checks completed and up to date since last inspection.
Quality-Statement breakdown (21)
safe: Assessing risk, safety monitoring and managementGood
safe: Using medicines safelyGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Learning lessons when things go wrongGood
safe: Staffing and recruitmentGood
safe: Preventing and controlling infectionGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Staff support: induction, training, skills and experienceGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Staff working with other agencies to provide consistent, effective, timely careGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
caring: Ensuring people are well treated and supported; respecting equality and diversityGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesGood
responsive: Meeting people's communication needsGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsGood
well-led: Engaging and involving people using the service, the public and staffGood
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: How the provider understands and acts on the duty of candourGood
Town & Country Homecare received a 'Requires Improvement' rating across all five key questions following a December 2022 inspection, representing a decline from its previous 'Good' rating in 2018. Widespread failures in risk management, medicines safety, care planning, consent processes, and governance resulted in warning notices and regulatory breaches under Regulations 9, 12, and 17.
Concerns (14)
criticalCare planning: “Care plans did not always include relevant information for staff to follow. People's care plans were not person centred and did not include relevant information.”
criticalMedication management: “Medicines were not managed safely. Multiple gaps were found in people's MAR's where topical creams were prescribed.”
criticalGovernance: “Medicines management audits had not been carried out since 2020. The registered manager failed to pick up concerns we found on inspection.”
criticalRecord keeping: “People's medicine administration records (MARs) were at times illegible. There were multiple unexplained gaps and controlled drugs were not appropriately recorded.”
criticalSafeguarding: “We identified a person who could have been at risk of potential physical harm and abuse. An alert had been made to the local authority safeguarding but did not include relevant details.”
criticalConsent / capacity: “The registered manager had failed to recognise the need to carry out assessments of people's capacity...had not had any training in relation to MCA assessing.”
criticalEnd-of-life care: “End of life care plans were not in place even though several people were receiving palliative care. Preferences and wishes were not discussed with people or their relatives.”
moderateIncident learning: “An analysis of accidents and incidents had not been carried out. Patterns and trends could then not be identified, and lessons could not be learnt.”
moderateSupervision / appraisal: “Staff did not receive supervision in line with the provider's policy...staff had only received one face to face conducted by a peer.”
moderateStaff training: “Staff hadn't received training specific to people's needs. Staff had not received training in end of life care.”
moderatePerson-centred care: “People's care plans lacked person-centred detail. Care plans were basic and did not include information such as life histories, personal wishes and aspirations.”
moderateLeadership: “The registered manager was not able explain to us what duty of candour meant. They were unaware of the details of the fundamental standards.”
moderateStaff competency: “Competence assessments including medicines administration were carried out by peers and additional training to carry out these assessments had not been completed.”
minorComplaints handling: “"Yes, I made a complaint, but there was no 'oh that is terrible,' an apology or feedback given. They just said 'oh, okay'."”
Strengths
· Staff were recruited safely with references, identity checks, employment history and DBS checks in place.
· People and relatives felt safe and reported being treated with dignity and respect by care staff.
· Staff understood safeguarding responsibilities and knew how and who to report concerns to.
· Infection control systems were in place and staff consistently used PPE during visits.
· The service worked effectively with healthcare professionals such as district nurses, who gave positive feedback.
Quality-Statement breakdown (21)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Using medicines safelyRequires improvement
safe: Learning lessons when things go wrongRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseRequires improvement
safe: Staffing and recruitmentGood
safe: Preventing and controlling infectionGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawRequires improvement
effective: Ensuring consent to care and treatment in line with law and guidance
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Requires improvement
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Staff working with other agencies to provide consistent, effective, timely careRequires improvement
caring: Respecting and promoting people's privacy, dignity and independenceRequires improvement
caring: Supporting people to express their views and be involved in making decisions about their careRequires improvement
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesRequires improvement
responsive: Meeting people's communication needsRequires improvement
responsive: Improving care quality in response to complaints or concernsRequires improvement
responsive: End of life care and supportRequires improvement
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Engaging and involving people using the service, the public and staff; Continuous learning and improving careRequires improvement
well-led: How the provider understands and acts on the duty of candourRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringRequires improvement