West Yorkshire (Team Personnel Solutions Limited) was rated Inadequate overall following an October 2015 inspection, with multiple regulatory breaches including failures in safeguarding, medicines management, recruitment, staff training, supervision, and governance. The service was placed in Special Measures, with warning notices served for Regulation 18 (Staffing) and Regulation 19 (Fit and proper persons employed), requiring compliance by 7 January 2016.
Concerns (10)
criticalSafeguarding: “Both staff members could not provide answers about recognising abuse...staff were not clear on recognising and responding to possible abuse.”
criticalMedication management: “There were no medicine administration records [MAR] forms...it was not possible to confirm if people had been given their medicines.”
criticalStaff training: “There were no other records relating to ongoing training...no records held of when this training took place and who had received it.”
criticalSupervision / appraisal: “There were no annual appraisals in place. The registered manager agreed that supervisions had not been happening as they had been busy providing care.”
criticalGovernance: “There were no audits in place of care files or other systems of safety...the provider did not gather information about the quality of their service from a variety of sources.”
criticalStaff competency: “The service did not carry out the appropriate recruitment checks to ensure fit and proper persons were employed.”
moderateRecord keeping: “We looked in the staff member's file, there was no record of this disciplinary hearing...no record of the statement, the meeting or any record relating to this incident.”
moderateCare planning: “There was no record of care plans or risk assessments being reviewed on a regular basis.”
moderateConsent / capacity: “Staff we spoke with also displayed a lack of understanding of mental capacity...they had not received training in this area.”
moderateComplaints handling: “We saw complaints were not fully investigated and records in relation to staff conduct were not updated.”
Strengths
· Staff were described as caring and treated people with dignity and respect by all relatives spoken with.
· Care was provided by consistent staff who were punctual, and families were notified of late arrivals.
· Care plans were written in a person-centred way, incorporating people's backgrounds, likes, dislikes, and religious and spiritual beliefs.
· Staff had developed therapeutic relationships with people, including consideration of cultural and religious needs.
· The service demonstrated flexibility, sending additional carers when people were unwell and staying beyond scheduled visit times.
Quality-Statement breakdown (10)
safe: Safeguarding service users from abuse and improper treatment (Regulation 13)Inadequate
safe: Safe care and treatment – medicines management (Regulation 12)Inadequate
safe: Fit and proper persons employed – recruitment checks (Regulation 19)Inadequate
effective: Staffing – training, supervision and appraisal (Regulation 18)Inadequate
effective: Mental Capacity Act understanding and consentInadequate
caring: Dignity, respect and person-centred relationshipsGood
responsive: Person-centred care – review of care plans (Regulation 9)Requires improvement
TPS Healthcare was rated Requires Improvement overall following a March 2020 inspection, representing a deterioration from its previous Good rating, with breaches of Regulations 12, 17 and 18 identified relating to unsafe medication management, poor governance and absent staff supervision and training. Caring remained Good, with people and relatives reporting kind, respectful and dignified care, but systemic failures in record keeping, care planning, end of life care plans and quality assurance systems posed elevated risk to the three people receiving personal care.
Concerns (10)
criticalMedication management: “one MAR recorded a person was to be given senna or movical. It did not detail the prescription for each medicine and staff had not recorded which of these medicines had been administered.”
criticalMedication management: “one staff member told us they had given a person their eyedrops but had not received any medication training.”
criticalStaff training: “one care plan directed staff to clean a catheter site. However, all the staff we spoke with said they had not received training in catheter care.”
criticalSupervision / appraisal: “one staff member had not had a supervision since 2016, another staff member had not had a spot check since 2017 and there had been no appraisal.”
criticalGovernance: “Governance systems were not robust. There was no evidence of audits being carried out to monitor the service.”
moderateIncident learning: “we found medicine errors during our inspection which had not been investigated.”
moderateCare planning: “one care plan had not recorded a person's preferences for dressing. One person was being seen regularly by a district nurse, however, this was not identified in the care plan.”
moderateEnd-of-life care: “People using the service were receiving end of life care. There was no end of life care plans in place to guide staff on how to support people.”
moderateConsent / capacity: “Best interest decisions had not been recorded. However, staff knew those people who lacked capacity and what support they required.”
moderateRecord keeping: “Some assessments had not been signed by staff to show who completed the record. Some care plans lacked detail as sections had not been completed.”
Strengths
· People and relatives said staff were kind, caring, respectful and treated people with dignity.
· Staff encouraged independence and sought consent before carrying out duties.
· Complaints were managed effectively with investigations carried out and outcomes shared.
· Staffing levels were sufficient and recruitment processes were safe.
· The nominated individual understood duty of candour responsibilities and promoted openness.
Quality-Statement breakdown (19)
safe: Using medicines safelyRequires improvement
safe: Assessing risk, safety monitoring and management, learning lessons when things go wrongRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
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: Supporting people to eat and drink, access healthcare services; staff working with other agenciesGood
effective: Ensuring consent to care and treatment in line with law and guidance
Team Personnel Solutions (West Yorkshire) improved from Inadequate to Requires Improvement following six regulatory breaches identified in October 2015, demonstrating sufficient remediation in safeguarding, training, care planning and governance. Ratings of Requires Improvement across Safe, Effective and Well-Led reflect the absence of a sustained track record of consistent good practice, with ongoing gaps in medication auditing and supervision frequency.
Concerns (5)
moderateMedication management: “the director was unable to locate the assessment records... There was no reference to this in their assessment of need or care plan.”
moderateMedication management: “there was a discrepancy when we looked at one person's medication administration record and daily notes... had not been picked up by the provider prior to the inspection.”
moderateGovernance: “At the time of the inspection there were no medication audits.”
minorSupervision / appraisal: “there was a variance in the level of support staff received... The provider had a supervision policy but this did not outline the frequency and method of staff support.”
minorRecord keeping: “one person was prescribed 'when required' medicine. There was no reference to this in their assessment of need or care plan.”
Strengths
· Consistent staffing arrangements with regular care workers visiting the same people, providing reliable and personalised care.
· Positive feedback from relatives about staff competency, reliability and the caring attitude of the workforce.
· Appropriate safeguarding systems and training introduced, with staff confident in reporting concerns.
· Mental capacity assessments carried out and best interest decisions clearly recorded.
· Specialist PEG feeding training provided to all staff assisting the relevant service user.
Team Personnel Solutions Limited (West Yorkshire) was rated Good across all five key questions at its July 2017 inspection, with people and relatives reporting kind, consistent and reliable care. Minor recommendations were made to strengthen daily recording practices and develop a recognised quality accreditation scheme to support the service's ongoing growth.
Concerns (2)
minorRecord keeping: “a health professional told us that daily recording could be improved, to enable them to be clear about what support had been delivered by care staff”
minorGovernance: “we recommend the service develops these further with a recognised quality accreditation scheme to help the service to learn and improve”
Strengths
· People reported consistent, reliable care staff who treated them with kindness, dignity and respect
· Safe recruitment practices including DBS checks, references and eligibility to work verification
· Medication administration records and MAR audits completed regularly to minimise medicine errors
· Staff induction linked to the Care Certificate with additional practical training tailored to individual needs, including specialist PEG feed training
· Regular supervision, one-to-one meetings and direct observations of staff practice to ensure competency
Requires improvement
caring: Ensuring people are well treated and supported; respecting equality and diversityGood
caring: Respecting and promoting people's privacy, dignity and independenceGood
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 preferencesRequires improvement
responsive: Meeting people's communication needsGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportRequires improvement
well-led: Managers and staff being clear about their roles; planning and promoting person-centred, high-quality careRequires improvement
well-led: How the provider understands and acts on duty of candour responsibilityGood
well-led: Engaging and involving people using the service, the public and staffGood
well-led: Continuous learning and improving care; working in partnership with othersGood