Date of assessment 11 November 2024 to 18 November 2024. On the day of the assessment there were 78 people being supported in their own homes by the service. This was a responsive assessment as there had been concerns raised about how risks were managed for people. Concerns raised included poor governance, a lack of learning from accidents and incidents, staff not being adequately trained and the ineffective management of medicines. During the inspection we found concerns relating to the management of risk and the governance and oversight of the service We assessed a small number of quality statements from the safe, and well-led key questions and found areas of concern. The scores for these areas have been combined with scores based on the key question ratings from the last inspection our overall rating remains requires improvement. We found governance systems and risk assessments were in place. However, they were not always effective in identifying and mitigating risks. There were sufficient staff deployed to support people and keep them safe and robust recruitment process were in place. Medicines were managed appropriately, and people received their medicine as prescribed The service had a management team who worked well together. There was a clear management structure which aided the smooth running of the service. Staff worked well together and told us they felt supported by the management team. Learning from accidents, incidents and events was shared and used to improve the service.
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Total Health Support and Training Services Limited was rated Requires Improvement overall following an April 2023 inspection, with regulatory breaches identified in safe care and treatment (Reg 12) and good governance (Reg 17). Key failures included unsafe medicines management, insufficiently detailed care plans for pressure ulcer risk, and significant staff training gaps, with one person having sustained serious skin damage as a result.
Concerns (8)
criticalCare planning: “People's care plans did not always contain sufficient information to help staff protect people from identified risks.”
criticalMedication management: “One person's care plan stated they required staff to support the administration of medicine. However, there was no medicine administration record in place.”
criticalMedication management: “signatures for medicines administered were missing on a number of occasions in January, February and March 2023”
criticalStaff training: “23 out of 85 staff members had not completed the provider's induction training... 38 out of 85 staff were not up to date with their pressure ulcer training.”
criticalGovernance: “The registered manager had failed to accurately identify how many staff had completed refresher training... the percentage of staff who were not up to date was actually 70%.”
criticalSafeguarding: “A third person had sustained severe skin damage as a result of staff not having sufficient guidance and training to mitigate the risk of skin damage.”
moderateIncident learning: “The provider's audits to identify errors and omissions did not evidence staff analysed themes and trends or took sufficient action to prevent staff making repeated errors.”
moderateRecord keeping: “In one person's MAR signatures had been added after medicines were administered on several days for several different medicines for November and December 2022.”
Strengths
· Sufficient numbers of staff to provide consistent care, with continuity of support from the same staff where possible.
· Thorough recruitment process including DBS checks, references, identity verification and employment history checks.
· Staff protected people from infection risk with access to adequate PPE.
· Staff worked collaboratively with healthcare professionals and social care agencies to promote positive outcomes.
· People's capacity to make decisions was assessed and MCA legal authorisations were in place where required.
Quality-Statement breakdown (15)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Using medicines safelyRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Staffing and recruitmentGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
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
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: How the provider understands and acts on the duty of candourGood
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood