Total Loving Care Ltd achieved a Good rating across all five key questions at this April 2023 inspection, having improved from Requires Improvement in 2019 and remediated all prior regulatory breaches. The small domiciliary care agency demonstrated safe recruitment and medicines management, personalised care planning, and a committed registered manager who implemented robust quality-monitoring systems.
Strengths
· People felt safe with staff and trusted the registered manager; risks were assessed and regularly monitored including premises, moving and handling, falls and medicines.
· Staff followed safe recruitment procedures including DBS checks, application forms and references.
· Medicines administration records were completed appropriately with no gaps; registered manager was the only person administering medicines.
· Staff completed the Care Certificate and a structured induction including shadowing; training was described as useful and effective.
· Regular supervisions took place and staff could access the registered manager outside of scheduled supervision times.
Quality-Statement breakdown (21)
safe: Staffing and RecruitmentGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Assessing risk, safety monitoring and managementGood
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
effective: Staff support: induction, training, skills and experienceGood
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
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
caring: Respecting and promoting people's privacy, dignity and independenceGood
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, quality performance, risks and regulatory requirementsGood
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: Engaging and involving people, the public and staff; duty of candourGood
Total Loving Care Ltd received an overall rating of Requires Improvement at its first inspection, with three regulatory breaches identified relating to recruitment (Regulation 19), staffing and training (Regulation 18), and good governance (Regulation 17). While the caring domain was rated Good and people expressed high satisfaction with the registered manager and staff, significant weaknesses in governance, staff training oversight, and record-keeping placed people at increased risk of harm.
Concerns (8)
criticalStaff training: “there was little evidence of this in the form of certificates...The registered manager told us they did not have this information.”
criticalStaff competency: “Recruitment procedures were not being operated effectively to ensure that persons employed were of good character and had the qualifications, competence, skills and experience.”
criticalGovernance: “there were no formal systems to monitor the quality of the service...systems were either not in place or robust enough to demonstrate safety was effectively managed.”
moderateSupervision / appraisal: “There was no formal system for supervising staff and the registered manager told us they did not record anything that came out from discussions with staff.”
moderateRecord keeping: “Records relating to the care of people and the general running of the service were inconsistent.”
moderateLeadership: “The registered manager did not have enough time or understanding of their role to ensure their responsibilities in running the service were clear.”
minorMedication management: “staff were applying a medicated cream that had been provided by a district nurse. This was not being recorded by staff.”
minorEnd-of-life care: “the registered manager told us that she had spoken with people about planning their end of life care...this had not been recorded on people's care plans, so the section was blank.”
Strengths
· People and relatives trusted staff and felt safe; one person stated 'We trust her very much, I'd be lost without [the registered manager].'
· Staff understood safeguarding responsibilities and knew how to report concerns to external authorities including police, social services and CQC.
· People and relatives were positive about the care received, describing staff as kind, respectful and treating people with dignity.
· Risk assessments involved people and staff understood how to mitigate risks in care provision.
· The registered manager worked collaboratively with external health professionals and understood when to make referrals.
Quality-Statement breakdown (21)
safe: Staffing and recruitmentRequires improvement
safe: Assessing risk, safety monitoring and managementGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Using medicines safelyRequires improvement
safe: Preventing and controlling infectionRequires improvement
safe: Learning lessons when things go wrongGood
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 careGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Supporting people to live healthier lives, access healthcare services and supportGood
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
caring: Respecting and promoting people's privacy, dignity and independenceGood
responsive: Planning personalised care to meet people's needs, preferences, interests and give them choice and controlGood
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, understanding quality performance, risks and regulatory requirements; Continuous learning and improving careRequires improvement
well-led: Promoting a positive culture; engaging and involving people; duty of candourGood