This inspection took place on 13 and 17 September 2018 and was announced. At our previous inspection of Total Home Care in August 2017, we found the service was in breach of Regulation 12, safe care and treatment, of the Health and Social Care Act 2018 (Regulated Activities) Regulation. This was in relation to the proper and safe management of medicines. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question of ‘is the service safe’ to at least good. At this inspection, we found improvements had been made and the service was no longer in breach of Regulations.

Total Home Care is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults and younger disabled adults. On the day of our inspection there were 51 people receiving care and support from the service.

There was 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 2008 and associated Regulations about how the service is run.

Medicines were managed safely and people were receiving medicines as prescribed.

Staff were recruited safely and there were enough staff to take care of people. Staff received appropriate training and they told us the training was good and relevant to their role. Staff were supported by the registered manager and received formal supervision where they could discuss their ongoing development needs, although these needed to be more regular.

People who used the service and their relatives told us staff were helpful, kind and caring. Staff explained how they respected people’s dignity. This was confirmed by people we spoke with.

Care plans were up to date, easy to follow and detailed what care and support people wanted and needed. Risk assessments were in place and showed what action had been taken to mitigate any identified risks. People felt safe with staff and appropriate referrals were being made to the safeguarding team when this had been necessary.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice. The service was compliant with the legal requirements of the Mental Capacity Act 2005 (MCA) and people’s consent was sought prior to staff delivering care and support.

The service liaised with a range of health and social care professionals to ensure people’s healthcare needs were being met.

Staff knew about people’s dietary needs and preferences.

Records showed most complaints received had been dealt with appropriately.

Everyone spoke highly of the registered manager and said they were approachable and supportive. The provider had some systems in place to monitor the quality of care provided. However, these needed to be integrated and embedded within the new electronic processes to ensure quality was being effectively monitored to ensure service improvements.

We found all the fundamental standards were being met. Further information is in the detailed findings below.

Our inspection of Total Homecare took place on 3, 4, 7 and 8 August 2017 and was announced.

At our previous inspection on 30 January 2017 we found breaches of regulation relating to safe care and treatment, good governance and failure to notify CQC of incidents. We rated the service as 'requires improvement' at that time, and 'inadequate in the well led domain. We saw some improvements had been made to meet the relevant requirements and the service was no longer in breach of regulations regarding good governance and notifications. However, further improvements needed to be made around medicines management before the service was no longer in breach of regulation regarding safe care and treatment and we recommended further improvements to the quality assurance system.

Total Homecare is a domiciliary care agency, which provides care and support to people in their own homes throughout the Bradford area. The agency provides a range of services including personal care, preparing meals, shopping, domestic duties and day sitting. The registered office is located in Saltaire, near Bradford. At the time of our inspection there were 50 people receiving the regulated activity of personal care.

A registered manager was 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 2008 and associated Regulations about how the service is run.

People felt safe with the care and support provided. Safeguarding policies and procedures were in place. Staff had received safeguarding training and understood how to recognise signs of abuse. Accidents/incidents were documented with record of actions taken.

A list of people's medicines was kept in people's care records. However, these were not always up to date with the information on people's medicines administration charts (MARs). We identified some signature gaps on people's MARs although some omissions had been identified at audit by the quality manager.

Sufficient staff were deployed to keep people safe and safe recruitment procedures were followed. Staff received appropriate training to offer safe care and support and treated people with kindness and respect for their privacy. Staff supervisions were in place although staff appraisals still needed to be implemented.

Staff mostly arrived on time and stayed for the allotted period, although this was not consistently so. Some people told us they were not informed if staff were going to be late.

People's independence was supported and choices respected. People and/or their relatives were involved in the initial planning of their care and support. Care records reflected person centred, individualised care. Care reviews were on-going as people's care and support needs changed, although some people said they had not received a recent care plan review.

Complaints were taken seriously, investigated and appropriate actions taken. People were generally satisfied with the service they or their relatives received.

The registered manager was pro-actively seeking ways to improve the service and staff told us the registered manager was supportive and approachable.

People's opinions were sought about the quality of the service and some quality assurance systems were in place. However those relating to medicines management needed to be more robust.

We have made a recommendation about quality assurance systems.

We found one breach of Regulations and you can see what action we told the provider to take at the back of the full version of the report.

Our inspection of Total Homecare took place on 30 and 31 January 2017 and was announced. We gave the service 48 hours' notice to ensure the manager would be present. This was the first inspection of the service.

Total Homecare is a domiciliary care agency, which provides care and companionship to adults in their own homes throughout the Bradford area. The agency provides a range of services including personal care, preparing meals, shopping, domestic duties and day sitting. The registered office is located in Shipley, West Yorkshire. At the time of our inspection, the service was providing the regulated activity of personal care to 68 people.

The service requires a registered manager to be 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 2008 and associated Regulations about how the service is run. The registered manager had left the service in December 2016 and the deputy manager had taken over the role of manager. The deputy manager told us they were applying to register with the Care Quality Commission (CQC).

Safeguarding policies and procedures were in place although no referrals had been made. The manager understood their responsibility to notify CQC and the local authority of any safeguarding concerns and staff understood how to keep people safe from harm or abuse. However, some staff safeguarding training was out of date. Accidents and incidents were not always fully documented with outcomes and actions taken as a result.

Staffing levels were sufficient to keep people safe and safe recruitment procedures were in place to ensure staff were fit to provide care and support to vulnerable people. Some staff had been employed with only one reference obtained although new procedures were in place to prevent this happening in future. Some gaps were identified with staff training which had also been identified by the manager.

A complete list of people's medicines was included in people's care records and documented on Medicines Administration Records (MARs) in people's homes. People's medicines were administered through dossette boxed medicine systems to minimise risk of error. However, gaps were noted in a number of MARs where staff had failed to sign the record.

No quality assurance audit processes were in place to monitor, assess and improve the quality of the service.

Statutory notifications such as notification of death, serious injury or medication errors had not been made to CQC.

The service had failed to submit a Provider Information Return to the CQC, detailing key information about the service, what the service does well and improvements they plan to make.

Staff meetings were being recommenced, as were supervisions and appraisals which had not taken place in recent months. No staff spot checks had been undertaken to ensure staff were competent in their roles.

The service was meeting the legal requirements of the Mental Capacity Act (2005) although some staff had limited knowledge of this.

People and their relatives told us staff were kind and caring and staff we spoke with had a good knowledge of people, their care and support needs and likes/dislikes.

Detailed risk assessments were in place in people's care records and plans of care formulated from these. These were clear and person centred with evidence of people's preferences, likes and dislikes although some duplication of information was evident. Nutritional guides were in place in care records where people were supported with their dietary needs. Plans of care were put in place with input from people and/or their relatives and care reviews held.

A complaints procedure was in place and we saw improvements had been made to ensure complaints were taken seriously, investigated and actions taken as a result.

The managem