We undertook an announced inspection of Totally Living Care Ltd. on 27 February and 5 March 2018.

Totally Living Care Ltd is a domiciliary care service providing personal care for people in their own homes in the Salisbury area. It provides a service to older adults and younger people with disabilities. At the time of our inspection 49 people were being supported by the service.

At the last inspection we found a breach in Regulation 12 of the Health and Social Care Act 2014, safe care and treatment. Risks to people’s personal safety had not always been assessed or plans put in place to manage these risks effectively and safely. At the last inspection on 10 and 11 January 2017, we asked the provider to take action to make improvements to people’s risk assessments and this action had been completed.

At this inspection we found that improvements had been made. Risk assessments were in place and specific risks to people’s personal safety had been identified; however the guidance and actions on how to manage the risks were inconsistent.

There was a registered manager in post and a service co-director who were jointly managing the service. 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.

Staff had a good understanding of the Mental Capacity Act 2005 (MCA) and were able to apply the principles in their work. The MCA protects the rights of people who may not be able to make particular decisions themselves. We observed that improvements had been made in gaining the appropriate consent to receive the care provided by the service; however documented mental capacity assessments were not always in place where people lacked the capacity to make decisions about their care.

People’s medicines were managed and administered safely and recorded appropriately. Robust monitoring checks were in place which included external and internal audits of medicines administration records (MAR charts) and any changes to people’s prescribed medicines were added to their charts weekly.

Staff benefitted from comprehensive regular training and materials to support their learning styles. Staff received an induction period, which included competency checks, observation and regular one to one supervision.

People told us they were well looked after and had good relationships with staff. There were sufficient staff to meet people’s needs and people received their care when they expected to and according to their care schedule. The service had safe recruitment processes in place.

People were safe and staff understood their responsibilities in relation to safeguarding and whistleblowing. The service had systems and information in place to instruct staff on how to notify the appropriate authorities.

Totally Living Care provides a domiciliary care service supporting people with individual needs in their own homes. At the time of our inspection 59 people were being supported by this service. This inspection took place on 10 and 11 January 2017. This was an announced inspection which meant the provider was given short notice of the inspection. This was because the location provides a domiciliary care service. We wanted to make sure the manager would be available to support our inspection, or someone who could act on their behalf.

There was a registered manager in post at the service and a co-director at the time of our inspection who were jointly managing the service. 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.

Risks to people’s personal safety had not always been assessed or plans put in place to manage these risks effectively and safely. The service had identified potential concerns in people’s initial assessments upon joining the service; however risk assessments had not been developed from these concerns. This included risks around falls, medicines and specific dietary needs.

People’s medicines were managed and administered safely but had not always been recorded appropriately. For example, one person who was prescribed a medicine patch for pain relief, did not have a rotational chart in place to show where the patch had previously been placed and should be put at the next administration. Another person had been prescribed medicine for use when required (PRN). The medicine administration record (MAR) had been handwritten and not signed by the member of staff who had added this addition to the person’s medicine record.

Staff had a good understanding of safeguarding and whistleblowing procedures. They knew how to report concerns and had confidence in both managers that these would be fully investigated to ensure people were protected.

People had on occasion experienced a late or missed call but spoke positively about the response to this from the service. We fed these concerns back to the management. One relative commented “There have occasionally been instances, although not recently as far as I am aware, of them not sending in a carer; I have then contacted them and the registered manager has then gone in, in place of the carer. But generally they are reliable”.

Safe recruitment procedures were followed. Staff said they undertook an induction programme which included shadowing one of the two managers, and meeting the people they would support. The provider had undertaken recruitment checks on prospective new staff to ensure they were suitable to care for and support vulnerable adults. Staff were appropriately trained in the core subjects relevant to their role.

We saw that consent forms agreeing to the service providing people’s care had been put into people’s care plans. However these forms were not always dated, completed or signed by the person to show they had agreed with the content. Reasons why some people were unable to sign their consent, were not stated.

Concerns were raised to us by people and their relatives about the skills and experience of staff. Comments included “Some staff need a little bit more training” and “There is a lack of experience of some carers, they have put clothes on back to front before. They don’t give me the confidence that they could deal with the unexpected, however in lots of ways they have been very good”.

People and relatives were very complimentary about the caring nature of staff. Comments included “I have got to know them and they are always helpful and friendly”, “If I want something staff are very good, they do it if I ask”, “They are caring and that’s the big importance” and “All