Top4Care Services Ltd

We assessed the service against ‘Right support, right care, right culture’ guidance to make judgements about whether the provider guaranteed people with a learning disability and autistic people respect, equality, dignity, choices, independence, and good access to community facilities.

The service is also registered as a domiciliary care service, although at the time of our assessment there was no one receiving a regulated activity. We therefore did not assess this part of their registration.

During the assessment, we identified breaches of regulation relating to governance. We discussed the concerns with the management team during the assessment to enable them to begin taking action. The provider responded positively, and following the assessment took prompt action to address the concerns identified.

Governance systems were not always robust and did not provide leaders with effective oversight of the service. As a result, leaders had not identified or addressed a range of concerns, including medicines management issues, gaps in competency oversight, the absence of key policies and procedures, and shortfalls in care planning. Medicines were not always stored safely, and medicines audits had not been completed. This meant the provider was unable to identify concerns, including gaps in staff competencies.

The provider had not ensured key policies and procedures were in place, such as the use of CCTV or how to support people if they wished to change provider.

Whilst people received care that met their needs, care plans did not always provide clear guidance to staff on how to support specific health conditions. We also found people were not consistently supported to consider and record their wishes for future care, including end-of-life preferences.

Whilst governance systems were not always effective, we also identified areas of good practice. Staff received training to support them to carry out their roles safely. Systems were in place to manage safety, including incident reporting. Leaders promoted an open culture and incidents, complaints and concerns were recorded and used to inform learning.