Total Care Norfolk

During our assessment of this key question, we found concerns relating to staffing which constituted a breach of Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can find more details of our concerns in the evidence category findings below.

Staff were not safely recruited as the provider’s recruitment processes were not robust. Staff were not selected and interviewed in line with the provider’s own policies and procedures.

People told us they felt safe, but some incidents left people open to potential risk of harm and had not been robustly investigated and learning shared.

Staff knowledge about safeguarding people from abuse was poor despite recent safeguarding training. The provider did not have robust processes in place to protect people.

Following a series of medication administration errors last year the provider had instigated an audit system to review medicines administration more robustly. People told us they were happy with the way their medicines were administered and records were accurate.

People’s needs were assessed to ensure the service could meet them. The provider ensured assessments by the local authority, where available, formed the basis of relevant care plans. Staff worked in line with healthcare professionals’ advice to ensure people’s needs were met.

Although the provider assessed people’s initial needs and documented major changes to people’s care, people told us they had not all been offered a planned review of their care. Most people told us they were routinely asked for their consent. However, some staff’s level of English language was found to be a barrier to establishing consent.

People told us they were able to exercise choice and control in relation to their care. However, for some, a language barrier existed with some staff which made communication about people’s choices difficult.

People mostly told us they were consulted about their care and understood their rights. They were happy with the inclusive approach of the provider.

During our assessment of this key question, we found concerns relating to good governance which constituted a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can find more details of our concerns in the evidence category findings below.

Systems and processes which were designed to ensure people who used the service received safe care were not always effective. Audits and spot checks to monitor the safety and quality of the service were not always robust and had not picked up the issues we identified during this assessment. Recruitment systems were not fit for purpose and did not protect people.

There were processes in place to enable staff to speak up about concerns and issues and staff told us they felt confident making their voices heard. However, records did not evidence staff meetings and supervision sessions were open forums with an inclusive approach.

A diverse workforce was in place and staff had received equality and diversity training. The provider lacked an ongoing proactive approach to supporting overseas staff once in post. Learning was not intuitive. Staff were not always well supported during initial online training, some of which took place before employment. Systems for checking knowledge and understanding were in place but needed to be more effective.