Totus Care Ltd

Totus Care is a domiciliary care provider, providing personal care to people within their own homes and in supported living. At the time of the assessment the service was supporting six people with personal care, three of whom were in supported living. The service is registered to support people with physical disabilities, sensory impairment, mental health, dementia, learning disabilities or autistic people, younger adults, older people, children and people with an eating disorder.

At their last assessment, the service was rated Good. At this assessment it has changed to Requires Improvement.

As the service supports people with a learning disability and autistic people, we assessed them against the commission’s guidance for supporting people with a learning disability or autism, Right Support, Right Care, Right Culture. The service was not working in line with the principles of Right Support, Right Care, Right Culture. People were not consistently supported to have choice, control or meaningful involvement in their care, and important information about their needs, preferences and aspirations was not always captured in care plans. The guidance was not well understood by leaders, and this limited their ability to ensure care was person‑centred, rights‑based and delivered in a way that promoted independence and inclusion. People were not supported to identify and plan for future goals and aspirations.

We also identified concerns regarding the application of the Mental Capacity Act 2005. Mental capacity assessments were not consistently completed and lacked sufficient detail to clearly demonstrate how decisions had been reached. We found inconsistencies between assessments completed for the same person, which meant we could not be assured that people's rights were being appropriately considered and protected. In addition, staff undertaking delegated healthcare tasks had not received competency assessments to ensure they were able to carry out these responsibilities safely and effectively.

Governance systems were ineffective in driving improvement. While some of the concerns identified during this assessment had been recognised through the provider's own audits, there was limited evidence that timely and effective action had been taken to address these issues and prevent them from recurring. Recruitment processes were not always robust; in one case, a member of staff had commenced employment with only an Adult First check completed, and the provider was unable to demonstrate that appropriate risk assessments had been undertaken or that staffing pressures had been fully considered. These concerns were compounded by a period of management instability. The previous registered manager had left the service several months before the assessment, and although an interim manager was in post and intending to register with CQC, they left the service towards the end of the assessment period. This lack of stable leadership had impacted the provider's ability to maintain effective oversight and drive the improvements needed to ensure safe, high-quality care.

The assessment identified a breach of Regulation 17 (Good Governance), with significant concerns regarding oversight, quality assurance, and the effectiveness of systems in place to monitor and improve the quality and safety of care. We have asked the service to submit an action plan to show how they are going to address the identified breech.

Despite these concerns, we found no evidence that anyone had come to harm as a result of the identified shortfalls. Relatives told us that people got on well with staff and felt they had a positive day-to-day experience of the care provided.