B & H Care

B & H Care is a domiciliary care service providing personal care to adult people living in their own homes. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. At the time of our inspection there were 52 people receiving personal care support.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

At the time of the inspection, the location did not care or support for anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.

People’s experience of using this service and what we found

Right Support:

People received their medicines, as required. Auditing supported the provider to identify and address shortfalls.

People’s independence was respected. People and their representatives were involved in care planning and reviews.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Right Care:

People’s care records were not always person centred and identified how people’s needs were to be met and risks mitigated. This was a risk of people receiving inappropriate care. We have recommended the provider include guidance for staff in care records to ensure they understood the signs and indicators of risks with people’s care and when to report concerns.

We received concerns about all staff not understanding how to support people with the preparations of their meals. We were assured the provider was taking action to improve, such as providing cultural training to staff.

We received feedback from people and relatives that people’s privacy and rights were respected and they were provided with a caring service. Staff were trained in safeguarding and systems helped to reduce the risk of abuse.

Right Culture:

The governance systems in place required improvement to ensure that the provider is able to independently identify shortfalls and address them. This included recording and oversight of the timings of care visits.

Improvements were needed in how the service monitored and addressed the times of people’s scheduled visits. We received feedback from some people that they often felt rushed by staff and they were not always staying for the planned amount of times for their visits. We had received feedback from a person who used the service which identified when they had raised a concern with a staff member, this was not responded to in an appropriate way. There was ongoing staff recruitment and staff were recruited safely. Staff received an induction and training to meet people’s needs.

People were asked for their views on the service and their comments were valued. There was a complaints procedure and records showed people’s complaints were investigated and addressed.

We received positive feedback about the registered manager and how they led the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

This service was registered with us on 9 September 2022 under the current location address. This is the first inspection of this service. The last rating for this service under the previous location address was requires improvement (published 22 June 2022).

Why we inspected

This comprehensive inspection was undertaken, because as a newly registered service, they had not yet received a rating. Prior to the inspection, concerns were received about medicines, people’s care records and governance. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the safe, responsive and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified breaches in relation to person centred care, staff deployment and governance at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

B & H Care is a domiciliary care service providing personal care to adults living in their own homes. At the time of our inspection there were 41 people using the service, all received personal care support.

CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

People’s experience of using this service and what we found

Prior to our inspection the provider had changed their address, which we were notified of. However, during our inspection we found the location had also moved to the same address, which we were not aware of. After we had spoken with the registered manager about this, they submitted an application to add a location with the current address.

We found people’s care plans did not clearly identify people’s specific needs and how they were met. There was limited information provided to staff in how to provide the care and support required. People’s risk assessments, including those relating to mobility and medicines, did not identify how the assessed risks were mitigated. Records were contradictory in parts. The provider’s governance systems had not independently identified the shortfalls, therefore, we were not assured they were robust enough.

People’s needs were assessed prior to them using the service. Where required, people were supported to access health care professionals and the service worked with other professionals to achieve good outcomes. Where people required support with their dietary needs, this was provided. We received positive feedback from social care professionals relating to how the service worked with them and acted on any guidance and advice.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

There were enough staff to ensure that planned visits were undertaken. Staff were recruited safely. Staff received training and the opportunity to achieve relevant qualifications relevant to their role. Staff told us they felt supported, they received supervision and their work practice was checked.

There were systems in place designed to reduce the risks of abuse, this included training for staff. Lessons were learned when incidents had happened, to reduce future risks. Staff received guidance and training relating to the pandemic and infection control and had access to personal protective equipment (PPE). Staff were trained and had their competency assessed relating to supporting people with their medicines.

People using the service told us how they felt the service was responsive to their needs and that the staff who supported them were respectful and caring. This was confirmed by feedback from relatives and social care professionals. People were supported to access the community where it had been identified to improve their wellbeing. Where people required end of life care and support staff were trained in how to support them.

There was a complaints procedure in place and records showed complaints were responded to and addressed. People using the service and relatives confirmed they were asked for their views and these were listened to and acted on.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

This service was registered with us on 17 December 2020 and this is the first inspection.

Why we inspected

This comprehensive inspection was undertaken because the service had not yet been inspected nor received a rating.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified two breaches at this inspection. One relating to safe care and another relating to governance.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.