We carried out a themed inspection looking at domiciliary care services. We asked people to tell us what it was like to receive services from this home care agency as part of a targeted inspection programme of domiciliary care agencies with particular regard to how people's dignity was upheld, and how they can make choices about their care. The inspection team was led by a Care Quality Commission (CQC) inspector joined by an Expert by Experience who has personal experience of using, or caring for someone who uses this type of service. We carried out 18 telephone interviews and three home visits to people who use the service and to their main carers (a relative or friend) to gain views about the service. We visited the office on the 28 August 2012 and the 9 October 2012 to look at records and talk to the person in charge. We also talked to senior staff and three care workers. We also looked at the results from the organisation's own survey carried out in March 2012.
At the time of the inspection the manager told us that they had been experiencing staffing problems, in particular, issues with a high rate of staff sickness. Both she and supervisors had been doing care work to cover the shifts. She told us about the measures they had already put in place to improve the quality of the service, which included a recruitment drive to add a minimum of 20 extra care workers.
A large number of people we spoke with were unhappy with the reliability of the service, stating they frequently had care workers turning up late, and not staying the agreed length of time. A number of people commented about care workers being rushed. Some said they had also experienced care workers not turning up at all. People told us when they had rung the office to find out what was happening, office staff had been unhelpful and could give them no information or explanation.
One person summed it up by telling us, "The carers are absolutely brilliant, the big snag is the timing though. They are often late and there's nothing worse than waiting. And they don't ring you, so you start to get worried about them, because they are such nice girls". Another person we spoke with had similar issues saying, "Most of the carers are top class, some could do with a bit more training, but it's Fridays and the weekends when the care is unreliable. We are sick of it".
Healthcare professionals also told us they frequently made appointments to meet with the care workers in people's homes to discuss care, or to demonstrate the use of equipment and the care workers turned up late or not at all.
However, the majority of people we spoke with said they received good care from the individual care workers during their visit. People we spoke with said that they were treated with dignity and respect by the care workers while delivering care. Saying things like, "The carers are great, you couldn't fault them" and 'I wouldn't swap them, my carers are out of this world, it's great to see a friendly face come through the door."
The majority of people felt they had been involved with decisions about their care. They told us they had been involved in setting up their care plans, and that from time to time supervisors came to check up to see if any changes were needed.
People also reported to us concerns about the high turnover of staff. A number of social workers also told us that their 'clients' had complained to them about the number of care workers they had from Bethsaida. They had been worried about not knowing any of them, and not knowing who was going to turn up for the next visit. One person told their social worker, "This has been going on for some time and things have not changed. I have had 12 different carers in the past 28 days due to staff sickness and holidays."
Overall we concluded that general staff shortages were affecting all aspects of the quality of the service being offered to people. When we gave the manager and owner feedback on our concerns about the running of the agency they acknowledged the seriousness and expressed their determination to put things right as soon as possible. We were immediately sent an action plan following our visit on the 28 August 2012. Due to the nature of these concerns we revisited the service on 9 October 2012 to see if these proposed plans had improved the delivery of the service.
Following this second visit we noted some improvements which included employing two new care workers, with a further seven going through recruitment checks. Care plans continued to be updated by one of the supervisors. The agency manager had held meetings with the local social work team to discuss how they intended to organise the care worker's patches more effectively. However, we still found that people were experiencing frequent late calls, and occasional missed calls as a result of staff shortages but also due to poor organisation of care workers. These improvements were not at the pace and level necessary to ensure that people were offered a safe and effective service. We have taken enforcement action against Bethsaida Home Care Services.