Background to this inspection
Updated
23 August 2016
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the registered persons were meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service and to provide a rating for the service under the Care Act 2014.
Before our inspection visit to the service we reviewed any notifications of incidents that the registered persons had sent us since the last inspection. In addition, we contacted local health and social care agencies who pay for some people to use the service. We did this to obtain their views about how well the service was meeting people’s needs.
The inspection team consisted of two inspectors and an expert by experience. An expert by experience is a person who has personal experience of this type of service. The inspection was announced. The registered persons were given 48 hours’ notice because they are sometimes out of the office supporting staff or visiting people who use the service. We needed to be sure that they would be available to contribute to the inspection.
During the inspection visit we spoke a director of the company who also acted as the nominated individual. This is a legal role that the registered provider is required to fill so that there is a named person who is responsible for ensuring that the company complies with the conditions of its registration. We also spoke with the registered manager. In our report we refer to the nominated individual and the registered manager as being, ‘the registered persons’.
In addition, we spoke with a team leader and a deputy team leader and examined a number of records in the service’s administrative office. These records related to how the service was run including visit times, staffing, training and health and safety.
After our inspection visit the inspector spoke by telephone with 10 people who used the service and four relatives. In addition, our expert by experience spoke by telephone with a further 12 people who used the service and three relatives. Two inspectors then visited 20 people in their homes when they spoke with them and their relatives and examined documents relating to the planning and delivery of care. In addition, an inspector spoke by telephone with eight members of staff who provided care to people in their homes.
Updated
23 August 2016
We completed this inspection on 4, 5, 6, 7 and 8 July 2016. The inspection was announced.
Bloomsbury Homecare – The Butterfield Centre provides care for people in their own homes. The service can provide care for adults of all ages. It can assist people who live with dementia or who have mental health needs. It can also support people who have a learning disability, special sensory needs, a physical disability or who misuse drugs and alcohol. At the time of our inspection the service was providing care for 310 people most of whom were older people. The service covered Stamford, the Deepings, Bourne, Spalding and Grantham and surrounding villages.
The service was previously registered to operate in Lincolnshire and provided care to a small number of people in their homes who lived in Spalding, Grantham and Lincoln. This service was run from an office that was not based in Lincolnshire. In late Autumn 2015 the service won a much larger contract with the local authority that involved it providing care to people in their homes in Stamford, the Deepings and Bourne. As a result of this development the company decided to open a new office in Bourne from which to administer the extended services it had been commissioned to provide in Lincolnshire. We registered this new arrangement on 29 January 2016 and this was our first inspection since that date.
There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. This was because the registered persons had not always provided staff at the right time to safely care for people some of whom needed to be helped to use medicines. The procedure used to recruit new staff was not robust. Although most people had received the basic care they needed some people were not being reliably assisted to eat and drink enough to promote their good health. Furthermore, the registered persons had not always effectively resolved complaints. All of these problems resulted from the registered persons not operating a system of rigorous quality checks. A further shortfall involved the registered persons not telling us about significant events that had happened in the service and this had reduced our ability to make sure that people were kept safe. You can see what action we told the registered persons to take at the end of the full version of this report.
Possible risks to people’s health and safety had not been effectively managed and this had increased the risk that avoidable accidents would occur.
Some people who paid for the service on a private basis had not always been provided with bills that accurately reflected the service they had received and had been over-charged.
Some staff did not have all of the knowledge and skills they needed in order to care for people in the right way and the registered persons had not consistently provided staff with the guidance and training they needed.
The registered persons and staff were following the Mental Capacity Act 2005 (MCA). This measure is intended to ensure that people are supported to make decisions for themselves. When this is not possible the Act requires that decisions are taken in people’s best interests.
People were not always treated with kindness, compassion and respect.
People had not always been consulted about the care they wanted to receive. In addition, care was not always planned, delivered and assessed in a consistent way.
People had not been fully consulted about the development of the service and had not benefited from staff acting upon good practice guidance. However, the service was run in an open way and staff were able to speak out if they had any concerns about poor practice.