Bspoke Social Care

Bspoke Social Care is a domiciliary care service providing care and support to older people and younger adults, as well as people who may be living with a learning disabilities or autistic spectrum disorder, dementia, mental health needs, or a physical disability.

Not everyone using the service receives regulated activity; the Care Quality Commission (CQC) only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the time of our inspection 24 people were being supported with personal care.

At the time of our inspection, the service was not providing support with personal care to anyone with a learning disability or autistic spectrum disorder. Non-the-less the service applied the principles and values of Registering the Right Support and other best practice guidance. These principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence.

People’s experience of using this service

People were at risk of receiving unsafe or ineffective care. Medicines had not been managed safely; information about people’s needs, risks to their safety and how these risks should be managed had not always been recorded.

New staff completed shadowing to learn how to meet people’s needs, but had received limited formal training or practical training. The provider did not have a robust approach to assessing and evidencing new staff had the skills and knowledge needed to safely support people. Clear and complete records were not always available to show risks had been assessed and managed. More detailed audits were needed to monitor the quality and safety of the service.

We made a recommendation about exploring and recording any wishes and views people had for care and support approaching the end of their life.

People and relatives consistently praised the kind and caring staff. They told us they felt safe with the support staff provided and complimented the person-centred support they received. People enjoyed staff’s company and had developed positive caring relationships with them. Staff understood people’s needs and took account of people’s likes, dislikes and personal preferences when providing care. People’s privacy and dignity were maintained.

New staff were safely recruited. The provider made sure enough staff were deployed and people praised the reliable staff who arrived on time and never missed visits. Staff were supported to identify and respond to any safeguarding concerns.

People were supported to receive medical attention if they were unwell or an accident or incident occurred.

Staff listened to people and followed their instructions. 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.

People felt able to raise any issues or concerns. The provider listened and responded to any complaints about the service.

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

Rating at last inspection

At the last inspection service was rated Good (report published 7 December 2016).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified a breach in relation to the governance of the service 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 for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We inspected the service on 19 October 2016. The inspection was announced.

The service was managed on a full-time basis by the owner who worked in the service on a daily basis, both in the office and delivering care. The owner was the registered provider (‘the provider’) with legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run.

CQC is required by law to monitor how a provider applies the Mental Capacity Act 2005 (MCA) and to report on what we find. Staff demonstrated their understanding of how to support people who lacked the capacity to make some decisions for themselves and reflected in this in the way they provided care and support.

People and their relatives told us that they were satisfied with every aspect of the service they received. In particular, the provider’s careful approach to managing staffing resources which meant people were supported by the same staff on a consistent basis.

Staff had the knowledge and skills required to meet people’s individual needs effectively. Staff also knew how to recognise and report any concerns to keep people safe from harm. The provider assessed potential risks to people's personal safety and gave staff detailed guidance on how to address them. People who needed staff assistance with their medicines were supported safely. Staff also worked closely with local health and social care services and supported people to access any specialist support they needed.

Staff had established warm, friendly relationships with people and went out of their way to help them in any way they could. People were involved in planning the care they received and their needs and wishes were understood and followed by staff. People were supported to prepare food and drink of their choice, whenever this was required. Staff treated people with dignity and respect and encouraged them to maintain their independence.

The provider had an open, responsive management style which set the cultural tone within the service. She was well-known to, and respected by, everyone connected to the service. She had a strong professional and personal commitment to the provision of person-centred care which was understood by her staff and reflected in the support they provided to the people who used the service. Staff worked together in a supportive way. They enjoyed working for Bspoke Social Care and felt listened to by the provider.