BGS Healthcare Ltd

About the service

BGS Healthcare Ltd is a domiciliary care provider providing personal care to 104 people at the time of our inspection.

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.

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

People’s medicines were managed, administered and disposed of safely. Improvements had been made to the management, recording and support people received with their medicines.

The service worked well with other professionals to ensure people had their prescribed medicines.

People were supported by staff who were trained in medicines management and had been observed administering medicines to ensure they were following safe practices. Staff told us they were confident managing medicines.

The registered manager had good oversight on the management of medicines, there were a number of effective quality assurance protocols in place to ensure medicines were consistently managed safely

There were clear policies and procedures in place to support the safe administration of medicines.

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

Rating at last inspection

The last rating for this service was requires improvement (published 22 August 2019). There were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

We completed a targeted inspection on 8 July 2020, this inspection was prompted in part due to concerns received about medicines management. A decision was made for us to inspect and examine those risks.

Following our last inspection, we served a warning notice on the provider and the registered manager. We required them to be compliant with Regulation 17 (good governance) of the Health and Social Care Act 2008 (Regulated Activities) 2014 by 04 September 2020. At this inspection we found enough improvements had been made to meet the warning notice.

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 17 (good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

BGS Healthcare Ltd is a domiciliary care service providing personal care to people living in their own homes and flats. At the time of this inspection there were 97 people receiving a service.

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.

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

People did not always have their medicines as prescribed. People’s medicines administration records had not always been accurately recorded which had led to medicines errors. The provider informed us they had changed their methods of working and had put in place systems to check the accuracy of recording.

Where medicines errors had occurred there was limited evidence of analysis or learning. The provider audited medicines and had action plans for improvement in some areas but it was limited and did not consider all factors.

Staff had been trained to administer medicines but had not always had their skills checked for competence in all areas. For example, most of the staff applied topical creams for people. Application of creams had not always been demonstrated or checked by the provider.

The provider had policies for medicines but limited procedures. This meant the staff were not following clear procedures on how to administer medicines safely. Whilst staff could call the office at any time if they were unsure, procedures guide the staff as to how to administer all types of medicines safely.

Despite the shortfalls we have found, people were happy with the support they had from staff to administer their medicines. They felt the staff were competent and helpful. Staff told us they felt competent and were able to ask at the office if they were unsure of anything.

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

Rating at last inspection (and update) - The last rating for this service was Requires Improvement (published 22 August 2019). Following that inspection the provider completed an action plan to show what they would do and by when to improve.

At this inspection enough improvement had not been made and the provider was still in breach of regulation.

Why we inspected

We undertook this targeted inspection to check on a specific concern we had about medicines management following a serious medicines error. The overall rating for the service has not changed following this targeted inspection and remains Requires Improvement.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Enforcement

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified a continued breach of Regulation 17 (good governance) of the Health and Social Care Act 2008 (Regulated Activities) 2014 in relation to medicines management and management oversight at this inspection. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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 to check improvement has been made. If we receive any concerning information we may inspect sooner.

BGS Healthcare Ltd. is a domiciliary care service. It provides personal care to people living in their own homes and flats. BGS was supporting 107 people in their homes at the time of our inspection.

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.

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

Following our last inspection, we served a warning notice in relation to safe management of medicines. At this inspection we found that the provider had met the warning notice however still required further improvement regarding quality assurance of medicine management. We will follow this up at the next inspection.

The service had implemented monthly medication audits in order to maintain oversight of medicine administration. We saw audits in place to monitor medicines management were not always robust.

Peoples were supported to manage their medicines safely. Staff received training in medicines management and were knowledgeable about safe medicine administration.

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

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 22 August 2019). There were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when they would have improved.

Following our last inspection, we served a warning notice on the provider and the registered manager. We required them to be compliant with Regulation 12 (safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 by 30 September 2019.

Why we inspected

This was a targeted inspection based on the warning notice we served on the provider and the registered manager following our last inspection. CQC are conducting trials of targeted inspections to measure their effectiveness in services where we served a warning notice. The provider completed an action plan after the last inspection to show what they would do and by when to improve the governance of the service.

We undertook this targeted inspection to check they had followed their action plan and to confirm the service now met legal requirements. This report only covers our findings in relation to medicines management at the service. The overall rating for the service has not changed following this targeted inspection and remains requires improvement. This is because we have not assessed all areas of the key questions.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

BGS Healthcare Ltd. is a domiciliary care service. It provides personal care to people living in their own homes and flats.

People’s experience of using this service:

We found the service to be in breach of three regulations. These were in relation to safe care and treatment, failure to submit required notifications and good governance around recording and quality assurance.

This is the third consecutive time we have rated this service requires improvement.

Medicines were not always managed safely. Records were not always fully completed, and medicine was left out for people to take independently when they required assistance.

Quality assurance systems were not always effective, they failed to identify some inconsistencies in recruitment practice and safety concerns.

We made a recommendation regarding staff training on the mental capacity act. Staffs understanding of the Act was inconsistent.

People told us staff asked them for consent before supporting them with care tasks.

People’s care plans were personalised; staff knew people well and people told us they were happy with the care they received.

People told us staff treated them kindly and with respect.

Staff supported people to maintain independence and promoted dignity in their care. People’s confidential information was stored securely.

Staff received regular training and had regular one to one support from their line manager.

Rating at last inspection:

At our last inspection, this service was rated as requires improvement overall. Our last report was published on 5 June 2018.

Why we inspected:

This was a scheduled inspection based on the previous rating.

Enforcement:

Some information regarding the actions the provider needs to take can be found at the end of the report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representation and appeals have been concluded.

Follow up:

We will continue to monitor intelligence we receive about the service until we return in accordance with our re-inspection schedule. If any concerning information is received, we may inspect sooner.

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

At the time of this inspection BGS Healthcare Ltd was providing a service to 115 people. The service also supports people on a short term basis who have been discharged from hospital. This inspection took place on the 17 April 2018 and was announced which means the provider had short notice that we would be visiting.

A registered manager was in post and available throughout the inspection. 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. The registered manager was supported by two other directors, one of which was also present during our visit and, a team of office staff.

At the last inspection in March 2017 we found a breach of Regulation 17, Good governance. The service was rated as Requires Improvement. The provider sent a report of actions to us on how they would make the necessary improvements to meet this regulation. A recommendation was also made in relation to the provider ensuring they had a robust system in place for monitoring staff training and development.

At this inspection we found the service had met the previous breach identified, however we identified another breach of Regulation 12 Safe care and treatment in respect to the management and recording of people’s medicines. This is the second consecutive time the service has been rated Requires Improvement. We will be asking the service for a report of actions of how they will make the necessary improvements and the service will be re-inspected to check this has been done.

We have made a recommendation to the service that they seek advice, guidance and further training from a reputable source, in following the principles of the Mental Capacity Act and ensuring all staff understand their role and responsibilities in supporting people around this.

We have made a second recommendation that the service review the documentation of people’s care and support to reflect a person centred approach to the care being provided.

Risks to people’s personal safety had been assessed and plans put in place, however these did not always provide clear detail on how to minimise the risks. Risk assessments were in the form of tick boxes. Some risk assessments were incorrectly completed and this had not been identified during reviews.

People we spoke with told us they had not experienced any missed visits, however people consistently raised that the times of visits were varied and this caused frustration. We raised this with the management team.

Quality assurance systems were in place to monitor the quality of service being delivered. However, completed audits had not identified all of the concerns we found during this inspection.

The service had taken measures since our last inspection to improve the monitoring of call visits. There was now a system in place to monitor when staff arrived and left care visits. All staff had a work phone issued to them and received their rota’s and information by email which was password protected.

People told us they were happy with the care they received and spoke positively about the staff. We saw that staff were encouraged to spend time during care visits talking to people and one person’s care plan recorded that if staff had any spare time they should use it to chat with the person.

The majority of people we spoke with told us the service was well managed and the registered manager was very approachable. Staff told us they felt well supported by the management team and interest was taken in their work and personal needs.

We were made aware that the registered provider address had changed when we gave notice of a an inspection in July 2016. We decided to wait until the registration of the new address had been completed before we conducted an inspection to ensure the findings would not be related to the previous provider name and address which would be de registered. At the last inspection 4 June 2015, we rated the service good overall. However we rated the well led domain as ‘requires improvement’ because although the service carried out regular audits to monitor the quality of the service, there were no records to show these had taken place, or whether any improvements had been identified.

A registered manager was employed by the service who was present throughout the inspection. The registered manager is also one of three owners, two of whom were present throughout the inspection. 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.

At this inspection we found the service required improvement overall.

We had not been notified as required of safeguarding alerts made to the local authority. Systems to identify if visits were missed or late were not robust.

Safe recruitment checks had been completed, however one record did not show the applicant’s full employment history.

The registered manager explained they had recognised that the recording of training was not robust and that this had prompted a review of their systems. However, as the system was not fully functioning, we could not see how effective it was.

People and relatives we spoke with were very complimentary about the standard of care and support they received, and were confident the staff had the skills and training in order to meet their needs.

There was a process in place for seeking consent to care, and staff were aware of the principles of the MCA.

The registered manager and staff were aware of what to do in order to keep people safe, such as how to make a safeguarding referral to the local safeguarding authority. People told us they received their medicines as prescribed.

Staff had developed positive relationships with people using the service and were described as being compassionate and kind.

Staff were passionate about providing good quality care and said they felt supported by the management team.

You can see what action we told the provider to take at the back of the full version of the report.