BB Healthcare

Updated 27 February 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is 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.

This comprehensive inspection took place on 15 January 2018 and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we needed to be sure that someone would be in.

The inspection was undertaken by one inspector and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Before the inspection, we reviewed information we held about the service including statutory notifications sent to us by the registered manager about incidents and events that had occurred at the service. Statutory notifications include information about important events, which the provider is required to send us by law. We used this information to plan the inspection. We did not request a Provider Information Return (PIR) form. A PIR is a document that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We gave the registered manager and provider an opportunity to provide us with information that was relevant to our inspection.

During and after the inspection visit to the provider’s head office, we spoke with 15 people using the service and one relative. We also spoke to seven care staff; one care coordinator, one field supervisor and the registered manager.

We reviewed eight people's care records and their risk assessments and management plans. We looked at seven staff records relating to recruitment, induction, training and supervision. We looked at other records related to the management of the service including quality assurance audits, safeguarding concerns and incidents and accidents monitoring. We checked feedback the service had received from people using the service, their relatives and health and social care professionals.

Updated 27 February 2018

The inspection was announced and took place on 15 January 2018.

BB Healthcare is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides personal care to people with a variety of needs including older people, younger adults, people with a learning disability, physical disability and people who need support with their mental health.

Not everyone using BB Healthcare receives a regulated activity; 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. When we inspected, 46 people were being provided with ‘personal care’.

At our last comprehensive inspection on 13 September 2016, the overall rating of the service was, ‘Requires Improvement’. This summary rating was the result of us rating the key questions ‘safe’, ‘effective’, ‘responsive’ and 'well-led' as, ‘Requires Improvement’. We asked the provider to complete an action plan to show what they would do and by when to improve the key questions is the service safe, effective, responsive and well-led to at least good.

At our last inspection for the key question, ‘is the service safe?’ we found one breach of regulation. We found people were at risk of harm due to unsafe care practices being followed, this included the use of unsafe moving and handling techniques. We also found a staff member had not followed recommended safe practice for administering medicines.

For the key question, ‘is the service effective?’ we found that the service was not working within the principles of the Mental Capacity Act (MCA). People who may not be able to make certain decisions for themselves had not been assessed to determine if they were able to do so. We also identified that there were some staff who had not received the training they were expected to have completed to ensure they knew about the safest and latest best practices in connection with people's care.

For the key question, ‘is the service responsive?’ we found people may not have received the care they required due to this not being clearly explained in their care plans.

For the key question, ‘is the service well-led?’ the service did not have the required systems in place such as policies and procedures.

At this inspection the overall rating of the service was changed to, ‘Good’. We found significant improvements had been maintained and we rated each of our key questions as being, ‘Good’.

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.

People were protected from abuse. Staff followed the provider’s safeguarding procedures to identify and report concerns to people’s well-being and safety.

Comprehensive assessments were carried out to identify any risks or potential risks to the person using the service and to the staff supporting them. This included any environmental risks in people’s homes, risks in the community and any risks in relation to the care and support needs of the person.

Staff were recruited safely and trained to meet people’s individual needs. Wherever possible people were only supported by staff known to them and trained to meet their needs. There were enough staff assigned to provide support and ensure that people's needs were met.

People’s needs were met where staff were responsible for supporting medicine administration and ensuring people had enough to eat and drink. Staff supported people to access healthcare services when required. Clear records were kept and issues followed up on. Staff knew how to minimise the risk of infection.

Staff received support, regular supervision and attended training to enable them to undertake their roles effectively.

Staff were aware of the requirements of the Mental Capacity Act [2005] and the Deprivation of Liberty Safeguards [DoLS] which meant they were working within the law to support people who may lack capacity who may need to be referred under the court of protection scheme through the local authority.

People had a care plan that provided staff with direction and guidance about how to meet individual needs and wishes. These care plans were regularly reviewed and any changes in people’s needs were communicated to staff.

People were supported to live a full and active life, offered choice and staff had safeguards in place to support people to experience outings and for activities to go ahead.

People knew how to raise concerns and make complaints. People had details of how to raise a complaint and told us they would be happy to make a complaint if they needed to. We looked at records that demonstrated the complaints procedure had been followed.

There was a management structure within the service which provided clear lines of responsibility and accountability. There was a positive culture within the service and the management team provided strong leadership and led by example.

There were quality assurance systems in place to make sure that any areas for improvement were identified and addressed. The registered manager and care co-ordinators were visible in the office. They regularly visited people in their own homes and sought their views about the service.