Better Care at Home East

Updated 19 March 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

The inspection was undertaken by an 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.

Service and service type

This service is a domiciliary care agency. It provides personal care to people living in their own homes.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

We gave the service two weeks’ notice of the inspection. This was because it is a small service and we needed to be sure the provider or registered manager would be in the office to support the inspection.

Inspection activity started on 12 November 2021 and ended on 26 November 2021. We visited the office location on 17 November 2021.

What we did before inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all this information to plan our inspection.

During the inspection

We spoke with three people who used the service and four relatives about their experience of the care provided. We also spoke with seven members of staff including the registered manager, the two office-based managers and four care workers.

We reviewed a range of records. These included three people’s care and medication records, two staff files in relation to recruitment and staff supervision, elements of a further seven staff recruitment records, and a variety of records relating to the management of the service, including policies and procedures.

Updated 19 March 2022

About the service

Better Care at Home East is a domiciliary care agency. It provides personal care to people living in their own homes. Not everyone who uses the service receives 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. At the time of the inspection, 15 people were receiving personal care from the service.

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

A strong person-centred culture was reflected in all aspects of the service. There was an emphasis on ensuring people were supported to live well, and this care and attention extended to those they lived with. It was clear in the way the registered manager and staff spoke with and about people and relatives, and in how care was planned and delivered. Staff demonstrated genuine empathy towards people. People and relatives told us how staff went above and beyond expectations, with acts of kindness that meant a lot to them.

The service was distinctive and innovative in how it trained and equipped its staff to take clinical observations and identify signs a person’s health might be deteriorating. People and relatives spoke very positively about the care received, saying staff were watchful for any changes in their or their loved ones’ health and contacted health professionals as needed. Because of this swift response, people were able to access healthcare without delay, avoiding the need for, or reducing the length of, hospital admissions.

The service worked closely with health and social care professionals, where necessary advocating for people to receive the treatment and equipment needed. This helped to ensure people had an improved quality of life, including being able to do things they cared about as they approached the end of their life.

People experienced an exceptionally responsive service that was tailored to their individual needs and wishes. People’s needs were thoroughly assessed and formed the basis of highly personalised care plans. There had been some simple but innovative reasonable adjustments to promote people’s independence and ensure their care needs were always met. Staff were attentive to people’s preferences and suggested practical ideas to improve their quality of life.

There was a strong emphasis on good nutrition and hydration for health, with close attention to people’s dietary needs and flexibility to accommodate people’s needs and preferences around eating and drinking. Call timings were organised so there was enough time for people to have any support they needed with preparing and eating meals. The registered manager and staff were attentive to poor food intake, poor hydration and weight loss, and the importance of respecting people’s preferences to address this.

People were supported to plan for and have a dignified, comfortable death in their own home, if that is what they wanted. End of life care planning took account of people’s ability to understand and communicate their wishes for the end of their life. Staff had the skills and empathy to understand and meet people’s and families’ needs at this time. Where necessary, the registered manager had provided a high level of practical assistance with arrangements after people died.

People and relatives had confidence in the ability of staff. Only staff of a suitable calibre were employed. However, there was one instance of reliance on an incorrect Disclosure and Barring Service (DBS) check. The registered manager addressed this immediately we drew it to their attention. We have made a recommendation about the service’s DBS process.

People, relatives and staff praised the quality and leadership of the service. They felt the management team were friendly, readily available and supportive. The registered manager encouraged them to give feedback and suggestions, which were promptly acted upon. The registered manager and staff were clear about their responsibilities and the high standards expected of them. The registered manager had clear oversight of the quality of the service.

People and relatives said they felt safe with staff. Managers and staff understood their roles in recognising and responding to abuse. Risks were assessed and managed safely, in a way that was acceptable to people. Staff adhered to infection prevention and control procedures. People received medicines support from trained, competent staff.

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.

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

Rating at last inspection

This service was registered with us on 17 June 2020 and this is the first inspection at which we have rated the service.

Why we inspected

This was a planned inspection based on the date the service was first registered and the focused inspection in November 2021.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.