Bell Green

Updated 30 June 2023

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 Health and Social Care Act 2008.

Inspection team

This inspection was carried out by 1 inspector.

Service and service type

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

Notice of inspection

This inspection was announced.

We gave short notice on 22 May 2023 to the registered provider. This was so they would be available to support the inspection process. We reviewed evidence on 23 and 24 May 2023 which had been shared with us electronically. We undertook a visit to the provider’s office location on 26 May 2023.

Inspection activity started on 22 May 2023 and ended on 26 May 2023.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and Healthwatch. The local authority purchase packages of care when people do not purchase their own care and support. 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 all of this information service to plan our inspection.

During the inspection

This inspection was carried out using technology using telephone calls and emails to enable us to engage with people using the service and staff. We used electronic file sharing to enable us to review documentation. We also undertook a site visit to the provider’s office.

We spoke with 1 person to gain their feedback on the service. Additionally, we gained feedback from 2 care staff and the registered provider who is also the registered manager of the service.

We reviewed a range of records. This included 1 person’s care plan and general risk management record. We looked at a variety of documents relating to the management of the service, including quality monitoring checks. We reviewed 3 staff employment records.

Updated 30 June 2023

About the service

Bell Green, also known as Asher Excellent Limited, is a domiciliary care agency which is registered to provide personal care and support to people in their own homes. The service is registered to provide support to younger adults and older adults, and people living with dementia. At the time of our inspection the service was supporting 1 person.

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 were not safe as the provider had failed to consistently identify and assess the risks associated with their care and support. The provider was aware of serious risks of harm and injury but had taken no action to address these or mitigate risks.

Care plans and general risk assessments failed to provide staff members with the information needed to ensure people received safe care which met their needs.

The provider had failed to put medicine administration records in place so there was no record of what medicines people had been supported with. There was no guidance in place for staff related to supporting people with other prescribed items such as creams.

The provider had failed to ensure staff were recruited in a safe way. Pre-employment checks were not fully completed on any of the staff employed.

People were not always protected from the risks of abuse because staff had no identify badge to show them before entering their homes.

Staff had not received all of the training they needed which meant that whilst they intended to have a caring approach toward people they supported, they were unable to identify unsafe caring practices.

The provider did not have effective systems and processes in place to monitor the quality of the service. Where the provider was aware of shortfalls, they had not taken any action to make improvements needed.

The provider’s office was a rented shared space with other unrelated businesses and could not offer any confidentiality related to meetings of telephone conversations.

The provider’s policies were not always fit for purpose, and they had not had effective oversight of these to ensure they had all the necessary policies and procedures in place for staff to refer to when needed.

People were supported to have maximum choice and control of their lives and the provider supported them in the least restrictive way possible and in their best interests. However, the provider had yet to develop policies and systems to support this.

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 12 September 2022, and this is the first inspection.

Why we inspected

This inspection was prompted by a review of the information we held about this service. This included concerns we identified about risk management.

Enforcement

Following our inspection visit, we asked the provider to respond to the immediate concerns we found. We continued to seek their updates and assurances they had mitigate the immediate risks to people.

We have identified breaches in relation to safe care and treatment, fit and proper persons employed and governance.

Please see the action we have told the provider to take at the end of this report.

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.

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. This means we will keep the service under review and, if we do not propose to cancel the provider's registration, we will re-inspect within 6 months to check for significant improvements. If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the

process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as

inadequate for any of the five key questions it will no longer be in special measures.