Boldglen Limited Medway Swale

Boldglen Limited Medway and Swale is a domiciliary care service providing personal care to people living in their own homes. The service also provided personal care to people living in flats within an extra care housing scheme in the borough of Swale. 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. The service was providing personal care to 65 people at the time of the inspection.

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

People and relatives had positive views about the service. Comments included, “The care I get is very good and really appreciate it”; “My carer really understands how I like things done and she always makes sure that is what I get”; “I think that they do a good job. The most important thing is that she is comfortable and happy with them” and “I would highly recommend them.”

We could not be assured new staff were adequately checked to ensure they were suitable to work with people to keep them safe. We found no evidence that people had been harmed however, systems were not robust enough to demonstrate staff recruitment was effectively managed.

There was a quality and assurance system in place and the provider had carried out the appropriate checks to ensure that the quality of the service was maintained. The provider had identified issues relating to people’s care and taken action to address these. However, the provider’s quality monitoring processes had not identified issues with safe recruitment practice, this is an area for improvement.

Risk assessments were in place to provide guidance to staff on how to support people. These were detailed and clear. However, safe ways of working when pets were present in a person’s home were not always listed. We discussed this with the registered manager as an area for improvement. Care plans contained up to date information about people’s medicines, as well as their care and support needs.

Prior to people receiving a service their needs were thoroughly assessed. People’s oral care, medicines and health needs were included in the information obtained before care packages started to enable staff to provide safe, person-centred care and support.

The provider had an up to date infection prevention and control (IPC) policy. Staff had completed IPC training. Staff had access to enough personal protective equipment (PPE) and wore this to keep themselves and people safe.

Enough staff were deployed to keep people safe. People were supported by regular staff who they knew well. Staff were well supported by the management team. Staff had completed mandatory training.

Care plans were in place which provided a list of tasks for staff to complete. These were person centred and detailed to show new staff what all the tasks were. People and their relatives told us staff knew their needs and preferences well. They told us they had been involved with the care planning process.

People and relatives knew how to complain. 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 and update

The last rating for this service was requires improvement (published 23 October 2019). We served the provider conditions on their registration after the last inspection.

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At the last inspection, we recommended that the provider reviews how to effectively deploy staff to enable them to carry out their duties to meet people's care and support needs and update their travel time practice accordingly. At this inspection we found the provider had acted on the recommendation.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations 9, 11, 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider remained in breach of regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safe recruitment practice. This service has been rated requires improvement for the last three consecutive rated inspections.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

Enforcement

We have identified a breach in relation to safe recruitment practice at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

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

Boldglen Limited Medway and Swale is a domiciliary care service providing personal care to people living in their own homes. The service also provided personal care to people living in flats within an extra care housing scheme in the borough of Swale. Not everyone who used the service received personal care. The Care Quality Commission (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. The service was providing personal care to approximately 177 people at the time of the inspection.

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

There continued to be shortfalls in the service provided to people.

Individual risks were not always assessed and managed to keep people safe. People could not be sure their prescribed medicines were always managed in a safe way. When people had accidents and incidents, appropriate reports had not been completed which meant action had not been taken to review and reassess people’s care needs and medical professionals had not been informed.

People could not be assured new staff were adequately checked to ensure they were suitable to work with people to keep them safe. We found no evidence that people had been harmed however, systems were either not robust enough to demonstrate staff recruitment was effectively managed. Staff had not always been allocated travel time to enable them to travel between care calls, this meant people received late care calls and staff were rushed to get to their next care call. One person told us, their staff member frequently finished their care call early.

Although initial assessments were undertaken with people before they received a service, the information gathered was not always used to develop a care plan where needed. Care plans were in place. However, care plans were inconsistent and did not always detail the relevant information staff would need to meet people's assessed care and health needs.

Records were not always accurate, complete or contemporaneous. Although there had been audits and checks of the service completed, these were not robust. This meant the management team were not always aware of concerns, changes in health or medicines issues, which led to delays in action being taken where needed.

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.

Staff had received training to make sure they had the skills to meet people's specific care needs. Staff told us they felt well supported by the management team.

Most people and relatives gave us positive feedback about their care and support. They told us, “They are all wonderful and see to my needs well”; “I have a regular male carer, who has become more of a friend. Knows me well”; “I am very happy with my carers”; “They are excellent” and “They phone me and ask how things are by way of feedback and I told them I am very happy with them.” One relative and one person raised some concerns in their feedback which we reported to the registered manager so that the management team could address these.

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 rating at the last inspection was requires improvement (published 23 October 2019) and there were breaches of regulation 9,11,12,17, 18 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The provider completed an action plan after the last inspection to show what they would do and when they would improve by. We met with the registered manager on 31 October 2019 to discuss the repeated rating of requires improvement and set out expectations as well as listened to their planned improvements.

At this inspection we found the provider had made some improvements by ensuring that staff received training and support to carry out their roles safely and consent and capacity had been improved. However, the provider requires further improvement in medicines management, risk assessment, safe recruitment practice, effective staff deployment, effective assessment and care planning and effective quality monitoring.

Why we inspected

CQC have introduced targeted inspections to follow up on requirement actions, warning notices or to check specific concerns. They do not look at the 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 the key question.

We undertook this targeted inspection to check whether the Warning Notices and Requirement actions we previously served in relation to Regulation 9, 11, 12, 17, 18 and 19 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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Boldglen Limited Medway Swale on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of 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 identified a new breach of Regulation 18 (Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to effective deployment of staff. 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.

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.

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.

Boldglen Limited Medway and Swale is a domiciliary care service providing personal care to people living in their own homes. The service also provided personal care to people living in flats within an extra care housing scheme in the borough of Swale. Not everyone who used the service received personal care. The Care Quality Commission (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. The service was providing personal care to approximately 157 people at the time of the inspection.

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

Staff had not always been recruited safely to ensure they were suitable to work with people. The provider had not carried out sufficient checks to explore staff members' employment history to ensure they were suitable to work around people who needed safeguarding from harm. People told us they had regular staff who they knew well. Their regular staff arrived at the right time to meet their needs.

Risks to people had not always been identified to ensure staff had the guidance necessary to follow a specific plan to prevent harm. Risk assessments were not in place where people had health conditions.

Medicines were not always managed safely. Medicines administration records (MAR) were not completed in a safe way to make sure people received their medicines as prescribed as they were missing essential information.

Accidents and incidents relating to people had not always been recorded. This meant that lessons could not be learnt and risks to people’s safety had not been reviewed and assessed in a timely manner, which put people at increased risk of harm.

Although initial assessments were undertaken with people before they received a service, the information gathered was not always used to develop a care plan where needed. Some care plans were in place. However, care plans relating to people’s health needs were missing which meant that staff did not have all the relevant information to meet people’s needs. Although people’s health and medical conditions were not included in a care plan, staff knew people well. Where people did need assistance, staff contacted the office staff to alert a health care professional or family member if people were unwell.

Records were not accurate, complete or contemporaneous. There had been no robust audits or checks of the service completed since our last inspection by the registered manager or provider.

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; but the policies and systems in the service did not support this practice.

Staff had not received training to make sure they had the skills to meet people’s specific care needs. Staff had not completed epilepsy awareness training, diabetes awareness, stroke awareness or catheter care training despite providing care and support for people with these conditions. This meant people were at risk of harm from not receiving appropriate care and support to meet their needs.

People told us they often experienced changes to times of care and support when their usual staff member was off, this led them to receive care and support at adhoc times which did not always meet their needs. We made a recommendation that the provider reviews how to effectively deploy staff to enable them to carry out their duties to meet people’s care and support needs and update their travel time practice.

People and their relatives told us their choices and decisions were listened to and they were in control of their support. People had only good things to say about the staff. On a day to day basis people directed their care. People and their relatives told us they were asked how they liked things to be done. People said staff treated them with dignity and their privacy was respected. People were supported to be as independent as possible.

People gave us positive feedback about their care and support. They told us, “My carer is there for me”; “When I have really down days I feel more positive when they come, I am able to talk to [staff member] and tell her what is upsetting me”; “She [staff member) knows me so well, very considerate, always asks if I need anything else done before she leaves”; “Staff aware of my needs, generally ask so that they know how to treat me, they are interested on how my health affects me”; “Happy with the care I get from my carer” and “[Staff] reassure me if I am unwell, always ask what I would like done to help me.”

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 service was rated requires improvement at the last inspection on 12 June 2018 (the report was published on 10 August 2018) and 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. At this inspection, not enough improvement had been made and the provider was still in breach of regulations.

The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified continued breaches in relation to; failure to ensure the safe management of prescribed medicines, failure to take appropriate actions to mitigate risks to people's health and welfare and failure to plan care and treatment to meet people's needs and preferences. Registered persons had also failed to operate effective quality monitoring systems and failed to ensure records were accurate and complete.

We also identified new breaches in relation to failing to provide care without the consent of the relevant person, failure to operate effective recruitment procedures and failure to provide staff suitable training to enable them to carry out their roles safely.

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.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

This service is a domiciliary care agency. It provides personal care to any adults who require care and support in their own houses and flats in the community. Not everyone using Boldglen Limited Medway Swale receives 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. At the time of inspection, although the service supported approximately 250 people in total, approximately 120 people were receiving personal care in their own homes.

A registered manager was employed at the service by the provider. 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 our last inspection on 11 March 2016, the service was rated as ‘Good’. At this inspection, we found that there were now areas that required improvement. This is the first time the service has been rated Requires Improvement.

Individual risks were not always identified to ensure measures were put in place to help keep people safe and prevent harm. Environmental risks inside and outside people’s homes were documented to keep people and staff safe from identified hazards.

Some areas of the management of people’s prescribed medicines needed improvement to ensure safe administration by staff at all times. Gaps were evident in medicines administration records (MAR). Guidelines and information about the medicines people took were not available.

A safeguarding procedure for staff to follow should they have concerns about people was available to staff. People told us they felt safe and knew who they would talk to if they did not.

Staff followed safe practice to control the risk of infection and always had enough equipment such as disposable gloves and aprons available to wear.

The provider and registered manager followed safe recruitment practices to make sure only suitable staff were employed. Enough staff were available to be able to run an effective service and be responsive to people’s needs. People told us they always, had the same staff supporting them; staff were on time when visiting; always stayed for the full time they were allocated.

Staff had suitable training at induction when they were new as well as continuing regular updates. Staff were supervised by a manager regularly to check their competency and offer support.

People told us they made their own decisions and choices. The registered manager understood the basic principles of the Mental Capacity Act 2005 and made sure their processes upheld people’s rights.

Although many people did not require the assistance of staff with their nutrition and hydration needs, some people did require this support. People and their relatives told us they were happy with the support given by staff and it worked well.

Many people did not require the assistance of staff to look after their health care needs as they either managed this themselves or had a relative or friend to help. Where support was required, people told us staff were observant and offered advice or to make appointments with healthcare professionals.

The positive and caring approach of staff was clear from the responses of people and their relatives, telling us how happy they were with all the staff who supported them. People told us they had regular staff providing their care and support so had got to know them well, creating confidence and trust. People were given a service user guide at the commencement of their care and support with the information they would need about the service they should expect.

An initial assessment was undertaken of people’s personal care needs so the registered manager could be sure they had the staff resources with the appropriate skills available to support people. People had a care plan to detail the individual support they required as guidance for staff. The information in the care plan was basic and did not always provide the level of information needed to ensure care and support was consistent. Assessments and care plans did not record the personal information necessary to provide a holistic guide to people’s support.

The provider had an up to date complaints procedure. No complaints had been made and people told us they had no need to complain but knew what to do if they did.

Although the provider had some systems in place to monitor the quality and safety of the service, these were not always used effectively to identify where improvements were needed and take action.

The provider sought people’s views of the service on an annual basis and regularly during their care plan reviews. Feedback was primarily positive. The registered manager had taken action when people had raised an issue that required improvement.

We received good feedback from people and their relatives about the running of the service, particularly about their regular care staff.

Staff were positive about the support they received from the provider, the registered manager and the office team.

During this inspection, we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations. You can see what action we told the provider to take at the back of the full version of this report.

Boldglen provides personal care to older people, including people with dementia and physical disabilities in their own home and support in the community. The agency provides care for people in the Medway area and Swale which includes Sittingbourne and the Isle of Sheppey. There were around 200 people receiving support to meet their personal care and community support needs on the day we inspected.

The service had a registered manager. 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 against the risk of abuse. Staff recognised the signs of abuse or neglect and what to look out for. Both the registered manager and staff understood their role and responsibilities to report any concerns and were confident in doing so.

Risk assessments were detailed and gave staff guidance about any action staff needed to take to make sure people were protected from harm.

Effective recruitment processes were in place and followed by the registered manager. Staff had the opportunity to discuss their performance during one to one supervision meetings and annual appraisal. Staff also received appropriate training with timely refresher training so they were supported to carry out their roles.

There were suitable numbers of staff on shift to meet people’s needs. People’s planned care was allocated to members of staff and at appropriate times.

People were supported and helped to maintain their health and to access health services when they needed them.

People told us staff were kind, caring and communicated well with them. People’s information was treated confidentially. Paper records were stored securely in locked filing cabinets.

Procedures and guidance in relation to the Mental Capacity Act 2005 (MCA) was in place which included steps that staff should take to comply with legal requirements.

People’s view and experiences were sought through review meetings and through surveys. People’s views about the service were positive.

People were supported to be as independent as possible. People had access to additional resources through the service to prevent loneliness.

People told us that the service was well run. Staff were positive about the support they received from the registered manager. They felt they could raise concerns and they would be listened to.

Audit systems were in place to ensure that care and support met people’s needs.

Communication between staff within the service was good. They were made aware of significant events and any changes in people’s behaviour.