Blossoming Hearts Care Agency Ltd.

Blossoming Hearts Care Agency Ltd is registered as a domiciliary care agency providing the regulated activity ‘personal care’ to people who live in their own homes in Grantham, Ancaster and Harlaxton. At the time of the inspection there were 23 people using the 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

Risks associated with people’s care and support had been identified and risk assessments were in place. Systems were in place to enable staff to support people safely with the application and removal of transdermal medicines. Records showed staff were allocated travel time between care calls.

There was an electronic care planning system in place which the registered manager used to have oversight of the care being provided to people. Staff received training in safeguarding and moving and handling. There was evidence the provider had acted on feedback received.

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

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 12 and 17 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.

We use targeted inspections to follow up on Warning Notices or to check 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, which will help inform when we next inspect.

Blossoming Hearts is a domiciliary care agency. It provides personal care to people aged 18 and over living in their own homes and flats.

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 support to 20 people with personal care needs at the time of our inspection.

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

We found a lack of oversight of systems and processes, particularly with regard to updating care plans and risk assessments. Risk assessments and care plans were not updated, and some staff were not aware of how to mitigate risks, which placed people at risk of harm. We did not find there was direct impact to people because of this, but the provider fully accepted the potential risks and had already started to work on improving these.

Staff had good insight as to people's likes and dislikes and respected their wishes, despite the lack of information about people’s preferences and choices. People and relatives supported this with both written and verbal reports about the level of care they received.

The system to monitor staff training was not effective. Staff had not had annual refresher training where it was required. Staff were unaware of the training they had completed although they did know what to do and who to go to for assistance, including safeguarding. However, further action was needed in relation to the moving and handling training, particularly with using equipment in confined spaces.

Staffing was not adequate as systems did not allow time for travelling from person to person. People and their relatives commented carers did not always stay their allotted time or were late arriving because of this. Transport for staff was raised as part of the problem.

There had been some difficulties covering shifts at short notice, partly due to staff being unfamiliar with a different system and partly due to difficulties with wifi and telephone signals in rural areas. Short notice sickness also caused a problem. The management team recognised this could be improved with better communication going forwards, and a review of rotas as well as additional recruitment.

The registered manager and director had learnt from a previous report and had put robust and safe methods in place for recruitment. All information was correct and appropriate to ensure safe recruitment was in place. When there had been a lack of understanding about regulations this was immediately addressed.

PPE supplies were good and there were positive comments about the appropriate use of PPE by Staff from people and relatives. People felt confident with their care delivery.

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; There were policies and systems in the service to support this practice.

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

Rating at the last inspection and update

The last rating for this service was Requires Improvement published 7 August 2019 with two breaches of regulations. The provider failed to complete an action plan after the last inspection 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 regulations. The service remains rated Requires Improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

The inspection was prompted in part due to concerns received about infection control and safe staffing practices. A decision was made for us to inspect and examine those risks.

We looked at infection prevention and control measures under the Safe key question. We look at this in all inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has not changed from Requires Improvement. This is based on the findings at this inspection.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Blossoming Hearts 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 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 found evidence that the provider needs to make improvements. We have identified breaches in relation to Regulation 12 (Safe Care and Treatment), and Regulation 17 (Governance)

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.

Blossoming Hearts Care Agency Limited is registered as a domiciliary care agency providing the regulated activity ‘personal care’ to people who live in their own homes in Grantham and surrounding areas. At the time of the inspection visit there were 25 people using the service.

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

This was the providers first inspection since registering with us. We found several shortfalls regarding systems and processes which meant people were placed at potential risk of harm. We did not find that there was direct impact to people because of this, but the provider fully accepted the potential risks and acted immediately to rectify the shortfalls.

Staff were not recruited safely. The provider had not undertaken their own criminal records checks relating to two staff employed. The provider implemented immediate measures to check all staff recruitment and restricted lone working of staff who did not currently have enhanced disclosures undertaken by the provider. Recruitment interviews were not structured to enable the provider to fully assess the competence and suitability of candidates, following the inspection the provider developed a comprehensive set of interview questions to use in all future interviews. Improvements were also required to ensure pre-employment checks and full employment history were thorough and comprehensive.

The provider did not always follow their own medicines policy which resulted in several shortfalls in relation to the administration of medicines. Informal observations of medicines administration were being done by the registered manager, but this was not formally recorded. The registered providers own policy included a pro forma for undertaking formal observations, but this was not being used.

Improvements needed to be made to risk management. Pre-admission assessments were being routinely carried out and had identified areas of risk for people, these risks were not always formally assessed and the provider did not provide staff with sufficient information about how to reduce risk.

The service employed sufficient numbers of staff to ensure that people receive the support they require. Staff received safeguarding training and were aware of how to protect people from abuse.

Staff received infection control training and were aware of how to reduce the spread of infection on a day to day basis.

People's needs were assessed at the point of using the service and included evidence of the involvement of people using the service. The provider described how people were involved and consented to their care, but this was not always formally recorded to demonstrate people's consent to care and treatment. People told us they were asked for consent. Staff received training to carry out their roles effectively. People had access to healthcare services and the provider worked with a range of health and social care professionals. 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 were caring and treated people with respect, kindness and compassion. People and relatives confirmed this. The provider had developed a positive culture and had the interests of people using the service at heart. People were consulted about their care and were asked to provide their views and opinions about the service they receive. We saw evidence of high levels of satisfaction and many written compliments about the service being provided. Staff told us that people's privacy and dignity was upheld to the highest standards, people confirmed this. Care plans would benefit from more information about people's likes and dislikes and could be more person centred. There was evidence good person centred information was obtained for a document called the 'hospital grab pack'. People's care plans would benefit from having similar information about them so that staff are clear about what is important to people.

The service had received no complaints in the last 12 months. The provider described a philosophy of addressing lower level issues promptly to avoid formal complaints being made. We saw evidence of many compliments made by people using the service. Staff received end of life training and could describe what good end of life care looked like.

Governance systems required improvement to ensure regulatory requirements were met. Care plan audits were being undertaken, but no other 'themed' audits were being carried out to check that regulatory requirements were being met. There was no formal evidence that the provider was analysing data to learn lessons. The provider told us anecdotally how lessons had been learned from previous experiences but this was not formally recorded to demonstrate the continual improvement the service had made.

Staff were very positive about the support and guidance they receive from the provider. The registered manager and director have a 'hands on' style of leadership which has benefited people using the service. Staff were engaged and enthusiastic about their roles.

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 07/03/2018 and this is the first inspection.

Why we inspected

This was a planned comprehensive inspection.

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.