Bhandal Care

Bhandal Care is a domiciliary care agency. The service provides personal care to older and younger adults, who may also be living with physical and sensory disabilities, dementia, mental health or learning disability and / or autism. At the time of our inspection there were 28 people using the service.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people

The service was not able to demonstrate how they were meeting some of underpinning principles of “Right Support, Right Care, Right Culture.

Right support: We have made a recommendation about care plans. Care plans did not always have sufficient detail on behaviours that challenged to ensure staff provided consistent care. Care plans and risk assessments were in place for other areas of people’s care needs. Systems were in place to help protect people from the risk of abuse. There were enough staff for people to receive timely care and checks on the suitability of staff to work at the service had been made. Steps were taken to help prevent the risks from infections. Medicines were managed safely and lessons were learnt when things went wrong.

Right care: 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. People’s needs were assessed and staff were trained in areas relevant to people’s care needs. People were supported to eat and drink well and staff worked with other agencies to help people receive effective care.

Right culture: Some improvements were still required in the management of the service. Staff treated people well and people were supported to express their views and be involved in their care. People were supported with their independence and their dignity and privacy was respected. The provider looked to improve the quality of care in response to feedback. People’s communication needs were assessed and staff checked people’s preferences and choices. The provider involved people, staff and relatives in the running of the service and worked in partnership with other agencies involved in people’s care.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 20 February 2023). At our last inspection we found breaches of the regulations in relation to assessment and risk management of people’s care needs, staff recruitment processes, staff deployment, skills and knowledge, complaints systems, record keeping and management of the service.

The provider completed an action plan after the last inspection to tell us what they would do and by when to improve. At this inspection, we found the provider had made some improvements and some improvements were still required and they remained in breach of regulations.

This service has been in Special Measures since 20 February 2023. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

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

Enforcement and recommendations

We have found breaches in relation to the management of the service at this inspection.

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 have made a recommendation in relation to care plans for when people express distress and agitation. We will check if the provider has acted on any recommendations at our next comprehensive inspection.

Follow up

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

Bhandal Care is a domiciliary care service providing the regulated activity of personal care to people living in their own homes in and around Derby. The service provides support to older and younger adults, who may also be living with physical and sensory disabilities, dementia and mental health or learning disability and/or autism. At the time of our inspection there were 29 people using the service.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

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

Staff recruitment records did not record that all the required pre-employment checks for care staff had been completed. There were not enough care staff to safely meet people’s needs. Systems to ensure safeguarding referrals were made to help keep people safe were not effective. Care staff did not always use personal protective equipment (PPE) safely. Not all people’s care needs were included in their care plans and risk assessments. Not all people were confident medicines were managed safely, and medicines administration record (MAR) charts had not always been completed in line with the provider’s policies. Systems to ensure lessons were learnt when things went wrong were not fully in place.

The provider had not registered their office location correctly with CQC and had not always submitted statutory notifications in a timely manner. There was a lack of contingency planning for when the registered manager was unavailable. The registered manager had not always provided clear leadership on the risks associated with infection prevention and control. Records were not always complete, accurate or developed at the time care had been provided. The provider’s policies for recruitment, complaints and records had not always been followed. Audits and spot checks were not effective at assessing quality performance and identifying improvements in care. We were not assured the duty of candour had been followed as there were no details of how complaints had been managed and responded to.

People and staff felt involved, but it was not always clear how people's feedback had been used to make improvements. The service worked in partnership with relatives and other professionals involved in people's care.

Not all training provided to care staff had been effective in providing staff with the knowledge and skills they needed in their job role.

Systems to manage complaints and improve the quality of care in response to complaints were not operated effectively. People’s preferences for call times were not always met.

Relatives had mixed feelings on whether the service was caring. Some relatives did not feel their family members had always been well-treated.

Other relatives commented that care staff were caring. People’s equality and diversity needs were respected, and steps were taken to promote people’s independence, privacy and dignity. People and relatives were involved in care planning.

Care staff found working with a more experienced member of staff to gain experience when they first started was helpful. Assessment processes were in place to help understand people’s care needs, including when they needed help with food and drinks. People’s equality characteristics were considered as part of the assessment process to help prevent discrimination. People were supported to live healthier lives and access the healthcare they needed when this was provided by other agencies.

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.

People’s care choices were respected, and their communication needs met. People’s relationships with their families were supported.

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

This service was registered with us on 21 December 2020 and this is the first inspection.

Why we inspected

This was a planned inspection based on the date of registration.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well-led sections of this full report.

Enforcement and Recommendations

We have identified breaches in relation to staff recruitment practices, staffing numbers, staff skills and competence, safe care, complaints management and the management and governance of the service.

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 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.

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 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.