Bay Care Domiciliary Care Ltd Also known as chloe.stark2@nhs.net katrina.hall9@nhs.net

The Bay Care Group is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to younger and older adults. Not everyone using The Bay Care Group received a regulated activity. CQC only inspects the service being received by people provided with ‘personal care', for example help and support with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided.

The service operated a number of different teams commissioned in partnership through the relevant local authority. The service had a ‘Rapid Response Team’, an ‘Urgent Response Team’, a ‘Peripatetic Night Team’, a ‘Reablement Team’, a ‘Care Home Team’ and a ‘Living Well at Home Team’. All of these teams operated separately within the service with both administrative and care staff allocated to each specific team.

At the time of this inspection, the service provided personal care to approximately 305 people, however due to the business model of the service this number continually changed. People who used the service lived in Torbay, Paignton, Newton Abbot and the surrounding areas. At the time of the inspection, the service delivered a total of approximately 1200 daily care visits which amounted to approximately 34,000 care appointments every 4 weeks.

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

Most of the people we spoke with commented positively on the care they received and the staff that supported them. We received some less positive feedback about people not being supported by care staff of the same sex and appointments times not being in line with people’s preferences.

We spoke with the provider and registered manager about these points. They told us that people received their care in line with the commissioned package funded by the local authority and records they held supported this. They told us that at the commencement of a care package, people were advised of their commissioned appointment timeframes and also that care could be delivered by either male or female care staff.

We saw contracts that people signed at the outset of a care package showed that care could be provided by male or female staff and the contracts also highlighted that on occasions, circumstances out of the providers control may result in appointment being late. The provider also told us people were able to decline accepting the package of care commissioned for them if they were unhappy with the proposed contract.

The provider and registered manager remained committed to recruiting a diverse workforce of both male and female staff from both within the United Kingdom (UK) and internationally. Internationally recruited staff were subject to pre-employment checks and language assessments prior to coming to the UK. Where required, additional support was given to internationally recruited staff through a mix of in-house training, the use of technology such as translator earpieces and additional language classes through local educational facilities.

Staff demonstrated an understanding of safeguarding and were able to identify what might constitute abuse and the reporting process they needed to follow to escalate concerns. Staff were confident any concerns raised would be handled effectively by the service management. One person told us, “They really look after me. They always leave me comfortable. I'm very happy with all my care.”

People’s individual and environmental risks were identified and care was planned in a way to reduce identified risks. The provider worked in partnership with Devon and Somerset Fire Service to reduce fire risks in people’s homes and care plans contained information around a national police missing persons protocol.

People had variable needs around their medicines and told us how they received different levels of support. The provider operated an electronic medicines system which sent alerts to the locations office when an administration had not been completed as prescribed. This allowed immediate action to be taken to establish why an administration had not happened.

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 access to Personal Protective Equipment (PPE) such as gloves, aprons and face masks. People we spoke with told us staff wore PPE. One said, “They do wear PPE and some still wear masks as well.” There were systems to ensure that staff compliance with PPE and infection control practice was monitored through quality assurance visits and spot checks.

Most people we spoke with told us that staff treated them with privacy and dignity. A relative said, “Yes, very good, they are lovely with her.” Another told us, “They treat her with respect and always talk [person’s name] through everything. They are just very patient with her.” Staff we contacted understood the importance of promoting people’s privacy and gave examples of how they achieved this.

There were examples of where the service had gone above and beyond in some elements of care provision. This had positively impacted people’s lives. One person had been identified as being at risk of self-neglect through poor personal hygiene. The service adapted the person’s care package to ensure the same member of care staff worked consistently with this person. This build-up of trust resulted in the person showering, changing clothes and increasing their personal hygiene. This evidenced the positive outcomes good care continuity could achieve.

There were systems in place to monitor the standard of care provided by the service. People and staff were invited to give feedback on the service provision. For people using the service, there were quality assurance processes in the form of telephone calls, surveys and home visits. People we spoke with gave mixed responses on the opportunities they had to provide feedback. Some people that did feedback told us there had been no change as a result. From the people we spoke with, this was again primarily based on if they received care from male or female staff.

Whilst some concerns were raised, most of the people when asked told us they would recommend The Bay Care Group to others. One person told us, “I have recommended them already.” Another said, “We are very happy with them and I would recommend this agency.”

Staff we spoke with during the inspection process were overall positive about most aspects of their employment. Nearly all staff asked would recommend The Bay Care Group as a good place to work. Nearly all said they would recommend the service to friends and family for care provision.

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

Rating at last inspection

The last rating for this service was Outstanding (published 3 May 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

The overall rating for the service has changed from Outstanding to Good based on the findings of this inspection.

Follow up

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

The Bay Care Group is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to younger and older adults. Not everyone using The Bay Care Group 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 this inspection 154 people were receiving personal care from the service. People who use the service live in Torbay, Newton Abbot and the surrounding areas.

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.

The management team placed a strong emphasis on providing a high quality service, looked for ways to continually improve, and was an excellent role model for other services. Community professionals were highly complementary about the quality of care provided. Comments included “As a provider they have always demonstrated they are forward thinking, have passion and care about their work”, “The staff have a genuinely caring attitude and are willing to work with professionals. I am hugely impressed by their commitment to the person and their family” and “There has been a need for quite a creative and very person-centred approach which Bay Care has achieved. The progress has been significant with really positive outcomes.”

The registered manager was the founder and co-chair of the local ‘Care Manager’s Network. One community professional told us “she’s doing a really great job and is very inspiring.” The network had received ‘Gold’ in the Torbay and South Devon NHS Trust Blue Shield Awards for Best Community Partnership. This award was designed to give recognition to hard work and dedication which improves the lives of people who use health and social care services. Staff worked in partnership with healthcare professionals to ensure ‘joined up’ care was delivered to people. This meant people benefited from high quality care and improved outcomes.

People and their relatives told us about the consistently high standards of management and care they received from The Bay Care Group. Comments included “The people who run it now are really on the ball”; “I don’t think I could do better anywhere else” and “The best I’ve ever used.”

Staff were highly motivated and were exceptionally kind, caring, and compassionate towards people they supported. Comments included “All the carers are excellent”, “We have a good old laugh” and “They look after me extremely well and instinctively know if I am having a bad day”. A relative wrote “She looks after my mum as if it was her own grandmother”. There were many examples of staff going over and above and the very positive impact this had on people’s lives.

The registered manager told us their focus was on caring and people were put at the centre of the service. The service had introduced ‘Operation connect’, an initiative to enable staff to engage more with the people they supported. Staff had taken time to gather the outcomes and goals that people wanted to achieve. They then worked with the person to realise those goals. People were invited to take part in the running of the service and were asked for regular feedback. This had resulted in improved outcomes for people.

The service had strong links with the local community and had arranged events that had benefited people who used the service, local people and charities. This had provided opportunities for people in the community to meet and socialise.

People told us they felt safe and comfortable when staff were in their home and when they received care. Staff knew how to recognise signs of potential abuse and understood how to report any concerns in line with the service's safeguarding policy.

Safe staff recruitment procedures were in place. This helped reduce the risk of the provider employing a person who may be unsuitable to work in care. Staff completed a comprehensive training programme. One staff member said, “The training is exceptional.” Where training needs were identified, additional support was provided.

Staff knew people well and were able to tell us how they supported people. Care plans were developed with each person. They described the support the person needed to manage their day to day health needs. The provider had introduced an electronic care planning system. This allowed information to be shared with people, care staff, and office staff in real time. This meant the service was able to respond more rapidly to changes in people’s needs. People’s communication needs were met. The service was complying with the Accessible Information Standard (AIS). The AIS applies to people using the service who have information and communication needs relating to a disability, impairment or sensory loss.

Some people did not have capacity to make decisions relating to their care. Mental capacity assessments and best interest decisions had been undertaken in accordance with the principles of the Mental Capacity Act. Staff told us they gained consent from people before carrying out personal care and respected people's choices.

Risks had been assessed for each person and were safely managed. Risk assessments had been carried out in relation to falls, nutrition, skin care, mobility and activities. Risk assessments relating to each person's home environment had been completed. Where concerns were identified, action had been taken to reduce the risks to people.

People were supported safely with their medicines and told us they were happy with the support they received. Staff completed electronic medication administration sheets (eMAR). The computer system alerted staff if all parts of the eMAR had not been completed before the care staff left a visit. This reduced the risk of missed medicines. The service’s medication champion carried out practical medicines assessments with each staff member every twelve weeks.

People and their relatives felt able to raise concerns or make a complaint. They were confident their concerns would be taken seriously. People said “No complaints” and “I have nothing to complain about.” They were confident their concerns would be taken seriously. Where the service had received complaints, these had been resolved to people’s satisfaction. One person said “The person I spoke to was very helpful and the complaint got resolved.”

Records were well organised and up-to-date. A comprehensive audit system was in place to monitor the quality of the service. Checks to observe staff's competency were carried out on a regular basis.