We carried out a review of the data available to us about Bespoke Home Care Ltd on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Bespoke Home Care Ltd, you can give feedback on this service.
Bespoke Home Care Ltd is a domiciliary care agency. It provides personal care to people living in their own homes in the community. On the day of the inspection the service was supporting 38 people with a range of health and social care needs, such as people with a physical disability, sensory impairment or people living with dementia. Support was tailored according to people’s assessed needs within the context of people’s individual preferences and lifestyles to help people to live and maintain independent lives and remain in their homes. Not everyone using Bespoke Home Care Ltd receives the 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.
People’s experience of using this service:
People were happy with the care they received, felt relaxed with staff and told us they were treated with kindness. They said they felt safe, were well supported and there were sufficient staff to care for them. One person told us, “Everyone is really nice, if I call the office they have a chat and are helpful. I have breathing problems and they encourage me with my breathing in the shower and they don't rush me”.
People’s independence was promoted and told us their needs were met. They told us that they had a regular team of care staff who arrived on time and knew them well. One person told us, “I have never felt unsafe with any of them, they let themselves in with the key safe and call out to me”.
People felt they were offered choice in the way their care was delivered and that they had no concerns around their dignity and privacy in their own homes being respected. One person told us, “They are all very kind, and speak nicely to me make me feel a bit special and that I'm not a pain”.
Staff had received essential training and feedback from people indicated that they knew the best way to care for people in line with their needs and preferences. 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.
The provider had systems of quality assurance to measure and monitor the standard of the service and drive improvement. These systems also supported people to stay safe by assessing and mitigating risks, ensuring that people were cared for in a person-centred way and that the provider learned from any mistakes.
People told us they thought the service was well managed and they received high quality care that met their needs and improved their wellbeing from dedicated and enthusiastic staff. One person told us, “I would recommend them to anybody, I look forward to them coming”.
Rating at last inspection: Good (report published 23 December 2016).
Why we inspected: This was a scheduled inspection based on the previous rating.
Follow up: We will continue to monitor the intelligence we receive about this service and plan to inspect in line with our re-inspection schedule for those services rated Good.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
As part of this inspection, we checked what action had been taken to address the breaches of legal requirements we had identified at our last inspection on 21 October 2015. We found areas of practice that required improvement. There was not a robust quality assurance framework in place and systems were not in place for reviewing, monitoring and assessing the delivery of care and support. We also found employment procedures were not robust. The provider had not always obtained all the information required such as references from previous employers. Therefore, the provider could not be assured these staff were suitable and safe to undertake their role. After our last inspection, the provider wrote to us to say what they would do to meet legal requirements and sent us an action plan detailing how they intended to ensure they met the requirements of the law. We looked at the improvements made as part of this inspection. At this inspection, we found improvements had been made and sustained and all the breaches previously identified were addressed.
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 felt safe when staff supported them in their own homes. Systems were in place for staff to follow which protected people and kept them safe. People and their relatives told us they felt safe, that staff were kind and the care they received was good. One relative told us, “Yes, we feel safe with them in the house I can just leave them with him. I trust them and have no concerns.”
There were systems and processes in place to keep people safe. Assessments of risk had been undertaken and there were clear instructions for staff on what action to take in order to mitigate them. Staff knew how to recognise the potential signs of abuse and what action to take to keep people safe. The provider made sure there was enough staff at all times to meet people’s needs.
People were supported by staff that were familiar to them for the most part. One person told us, “We do have different carers and they are very nice and polite and if there is a new one they are introduced to us,” Care calls were monitored by the office team to make sure staff arrived on time and stayed for the agreed amount of time. Checks were completed on potential new staff before they started work to make sure they were suitable to support people living in their own homes.
Staff had the skills and knowledge to understand and support people's individual needs. These skills were kept up to date through regular training and staff were also supported in their roles by managers and colleagues.
Staff considered people’s capacity using the Mental Capacity Act 2005 (MCA) as guidance. Staff asked people's permission before they helped them with any care or support. People's right to make their own decisions about their own care was supported by staff. One relative said, “They encourage [named person] to use the walking frame which she likes to do if she can.” People were supported by staff who knew them well and were caring in their approach. A member told us, “We give plenty of time for those needing a lot of care; an hour or more sometimes and if we think someone needs more time because they are unwell, the office do listen.” Staff made sure people were involved in their own care and listened to what people and their relatives had to say.
People and their relatives had opportunities to give their opinions on the service that was provided and about the staff that supported them. People and relatives knew how to complain and were confident that the registered manager would listen to their concerns. People and their relatives had regular contact with the service's office staff and found them approachable, polite and helpful. One person said, “I’ve met [named manager] several times and they are very approachable. Sometimes it can be difficult to get through to them at the busy times but if I leave a message they do get back to me.”
Staff felt supported within their role and described an ‘open door’ management approach. The management team were always available to discuss suggestions and address problems or concerns. A staff member said, “It feels like a family atmosphere. Everybody gets on really well. I think that comes through in the care we give.”
Bespoke Care Ltd is registered to provide support to people living in their own homes who need help with their personal care. At the time of the inspection there were 85 people using the service. The majority of people using the service were older people, some of whom had physical disabilities and some were living with dementia.
This comprehensive inspection took place on the 2 and the 21 October 2015. We gave the provider forty-eight hours’ notice to ensure management and staff would be available to speak with. This was the first inspection since the service re-registered following a change of address.
The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.
We undertook this inspection earlier than initially planned so we could follow up on concerns we had received that the service did not employ enough staff to complete the calls they were contracted to fulfil. We had also been told that some people had experienced missed care calls and sometimes staff arrived late and left early. However our findings did not support what we had been told. We found the provider did employ sufficient numbers of staff, where ever possible action was taken to avoid late or missed calls and staff did stay for the full duration of the calls they were contracted to undertake.
The provider obtained feedback from people about the service provided on an on-going basis and dealt with concerns and complaints as they arose. However robust systems were not in place for reviewing, monitoring and assessing the delivery of care and support. The provider was not undertaking their own internal audits, therefore they were unable to demonstrate how they monitored and identified if standards were falling and improvements were needed. The absence of a robust quality assurance framework meant the provider had not identified and taken corrective action to address errors in the MAR (Medicine Administration Records) charts.
Employment procedures were not robust. Identity and security checks had been completed before new staff started work. However the provider had not always obtained all the information required such as references from previous employers. Therefor the provider could not be assured these staff were suitable and safe to undertake their role.
The registered manager and provider had failed to fulfil their legal responsibilities to notify the CQC of incidents where they suspected abuse may have taken place. Whilst action was taken to rectify this issue, it is an area of practice that needs to be embedded into every day practice.
People, relatives and care workers spoke highly of the service, the management and staff. One person told us they were “Completely satisfied” and that the staff were “very good”. People described staff as being kind, patient and considerate. One person told us “I’m happy with the carers. They are caring and very genuine.” Another said, “Each one who comes in has always been polite and friendly. I’m happy with the carers.”
When we asked staff what the philosophy of the service was, one staff member told us “To make sure the elderly are being cared for, its very family orientated it’s about caring for people as you would want other people to care for your nan”.
People’s privacy and dignity was respected. Staff had a firm understanding of respecting people within their own home and providing them with choice and control. People said the service met their needs and encouraged them to be as independent as possible. People were asked for their views of the service and complaints and concerns raised had been responded to promptly.
People confirmed they felt safe with the staff. Systems were in place to protect people from abuse and harm and staff knew how to use them. Where concerns had been identified these had been passed to the local authority for them to consider under safeguarding.
Staff knew the people they were supporting and were aware of their personal preferences, likes and dislikes. One person told us “They are very good and always find out how I feel”. A staff member told us “I love the job and my clients, I want to really make a difference to their lives and I think I do that”. Care plans were in place detailing how people wished to be supported and people and or their representatives were involved in making decisions about their care. They were supported with their healthcare needs and staff liaised with their GP and other health care professionals as required.
Staff received regular training and were knowledgeable about their roles and responsibilities. They had the skills, knowledge and experience required to support people with their care and support needs. They felt supported within their roles, describing an ‘open door’ management approach, where the registered manager and management team were available to discuss suggestions and address problems or concerns. One member of staff told us “It’s brilliant I can just pop in the office whenever if you have any concerns or need anything. I’ve had some feedback about how I am doing and was told that I have had lots of compliments from clients which is really nice to be told this”. Another staff member told us “It’s a lovely place to work, the clients are all great and I love caring for them”.
The registered manager and provider, along with senior staff provided good leadership and support to staff who delivered care to people. They understood the needs of the people well and accommodated people’s preferences.
We identified two areas where the provider was not meeting the requirements of the law. You can read what action we have told the provider to take at the back of the full version of the report.