Archived: Better Healthcare Services (Cambridge)

Updated 10 October 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 19, 20, 21 and 28 October 2016 and was announced. This was because it is a small domiciliary care service and we needed someone to be in the office. The inspection visit to the office was carried out by one inspector. A second inspector carried out phone calls to care staff.

We undertook this inspection earlier that we had planned to because of concerns that we received from Cambridgeshire County Council and the local safeguarding team. Before our inspection we reviewed the information we held about the service. We reviewed notifications the provider had sent us since our previous inspection. A notification is important information about particular events that occur at the service that the provider is required by law to tell us about.

We spoke with the manager, the quality and training manager, the area manager, and three members of care staff. We spoke with four people who use the service and three relatives of people who use the service. We looked at the care records for three people. We also looked at records that related to health and safety including audits and medication administration records (MARs).

Updated 10 October 2017

Better Healthcare (Cambridge) is registered to provide personal care to people in their own homes. At the time of our inspection they were providing a service to 17 people living in the Cambridge area. They are also registered to provide nursing care and treatment of disease, disorder or injury. However a representative of the provider stated that they did not carry this out and would be applying to cancel these two regulated activities.

This announced inspection took place on 19, 20, 21 and 28 October 2016.

At the time of the inspection there was not a registered manager in place. 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 home is run. A new manager had commenced working in the role in September 2016 and was in the process of applying to the commission to be registered.

The system to monitor the quality of the care being provided and to drive improvement was not effective and this impacted on all areas of the service.

Risks had not always been managed to keep people as safe as possible. Risk assessments had not always been completed. This meant that staff did not have the information they required to ensure that people received safe care.

Incidents had not been recorded or managed effectively to identify any action that needed to be taken. Systems and training were not in place to ensure that staff dealt with behaviour that challenged others appropriately.

We could not be confident that people were receiving their medication as the prescriber had intended. Medication administration records (MAR’s) had not been completed accurately which meant that it was not clear if people had received the medication that they were prescribed. The audits of the MAR’s were not effective as they did not always identify areas of concern that required investigation. There were not enough staff employed to ensure that people received their care at the agreed time, and on some occasions staff did not arrive at the persons home to provide care at all. Due mainly to an insufficient number of care staff, people had experienced a high number of missed calls.

The recruitment procedure had not always been followed to ensure that only the right people had been employed.

The Care Quality Commission (CQC) is required by law to monitor the Mental Capacity Act (MCA) 2005, and to report on what we find. The provider was not acting in accordance with the requirements of the MCA. They could not demonstrate how they supported people to make decisions about their care and where people were unable to make decisions, there were no records showing that decisions were being taken in their best interests. This also meant that people were potentially being deprived of their liberty without the protection of the law.

Care plans did not contain all of the relevant information that staff required so that they knew how to meet people’s current needs. We could not be confident that people always received the care and support that they needed. People had not always received food and drink as their care plan stated.

Not all complaints had been recorded appropriately. This meant that we could not be confident that complaints were being dealt with effectively.

The provider is required by law to notify the Commission of certain events so that we can monitor the service. These notifications had not been submitted to the Commission.

Staff were aware of the procedure to follow if they thought someone had been harmed in any way.

New care staff completed induction training and shadow shifts to ensure they were competent for their role. The care staff treated people with dignity and respect.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.