Background to this inspection
Updated
17 February 2021
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
The inspection was undertaken by one inspector.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own homes.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was announced. We gave the service 72 hours’ notice of the inspection. This was because we needed to be sure that the provider or registered manager would be in the office to support the inspection.
Inspection activity started on 25 January 2021 and ended on 01 February 2021. We visited the office location on 25 January 2021.
What we did before the inspection
The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We looked at all the information we hold about the service including notifications. This information helps support our inspections. We used all of this information to plan our inspection.
During the inspection
We spoke with two people who used the service and seven relatives about their experience of the care provided. We spoke with 10 members of staff including the director of homecare, operations director, operational support manager, senior care workers, care workers and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider.
We reviewed a range of records. This included four people’s care records and two medication records. We looked at four staff files in relation to recruitment, training and staff supervision. We looked at training data and quality assurance records. A variety of records relating to the management of the service, including policies and procedures were reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found.
Updated
17 February 2021
About the service
Better Healthcare Services (Luton) is a domiciliary care service. The service provides personal care to people living in their own homes. At the time of the inspection, the service provided support to 158 people, of which 142 were in receipt of personal care.
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
People were not always safe and were left without care at the time they required it due to the large number of missed and late care visits.
People had risk assessments in place. However, these had not been consistently reviewed and did not provide staff with relevant information to keep people safe.
Medicines were not always administered to people at the times prescribed. The many missed and late care visits meant that medicines were not being managed safely. One person told us, “Sometimes the timings of calls mean that medicines are not regularly spaced out between doses.” Audits were inconsistent and there was minimal information available of actions which had been taken to address areas of concern.
The quality assurance processes were not robust and did not drive improvements in the service. There was a lack of management oversight and leadership within the service.
The provider had an infection control policy in place which had been updated to include information relating to COVID-19. Staff were provided with an adequate supply of face masks, gloves and aprons.
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 good (published 11 December 2019).
Why we inspected
We received concerns in relation to missed and late care visits, the management of medicines and the leadership of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.
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 changed from good to requires improvement. This is based on the findings at this inspection.
We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.
We asked the provider how they intended to improve following our visit to the service. They provided enough information to assure us they would take action in response to our most urgent concerns.
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 Better Healthcare Services (Luton) 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 identified two breaches of the Health and Social Care Act 2008 in relation to safe care and treatment and good governance of the service at this inspection.
Follow up
We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information, we may inspect sooner.