Bloomsbury Home Care - Essex

Bloomsbury Home Care - Essex is a domiciliary care agency providing personal care to people in their own homes and flats. The service provides support to people living in and around North Essex. At the time of our inspection there were 52 people using the service.

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 had completed COVID-19 individual risk assessments to check for underlying health conditions or other characteristics that might place them at an increased risk of COVID-19, but these did not always give guidance on how the risk could be reduced. Medicines were managed safely, and staff had received appropriate training in this area. The provider had introduced a new medication competency assessment tool, however, staff required further training to use this tool appropriately. The provider had also introduced new oversight and quality check procedures, as these were new, there was little evidence that these processes were effective or embedded within the service.

We have made recommendations to the provider surrounding assessing risk to staff.

People told us they felt safe and well cared for. All staff were trained in safeguarding and there was a safeguarding policy to provide guidance. Staff wore personal protective equipment (PPE) in line with current government guidance and were regularly updated by the management team to any changes in guidance. There was a newly implemented policy for infection prevention and control, and a newly implemented policy specifically for COVID-19.

Peoples care plans and records included details of interests, personal histories, and what support needs they required. Risks to people had been reviewed and recorded and were specific to the person. The provider reviewed peoples’ call times and durations to ensure they were getting the most appropriate service.

Staff were recruited safely, and in line with best practice guidance. Staff received full training appropriate for their role, and regular supervisions with team leaders. Additional training was available to address specific areas of care, such as diabetes. The provider recently improved their analysis of themes and trends for accidents and incidents, allowing them to share information with all staff to improve the service.

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.

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

The last rating for this service was requires improvement (published 20 July 2021) with a breach of regulation 17 (Good Governance). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an announced comprehensive inspection of this service on 3 April 2019, and an announced focused inspection on 28 April 2021. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Bloomsbury Home Care - Essex on our website at www.cqc.org.uk.

Follow up

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

Bloomsbury Home Care - Essex is a domiciliary care agency providing personal care to people in their own houses and flats. It provides a service to people living in areas of North Essex, including Colchester, Clacton-on-Sea, Thorpe-le-Soken, Harwich and Dovercourt. At the time of the inspection, the service was supporting 81 people.

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

Risk assessments were not always completed with sufficient information on how to keep people safe from the risk of harm. Whilst medicines were managed safely and staff were trained in this area, medicine competency assessments were not thorough enough to demonstrate the checks undertaken on staff practice. As the analysis of themes and trends was not formally carried out in some areas, this limited the ability to share lessons learned and the opportunity for improvement with the staff team.

Infection prevention and control (IPC) and COVID-19 policies, procedures and oversight systems at the service were not robust. Staff did not receive risk assessments to check for underlying health conditions or other characteristics that might place them at an increased risk of COVID-19. Notifications about incidents such as alleged safeguarding concerns were not always made to the Care Quality Commission as required. People were asked for their views on the quality of the service and told us improvements were made as a result. A new registered manager was in post since the last inspection. They told us they were making improvements to systems and processes: this will need to be embedded and sustained.

A safeguarding policy was in place, and people told us they felt safe and comfortable with staff. Staff followed government guidance in relation to personal protective equipment (PPE). Safe recruitment practices were in place to ensure staff were appropriate for the role.

People’s preference, interests and care and support needs were included in their care plan records. An electronic call monitoring system was in place to ensure people received visits on time and for a duration in line with their assessed care needs. People told us they did not have cause to complain but were able to do so if required. Where concerns had been raised in the past, they had been resolved to people’s satisfaction. The service had considered how to ensure information was accessible to all people being supported by the service. A policy was in place for end of life care.

The service worked with other organisations and professionals where appropriate.

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.

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

The last rating for this service was requires improvement (published 14 May 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made in some areas and the provider was no longer in breach of regulations 12 (Safe care and treatment) and 16 (Receiving and acting upon complaints). However, improvement had not been made in regulation 17 (Good governance) and the provider was still in breach of this regulation.

The service remains rated requires improvement. This service has been rated requires improvement for the last four consecutive inspections.

Why we inspected

We carried out an announced comprehensive inspection of this service on 3 April 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, receiving and acting on complaints and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Responsive and Well-led which contain those requirements. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained as requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Bloomsbury Home Care - Essex 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 a continued breach in relation to good governance.

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 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.

People’s experience of using this service:

¿ At our last inspection, there was a continued breach of regulation under the Health and Social Care Act, 2008 (Regulated Activities) Regulations 2014. This was because the provider did not have a robust oversight of medicines management, which could have placed people at risk of harm. Staff turned up to people late. Risk assessments had not always been updated. Systems were not in place, so learning could be shared when events had occurred. Assessments had not always considered how people’s needs were to be met. Staff had not always been given the training they needed. The service did not have a registered manager and systems were not in place to consider the retention and wellbeing of staff. Governance systems which monitored the quality of the service were poor, resulting in a breach of regulation 12 and 17 of the Health and Social Care Act, 2008; Safe Care and Treatment and Good Governance. At this inspection, improvements had been made in some areas.

¿ At this inspection, mixed feedback was received when people were asked if they got their medicines on time and in the right way. The registered provider had been working to update the care plans and risk assessment. Some of these documents still needed to be updated to ensure there was guidance for staff about how to manage these risks. This was a continued breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

¿ A registered manager had been recruited. There had been some occurrences where we had not always received all required notifications, these had been submitted following the inspection.

¿ When people had made a complaint, there was a lack of evidence that a representative of the registered provider had given a meaningful apology when they had been at fault.

¿ Because this is the third consecutive time the registered provider has been rated as requires improvement, this is a continued breach of regulation 17 of the Health and Social Care Act 2008.

¿ Overall, most people’s experience of the service had improved. People and / or their representatives told us they were supported by staff who turned up on time and stayed for the duration. Some people said they were supported by different staff and this had affected the quality of the care they received.

¿ People were supported to eat and drink in line with their assessed needs, and professional guidance had been obtained if people were supported with a textured diet. Whilst risk assessments for people who were at risk of choking had been put in place, they needed to have more information to ensure they were robust.

¿ Staff had been trained in mandatory subjects and had regular supervision and appraisals. New employees had been given an induction.

¿ The registered manager did not carry out an assessment of people’s needs, because this was the role of the team leader. Formal assessments were not used. We have made a recommendation about assessing people's needs.

¿ Care plans were completed and highlighted the areas people needed support with. Some people’s records had not been completed with enough detail.

¿ Complaints or concerns were not always resolved effectively, because when people had made a complaint they had not always been provided people with written outcomes. This was a breach of Regulation 16 of The Health and Social Care Act 2008 (Regulated Activities) Regulation 2014.

¿ People told us they were treated with dignity and respect. People and their relatives were positive about the staff and told us they had a caring attitude towards them.

¿ People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

¿ Regular staff meetings were taking place, we have made a recommendation about sharing learning when incidents have occurred.

¿ Governance systems were in place and a range of audits had been carried out. Surveys had been completed to obtain people’s views. Actions plans had been put in place to look at ways people’s experience of the service could be improved.

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

Rating at last inspection: Requires Improvement. The last report was published on 11 September 2018. After the inspection, the service was placed into 'special measures'. We do this when services have been rated as 'Inadequate' in any key question over two consecutive comprehensive inspections. At this inspection, the service had improved and was no longer rated inadequate in any key question. This will be the third consecutive time this service has been rated requires improvement.

Why we inspected: This was a planned inspection based on the previous rating.

Follow up: We will continue to monitor the service through the information we receive.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to older adults. On the day of our inspection, there were 33 people using the service, all of which received personal care.

At our last inspection on the 12 December 2017, we rated this service as requires improvement overall. We found breaches in regulation under the Health and Social Care Act, 2008. This was because risk assessments were not always in place. People’s medicines were poorly managed. People who were at risk of neglect, malnutrition and dehydration did not have robust person-centred care plans for staff to follow. The provider did not have robust governance processes in place to mitigate concerns about the safe running of the service.

This is the second consecutive time the service has been rated Requires Improvement. This was because the provider had not made the required improvements needed and breaches of regulations remain. The overall rating for this service is ‘Requires improvement.’ However, we are placing the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any key question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services 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 enough improvement is not 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 service’s, 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.

Whilst some progress had been made since the last inspection, the provider did not have a robust oversight of medicines management, which potentially could place people at risk of harm.

People told us staff would sometimes turn up late, but when they were there they stayed for the duration. Information we inspected reflected this feedback. Running up to the inspection, the provider had given back a number of care packages back to the local authority because they were unable to deliver the care that had been agreed with people and commissioners.

Risk assessments had not always been updated when a change had occurred. Which meant information in some people’s care plans was not always clear. Systems were not in place so that learning could be shared and used as a learning point, when events may have happened. We have made a recommendation about learning from events. Staff had access to PPE (personal protective equipment) such as gloves and aprons and equipment, which had been stored in a clean environment.

Since the last inspection, fluid charts had been introduced, but, for those who needed support to eat safely, or for those who may have been at risk of choking, it was unclear what action staff should take to mitigate these risks.

The assessment process did not design people’s care or treatment with a view to achieving service users' preferences to ensure their needs were met. Training had not improved since the last inspection. There were gaps in staff training records and we were told that more training was being sourced.

Care staff understood their responsibilities in relation to safeguarding vulnerable adults and knew who to contact if they had any concerns over people’s wellbeing and safety. At the time of the inspection, the police were carrying out an investigation in to an incident that had previously occurred.

The service did not have a registered manager in place, and had not had one in place since the last inspection. 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.

Systems had not been put in place to improve the retention and wellbeing of staff. Systems were in place to seek the views of people who used the service, but this information was not used to drive improvement. Governance systems were not robust and not consistently applied. Audits did not maintain or improve the quality of the service people received.

Further information is in the detailed findings below.

This service 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 adults who require a variety of care and support with personal care and everyday living across a number of locations. This included, Southend, Colchester, Clacton and Tendering areas and Ipswich.

During the last inspection in 2015, we rated the service good in all domains. However, during this inspection we found breaches in regulation under the Health and Social Care Act, 2008, and have rated the service as Requires Improvement overall.

A registered manager was in place at the time of inspection. However, following inspection the registered manager resigned and a the provider is recruiting to fill this post.

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 receiving care who had complex needs did not always have robust risk assessments and care plans in place for staff to have a full understanding of how to meet their needs safely.

Medicines were poorly managed and systems in place to ensure that staff were administrating medicines safely were significantly lacking. This was a breach in regulation 12 of the Health and Social Care Act.

Care staff had a good understanding of safeguarding vulnerable adults and knew who to contact if they had any concerns over people’s wellbeing and safety. However, the local authority had received a large number of safeguarding concerns over the previous 12 month period. These related to the care and treatment at the service.

Staff had access to PPE (personal protective equipment) such as gloves and aprons worked in a way that promoted good infection control, but equipment was not kept in a sterile or clean environment.

A computerised monitoring system was in place to monitor missed calls. Previously late calls had been safeguarding concern, but this had improved.

We made recommendations about how the provider assess risks to people in their home environment.

Training had been highlighted as a concern by the local authority, but this was improving and a the service now monitored this.

People at risk of neglect, malnutrition and dehydration did not have robust person centred care plans for staff to follow. This was a breach in regulation 14 of the Health and social care act.

Staff adhered to principles of the Mental capacity act, seeking consent and not limiting freedom, but assessments were not robust. We made recommendation's for the provider to review these processes to keep abreast of current legislation and guidance.

Supervisions were not robust and we made additional recommendations for this to be improved.

People told us that staff were caring but felt undervalued by the service and this resulted in staff leaving. This disrupted good continuity of care.

Care plans were not person centred and did not give staff the information that would support them to provide person centred care. This was a breach in regulation 9 of the Health and Social Care Act 2008; Person centred care.

Written complaints were responded too, but verbal complaints were not always followed up. When investigations took place, the registered manager did not explore all available facts to reach a decision. This is a breach of regulation 16, of the Health and Social Care Act, 2008; Complaints.

Staff felt undervalued due to the pay and conditions. Systems were not in place to improve retention of staff.

The provider had not acted swiftly to mitigate concerns about the safe running of the service as they did not agree with external findings of processes. Governance systems in place to monitor the quality of the service were poor resulting in a breach of regulation 17 of the Health and Social Care Act, 2008; Good Governance.

You can see what action we told the provider to take at the back of the report.

During our inspection we gathered evidence to help us answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well-led?

Below is a summary of what we found. The detailed evidence supporting our summary can be read in our full report.

Is the service safe?

People who used the service all told us that they felt safe when Bloomsbury Home Care staff visited their home. People told us that they felt their rights and dignity were respected and they felt in control of decisions about their care and support. One person told us: 'I feel safe when they come. You're always introduced to new staff. That reduces my stress.' Another person told us: 'Previous agencies were really awful. I wasn't getting my medicines. Now they check that I have enough medicines and it works really well.'

There were systems in place to protect people from poor practices or abuse. In general safeguarding procedures were robust and staff understood their role in safeguarding the people they supported.

Staff were not consistently following up on health concerns and reporting them to health professionals when appropriate. This could potentially put people at risk. The provider was aware of this issue and was taking steps to address this with staff. Some people did not have risk assessments that covered their medical condition. People might potentially be put at risk of harm if staff did not have guidance on minimising risks for the individual person.

Recruitment records were disorganised, it was therefore difficult to establish if practices were consistent across the service. This could potentially lead to inappropriate staff being employed. The manager had used disciplinary action when needed. Some staff needed additional training to help them meet people's needs.

We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to risk management, training and recruitment.

Is the service effective?

People told us that the service met their needs. However, there was considerable variation in the standards and content of support records. Some were of a good standard and related to the person's individual needs. However, others were mainly concentrated on staff tasks. There was very little information in these records about people's abilities, preferences and how they liked their support provided. This lack of information would make it difficult for new or temporary staff to provide support that met their needs and wishes. It also could lead to a lack of consistency and effectiveness of the support provided.

Some people's support files showed evidence of regular reviews while others had no evidence of any reviews. This meant that some people were not being offered regular opportunities to discuss their care and support needs.

We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to involving people in planning their care.

Is the service caring?

People and their relatives were very complimentary about the staff and said that they respected people's privacy and dignity. One person told us: 'The staff are very caring and supportive. The client comes first. They stay on if there's anything out of the ordinary.' A second person said: 'They always ask if there's anything else they could do before they leave.' A third person said : 'They are genuinely caring. They don't make me feel they're invading my home.'

Is the service responsive?

People told us that the service was responsive to their needs and that staff would change their usual visit time if they had an appointment. They said that the management team would provide another support worker if they were not happy with them for any reason. Some concerns had been raised about individual members of staff. The records demonstrated that the manager had investigated and resolved the concerns to the satisfaction of the person concerned.

One person told us: 'They've never let me down. They come at the time I need. They do what I want them to do.' Another person said: 'They give me space and respond to changes in my needs and moods.' People particularly appreciated that staff promoted their independence wherever possible. This enabled them to remain in their own homes and in some instances to reduce the care they needed.

Is the service well-led?

There was evidence from talking to staff and looking at records that there was variation in standards across the agency. It was not possible to establish whether staff were receiving regular supervision and support. The management team did not have fully effective quality assurance systems to monitor and improve standards within the service.

A third of the team leaders had no qualifications. Team leaders were responsible for the assessments of people's needs and staff recruitment, supervision and training within their teams. The manager, with the support of the provider, managed fifteen team leaders in seven counties. It was difficult for him to provide the level of support and supervision needed by some team leaders.

We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to quality assurance and support for staff.

We spoke with two people receiving support from the service and three relatives of people using the service. The people we spoke with were both very complimentary about the care and support they received. One told us: 'The staff are marvellous, I couldn't wish for better. It's like having a daughter giving my care.' Another person said: 'I can't praise them enough.' A relative described how staff had behaved 'very professionally in an emergency' and 'do things above and beyond' what they needed to do. Another relative was also extremely complimentary about the standard of support and care provided. A third relative considered that the quality of staff varied. They said that a few staff needed more training but felt that the overall standards had improved since they started using the agency.

The care records, however, did not always provide evidence of the good standards of care that people described. The manager told us that the care documentation was being revised and additional staff training would be given to improve their recording. There were systems for monitoring standards in the agency but some of the audits checked whether records had been completed rather than the quality of the information contained in them. The manager told us that they would make further developments to improve these the audits.