We carried out an inspection of Bellcare Domiciliary Care Services Limited (Bellcare) on 20 and 22 September 2016. The inspection was announced. We last inspected Bellcare in September 2014 and found the service was meeting the legal requirements in force at that time.Bellcare provides personal care to adults in their own homes mainly in the west of Cumbria. At the time of inspection the agency provided care and support to 224 people. People who received a service included those living with physical frailty or memory loss due to the progression of age. Visits ranged from half an hour up to seven and a half hours; and 24 hour support packages. The frequency of visits ranged from one visit per week to six visits per day depending on people’s individual needs.
The service had a registered manager in post. 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. During our inspection the registered manager was present.
The feedback we received from people was excellent; they expressed great satisfaction with the caring attitude of staff and the reliability of the service. People were all very enthusiastic about how the way in which care was given made a “huge difference” to their lives. They all spoke very highly of the registered manager, the owner and staff. People, relatives and professionals consistently gave us positive feedback about how the service was personalised to meet people's individual needs.
A social care manager told us,"Bellcare are really stepping up to the mark and are delivering really good packages of care to people. We can always rely on them. The staff are well trained and confident in what they are doing."
People told us they felt very safe with the staff that came to their home and confident in the care they provided. Staff were trained in safeguarding and understood the signs of abuse and their responsibilities to keep people safe. The provider's policies and procedures for keeping people safe included very thorough pre-employment checks, to make sure staff were suitable to deliver care in people's own homes.
People told us that staff were always kind and respected their privacy, dignity and independence. Care staff were very thoughtful and recognised and respected people's cultural values and preferences. One person summed up people’s positive views by telling us, “The staff make me feel like the Queen mother. There’s nothing they won’t do.” Another said, “Bellcare and the staff have given me back the will to live, they are so positive with me.”
We saw that staff had created really positive, caring and empowering relationships with those people they supported. Staff had high expectations for people and were positive in their attitude. People expressed how their independence had been promoted to the extent that many had regained skills they thought they had lost. For example one said, “I never thought I’d be up on my feet again, I’m over the moon. It’s all down to the staff being so patient with me and letting me take my time to build up my confidence again.” Another person said that they had been "thrilled" to be supported to have a bath again. The service worked towards every person being able to regain or maintain skills wherever possible while feeling supported at the same time to help build confidence.
Risks to people's health and wellbeing were identified at the initial assessment of care and their care plans included the actions staff should take to minimise the risks. Staff understood people's needs and abilities very well because they read their care plans and shadowed experienced staff, so they could get to know people well before working with them independently.
We found that the service worked with people’s wider networks of support and encouraged and supported their involvement in activities which were important to them. One person said of his support, “I have my care plan but now me and my staff team are bouncing ideas off each other, it’s great. They keep me on my feet with a ‘can do’ attitude. I go to all sorts of places and I can plan where I want to go next, shopping, a show or a day out.”
People were effectively supported by stable and consistent staff teams who knew people well and had received training specific to their needs. Bellcare had developed it’s own induction programme, Junior care workers programme and a Manager Development Programme. One new starter told us, “The induction has been fantastic, we covered all the areas you can think of." All staff were well trained in medicines management and regularly had their competency checked. This was to ensure they knew how to support people to take their medicines safely and to keep accurate records.
We found that this organisation was particularly effective in delivering consistently high quality care because of the emphasis it placed on building a really strong staff development programme. The provider valued their staff and saw them as an asset when delivering high quality care to people. Staff received extensive training and support to meet people's needs effectively. Staff had regular opportunities to reflect on their practice and to request any additional support or training. A staff member told us, “The training is really good, the managers are a fantastic support. We have lots of opportunities here for career progression. I’ve been able to do a management course and now have responsibility as a supervisor and manage a team of carers. Never in a million years did I think I could do it.”
The registered manager told us, “We invest in, nurture and promote staff. They’re our biggest asset.” All these measures ensured that people were receiving an efficient and effective well run service.
Staff had sought people's consent for their care. Where people were not able to make important decisions about their lives the principles of the Mental Capacity Act 2005 were followed to protect their rights. Staff had received relevant training and understood the principles of the Act. People's consent to their care and support was in line with legislation and guidance.
People were supported to eat meals of their choice and staff understood the importance of people having sufficient to drink. Staff referred people to healthcare professionals for advice and support when their health needs changed.
People were confident any complaints would be listened to and action taken to resolve them. When people raised issues, the registered manager resolved them immediately, through face-to-face meetings with people. One person told us, “I can talk to them all, the carers, the team leaders, the manager (name), the owner (name). I often ring up the office staff they're great too. It's that sort of agency they all listen to you.”
The systems in place to organise the delivery of care were very efficient. People told us that the owner of the company and the registered manager often visited to check on the quality of care. The agency had a policy of doing half hour visits as a minimum so that people wouldn’t be rushed and the quality of peoples’ experiences could be maintained. People could request, however, 15 minute visits for simpler tasks and a well-being check. People told us they had "never" experienced a missed care visit. We found staff consistently provided care visits of the correct visit length. The service's visit schedules were well organised and there were a sufficient number of staff available to provide people's care visits in accordance with their preferences.
People and relatives told us their staff never rushed them. A relative said, “It’s been life changing having this agency. My friends told me not to use one as they had experienced lots of problems. But with Bellcare from day one they have been so professional. This had given me total confidence that my mother’s is being looked after properly.” A staff member said, “This agency is great. There’s no rushing with people, you take your time and do the job properly and make sure people are safe.”
There was a positive culture and the provider's value system placed people at the heart of the service. There was a whole team culture, the focus of which was how they could do things better for people. The registered manager demonstrated a good understanding of the importance of effective quality assurance systems. She had strong values and a desire to learn about and implement best practice throughout the service.
Staff were very highly motivated and proud of the service. There was an emphasis on developing staff potential within a positive learning environment to create a high quality service. Staff were 'champions' in specialist areas and. Champions had received additional training and skills in their specific areas. Skills were then shared within the rest of the staff team to create more positive outcomes for people who used the service.