Biliv Care Limited

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

This is the first inspection for this service. This key question has been rated requires improvement.

This meant the management and leadership was not always consistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

The service was in breach of legal regulation in relation to good governance of the service.

This service scored 61 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider encouraged and operated an open culture and had a vision that was shared with staff. The conversations we had with staff supported there was an open culture within the service. Staff told us they felt very well supported by the provider and were clear about the value of the service to provide quality care to people.

People and their relatives were happy with the care and support. Staff told us they would report to the provider any poor practice and were confident concerns would be acted on by management team.

People and relatives told us staff were kind, caring and compassionate. Health and social care professionals provided positive feedback about the care and support provided to people.

Staff and management fed back passionately about the care being delivered to people and spoke fondly of the people they were supporting. The provider responded positively to the feedback we provided and demonstrated a willingness to make the improvements needed.

Recruitment records were not always complete with references not always obtained for staff, in line with the provider’s own recruitment policy. Gaps in employment had not always been explored and explained. Training had not always been monitored to make sure staff had updated their mandatory annual training, with some staff having not updated their training since 2023. The provider’s own audits had not identified staff logging in and out of calls at the same time. The provider took immediate action to address this at the time of the inspection.

The service had inclusive leaders who understood the context in which they delivered care, treatment and support. Although leaders were not always aware of regulatory requirements to notify CQC of notifiable incidents and events, the provider took immediate action to address this at the time of the inspection.

Leaders were visible within the service and led by example to their staff team, demonstrating inclusive behaviours. There was a stable management and staff team. Where areas of concern were identified, managers were open, honest and committed to making the required improvements. Staff knew their roles, responsibilities and how to support each other. Relatives spoke highly of the staff and management team.

Staff spoke positively about the service and the provider. They told us they were always accessible to them and on the end of the phone. All staff we spoke with felt they could speak to the management team regarding any concerns or questions they may have and they would be answered and acted on promptly.

People and their relatives told us they were happy with how the company was run with many saying they would recommend Biliv Care. One person told us, “I’m very happy with the care I receive and yes I would recommend them (Biliv Care).”

People told us they would speak up and felt their voice would be heard. Staff were provided with the relevant policies and procedures detailing what was expected of staff working for the service. Staff told us they felt able to raise any issues or concerns, including poor practice. Staff were confident the provider would listen to them. They advised us the management team were always accessible on the phone.

During the assessment process, the provider was open and transparent and took on board the findings of the inspection.

We were told by people the registered manager had a calm manner and spoke to people and their relatives with kindness.

There was a whistleblowing policy in place and staff were aware of this and the procedures they needed to follow.

Staff felt listened to by the provider. The provider took steps to ensure staff felt that their were heard by the provider and were confident to raise any concerns they may have.

The provider ensured they were regularly available to staff, visiting them when they were supporting people and holding regular meetings, providing staff with the opportunity to engage with them.

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for the people who worked for them.

Staff told us they were happy working within the company and felt they were treated fairly. There were procedures in place to consider staffs’ individual needs and ensuring all staff were treated equitably.

The provider’s systems had failed to operate effectively to enable them to assess, monitor and improve the quality and safety of the service. Policies and procedures were in place but were not consistently followed. For example, the provider had failed to follow their own recruitment process to ensure they were safe and robust.

Where audits and checks had been completed, these were ineffective and did not provide oversight of the service. There was no system to monitor call times which would ensure staff arrived on time and stayed for the correct length of time. There was no effective system to ensure people had their calls delivered at their preferred time. The provider told us they checked the live system when they were in the office and printed reports on the number of care hours delivered by staff. Information also suggested travel time between some calls was not always allocated. We noted in some instances, staff were scheduled to be in 2 or 3 places at once. However, people and relatives all confirmed they had not had any missed calls and if staff were running late, generally, they would contact people to let them know. People also had the staff member’s phone number and felt comfortable in contacting them if they were running late. One person told us, “They (staff) come when meant to, I do like to specify a time and they do try to come on those times but sometimes, I don't know if it’s communication, but they infer they didn't know it should be 10am or 5.30pm and they come at sometimes 6pm. Sometimes they do phone me and sometimes they don't.”

Accidents and incidents were not routinely analysed for lessons to be learnt. Although safeguarding concerns had been reported to the appropriate local authority and had been thoroughly investigated by the provider, notifications had not been notified to CQC. The provider submitted these following the inspection.

Risk assessments were not always in place and some care plans lacked person-centred information related to specific health and medical conditions, to ensure staff had clear guidance on supporting people safely. Reviews of people’s care were completed, however these reviews had not identified the issues we found regarding missing risk assessments and information from care plans.

Medicines administration records (MAR) were viewed on the ‘live system’ and random spot checks were completed with staff to ensure medicines were administered. Regular audits were also completed to ensure medicines were safely administered

The provider had systems and processes in place to record contact with health and social care professionals and would make referrals where appropriate.

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people.

At the time of this inspection, the provider was working with the Local Authority to address issues identified from a quality monitoring assessment. The provider shared the information with us to demonstrate how they were working towards the improvements required.

The provider’s vision was focused on continuous learning and improvement across the service. However, the systems and processes in place for monitoring the safety and quality of people’s care were not always robust or effective. Leaders understood how to make improvements but lacked a consistent approach measuring outcomes and monitoring impact. The provider took all concerns raised seriously and responded to them on an individual basis. They had investigated them but it was not clear if a thorough root cause analysis had been completed to monitor for patterns and trends to minimise the risk of further recurrences.

Staff meetings were held regularly and minutes were kept of the meetings. These were used to discuss care practice, such as medicine administration and encouraged staff to ask for assistance if they needed guidance. The meetings also gave the provider the opportunity to remind staff about their training and the importance of working together to make sure the service provided good quality care for people.

The provider had processes to gather formal feedback from people and maintained regular contact with people through home visits or phone calls. People told us the provider was responsive to any concerns and dealt with matters in a timely way.