Archived: Bliss Support

This inspection took place on 17 and 24 January 2017. The service is run from an office in Hasland, Chesterfield and provides care to people in north Derbyshire. The provider was given 48 hours' notice because the location provides a domiciliary care service and we wanted to make sure there was someone available. We spoke with three people at the agency’s offices on the first day of the inspection. In addition, we also carried out telephone calls to a further three people using the service, one relative and five staff on 18 and 19 January 2017.

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.

There was a registered manager at the service. 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.

The leadership of the service was ineffective. The registered manager had not provided information as requested both before and after the inspection visit. Some records we requested were not available on either day of the inspection visits. Systems to monitor the quality of the service were incomplete and disorganised and had not identified where improvements were required. The provider’s website contained misleading information and did not ensure people could make an informed choice about using the service.

The provider's arrangements for staff recruitment and deployment were unsafe and did not ensure suitable people were employed. There were insufficient staff at times and some were working excessive hours.

Support for staff was insufficient due to infrequent training and a lack of induction and supervision.

People’s assessment records were up to date but other aspects of their care records had not been updated and some people had not had their care reviewed for over two years. People were not consistently involved in reviews of their care.

Medicines were generally safely managed.

People were safeguarded from abuse because the provider had relevant guidance in place and staff were knowledgeable about the reporting procedure.

Staff understood their roles and responsibilities for people's care and safety needs and for reporting any related concerns.

The principles and requirements of the Mental Capacity Act (2005) were being met. People were supported by staff who knew them well. Staff were aware of promoting people’s safety, whilst providing information to support people to make day-to-day decisions.

People received appropriate support to manage their meals and nutrition when required. This was done in a way that met with their needs and choices. People’s health needs were met. Referrals to external health professionals were made in a timely manner.

People and their relatives told us the care staff were caring and kind and that their privacy and dignity was maintained when personal care was provided. They were supported to participate in leisure pursuits of their choice.

Complaints were managed satisfactorily.

We identified five breaches of Regulations. You can see what action we took at the end of this report.

At the time of the inspection 54 people were receiving care from Bliss Support Ltd.

Below is a summary of what we found.

Is the service safe?

People told us that they felt safe. People told us that they knew who was coming to care for them and that they had identity badges but did not wear a uniform. Also, if it's was a different carer then the service mostly let the people know. We were told that they always met the carers before they started looking after the people.

The provider had robust procedures for handling of peoples' monies and carers were able to explain this to us.

The service had good safeguarding procedures and staff told us they understood how to protect people they supported. This meant that people would be safeguarded as required.

Care staff had received training in the Mental Capacity Act (2005) (MCA) but not in the Deprivation of Liberty Safeguards (DOLs).

Is the service effective?

We found that people's needs were assessed and their care plans included some information about people's diagnosed health conditions or disabilities. People we spoke with told us that care staff were mostly knowledgeable about their care needs.

However we found that not all care records we reviewed contained the same information, some records were not signed or dated and there were no planned reviews of care. We saw assessments of risk did not always identify how the actual risks were to be managed.

We saw risks assessments about activities that could present a risk of harm to people receiving care had not been completed. Where people needed to be lifted or transferred using a hoist, for example, there was no information about the equipment and guidance for staff.

This meant that systems for planning and delivering their care did not fully ensure people's welfare and safety.

People we spoke with told us they had a care/support plan and that the care staff did everything they asked them to do. One person said 'They are excellent. I do not know what I would do without them.'

Care staff said 'Communication between the office and care staff has improved, since we have moved premises.'

Is the service caring?

When we spoke with people, we found they were highly satisfied with the care and support they received from the agency. One person told us "I could not manage without them . I have been with Bliss for a long-time.'

Another person told us "They mostly keep to time and the care staff are very friendly and pleasant." When speaking with the people using the service it was clear that they had a good rapport with their carer and with the registered manager.

We were told that on occasions the registered manager undertook calls.

Is the service responsive?

People told us they could raise any concerns about their care and they would be dealt with. One person told us they had no need to complain, but if they did it would be to the registered manager. "The service is flexible and they mostly fit around my appointments.'

People's likes and dislikes had been detailed in the care plan and people told us it was in accordance with their wishes.

People were treated with dignity and respect and care staff we spoke with were able to explain how they would ensure people were treated with dignity and respect when assisting with care.

Is the service well-led?

The registered manager completed regular checks of people's care records and other arrangements for the safe running of the service. Records showed quality audits were reviewed by the manager and changes were made to improve the service where required.

People using the service, their relatives and care staff were invited to complete satisfaction surveys every six months and records showed that action was taken where any improvements were required. However we found that staff were not receiving regular supervision and team meetings were not being held.

This meant staff were had limited opportunities to express their views about the running of the service or receive professional support and development.