BS Care Limited

BS Care Limited is a domiciliary care agency which provides support and personal care to people living in their own home. Not everyone using BS Care Limited received a regulated activity. CQC only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided. At the time of our inspection 137 people were receiving a regulated activity from the service.

People’s experience of using this service and what we found

People were generally satisfied with the service they received. The management team had processes for monitoring visits and endeavoured to ensure that office staff contacted people when care staff were held up or were running late for visits. However, we received mixed feedback about the timing and consistency of call times from people and their relatives. Staff also told us they did not have enough time in between visits for travel. Some improvement was required to make call times more consistent for people. We recommended the provider review staff schedules to improve outcomes for people and ensure staff had enough time to travel between visits.

People received support from caring staff who were appropriately trained and received an induction into their role. Appropriate recruitment procedures were in place to help ensure only suitable staff were employed.

Staff were aware of risks to people's safety and wellbeing and acted to minimise these risks. People felt safe with the staff and the care and support provided. Potential risks to people's safety had been assessed, managed and monitored to ensure their needs were met.

People told us they received safe care and felt that if they raised concerns, the management

team would act promptly to address these. People were safeguarded from the risk of abuse and staff knew how to raise any concerns with the management team.

Staff promoted people's independence and respected their rights, privacy and dignity. Staff knew people well and valued people’s individual lifestyle choices and culture.

A new system had been introduced to improve medicine administration checks. People received their medicines as prescribed and infection control risks were managed effectively.

Staff supported people to access healthcare professionals when they needed to, and worked alongside social care professionals to ensure a joined-up approach to people's care.

The provider had a quality assurance system. This included regular spot checks, audits and feedback surveys.

The registered manager was aware of their responsibilities in meeting their legal obligations.

They showed commitment and welcomed feedback to improve the quality of care people received and the overall service.

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 01 February 2020) and there was a breach 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 and the provider was no longer in breach of regulations.

Why we inspected

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.

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 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 BS Care Limited on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

BS Care Limited is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to younger and older adults. 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. At the time of the inspection the registered manager told us they were providing personal care to 160 people across Portsmouth, Hampshire and West Sussex.

People’s experience of using this service and what we found

Feedback from people who were supported by BS Care Limited, about the service they received was positive. People spoken with told us they felt safe and did not express any concerns about their safety.

Although the provider had invested in new systems to support the monitoring of the service and the registered manager had introduced new paperwork to ensure risk management was clearer and records were person centred, we could not be assured they would be effective as they had not yet been fully rolled out and embedded. In addition, auditing failed to identify the improvement needed to recruitment records which resulted in a breach of regulation.

Enough staff were available to meet people’s needs and they showed kindness, compassion and respect towards people. People could be confident they were supported by staff who had access to appropriate guidance and understood how to keep them safe. Staff’s knowledge of the people they supported was good and they were able to tell us about the risks associated with their care and how to minimise these. Where staff were responsible for supporting people with their medicines, suitable arrangements were in place to do this safely and in accordance with best practice guidance. Staff had been trained and understood their responsibility to safeguard people. People were protected from the risk of infection because staff used protective equipment. Incidents were used to identify improvements that could be made to people’s care and support.

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. Staff had received appropriate training and support to enable them to carry out their role safely. They received regular supervision to help develop their skills and support them in their role.

People knew how to raise concerns and told us how things had changed for the better when they had needed to do so.

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 requires improvement (published 24 December 2018). The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

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

Follow up: We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

Improvements to the assessment of risks and implementation of plans to reduce these risks were needed in some areas for people to ensure their safety. Quality assurance processes were in place but needed some further development to ensure they were always effective in identifying areas for improvement promptly, as well as identifying trends.

People and staff were encouraged to provide feedback and make suggestions. People were supported by skilled and competent staff. People received their medicines safely and as prescribed.

People received compassionate support which met their needs from kind and caring staff. People had the developed meaningful relationships with the staff, which was helped by the registered manager ensuring consistency of staffing. Staff knew what was important to people and ensured people had support that met their needs and choices. People’s dignity and privacy were respected and their independence was promoted.

The registered manager was open and committed to making improvements.

Rating at last inspection: Requires Improvement (report published 15 May 2017)

About the service: 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 to younger and older adults. At the time of the inspection the registered manager told us they were providing personal care to approximately 150 people across Portsmouth, Hampshire and West Sussex.

Why we inspected: This was a planned inspection based on our last rating and aimed to follow up on some concerns we found in January 2017. In addition, we had received some information of concern prior to the inspection which we had asked the provider to investigate. We explored the areas of concern as part of our inspection.

Follow up: As the service remains rated as Requires Improvement, we will request an action plan from the registered provider about how they plan to improve the rating to Good. In addition, we will monitor all information received about the service to understand any risks that may arise and to ensure the next planned inspection is scheduled accordingly.

BS Care Limited is a home care service providing personal care services to people in their own homes in Portsmouth, Chichester and Hampshire. At the time of this inspection there were approximately 280 people who received personal care services.

There was a registered manager in place at the time of our inspection. 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.

Processes and procedures to ensure medicines were handled and administered safely were not consistently followed in all cases. Records did not always show people received their medicines at the right time and in accordance with their preferences. There had been periods where there were insufficient suitable staff deployed to make visits according to the agreed call rotas.

Records of people’s care were not always accurate and consistent. Reports used by the registered manager to monitor and assess the quality of the service were not always accurate and did not reflect concerns raised by people we spoke with.

The provider had arrangements in place to protect people from risks to their safety and welfare, including the risks of avoidable harm and abuse. Recruitment processes were in place to make sure the provider only employed workers who were suitable to work in a care setting.

Staff received timely training and support to maintain and develop their skills and knowledge to support people according to their needs. Staff were aware of the principles of the Mental Capacity Act 2005 and of the need to obtain consent before supporting people. Where staff supported people by preparing their meals, this was done according to their preferences. People were supported to access healthcare services, such as GPs and paramedics.

Care workers had developed caring relationships with people they supported. People and their families were supported to take part in decisions about their care and support and their views were listened to. Staff respected people’s confidentiality, modesty, privacy and dignity.

Care and support were based on assessments and plans which took into account people’s abilities, needs and preferences. Processes were in place to make sure people’s care and support was in line with their plans. People were notified of the provider’s complaints procedure, and complaints were managed and followed up.

There was a caring, responsive ethos. Systems were in place to make sure the service was managed efficiently. People told us the care they received was flexible and responsive to their needs, but some raised concerns about the organisation and management of the service.

We identified two breaches of regulations. You can see what action we told the provider to take at the end of the full version of this report. We also made a recommendation with respect to people’s satisfaction with the timeliness of their calls.

One person told us. 'They are very good and patient even though they are under a lot of pressure'. Other comments from people included: 'The care workers are brilliant. They bend over backwards to do your wishes'. "They give me a sense of security when they come at night. I am 92 and live alone". A relative told us 'They understand mum better than I do'.

We spoke with a member of staff from social services who told us that BS Care Limited provided a reliable timely service, with a low level of visits being later or early than planned. They said that they found high levels of staff training being completed and that the agency worked well with them.

We also spoke with the manager and nine members of staff. They all told us they were well supported by BS Care Limited. They told us training was good and they were provided with the information they needed to support people effectively.

All the people we spoke to said that the agency arranged a replacement care worker when their regular care worker was away and almost all said that replacement care workers supplied were good. None of the people we spoke to, or their friends and families, said that they had ever had any concerns about the treatment they received from care workers. A service user told us "they are always polite." Another service user told us "they are very good, they always ask me what I would like."

We found that the agency considered people's individual needs and circumstances when providing care. The staff at the agency reported that they were well supported by the management team. We also found that the agency had policies and procedures in place to quality assure the services they provide to people.