Bionicare (Domiciliary Care Agency)

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

People were not always safe using the service. We found breaches of regulation in relation to safe care and treatment and staffing levels. The amount of support people needed from staff was not clear and staffing levels were not being monitored effectively to help make sure they were safe. Incidents and accidents were not always reviewed effectively to see if measures could be taken to improve people’s safety. People’s risk assessments and care plans were not always as clear or as detailed as they could be to guide staff to support people safely.

Staff had a good understanding of safeguarding and how to report concerns however external reporting and review of incidents did not always occur. Staff were trained to support people and had a good understanding of their training and how to support people as best as they could. People’s home environments were kept safe and staff followed good infection prevention control (IPC) measures. People were supported safely with their medicines.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Processes in place to monitor incidents and accidents were not always effective. In some cases, incidents should have been reported to other partners such as the local authority or CQC but were not. In other cases, it was not always clear what actions had been taken to make improvements for people’s safety in response to incidents that had happened. People’s care plans were not always updated clearly in response to incidents that happened, and staff did not always record people’s daily records in detail making it more difficult to review and promote a learning culture. For example, 1 person showed how they were feeling by harming themselves and did this in a different that had not happened before. This was recorded on an incident form, however, was not added to their care plan so staff were aware this may now be a risk the person needed support with. There were a lack of audits taking place to monitor trends in relation to incidents and accidents. This meant effective actions were not always taken to put improvements in place and promote learning at the service.

However, staff told us they discussed incidents regularly in staff meetings and in 1-to-1 discussions with the management team. Staff explained how they would report incidents. People told us staff learned lessons when things did not go to plan. One person told us, ‘‘[Staff] are fantastic at what they do and are always looking to support me as best as they can. They talk to me all the time and make sure I am happy and if I am not then they ask what they can do to make things better. The staff all get on well together and talk about any changes that can be made. It works really well.’’

People were safely supported to access other services such as visiting health professionals. One person said, ‘‘I get quite nervous when I need to go to appointments for things. [Staff] are trained to support me in any given situation and help me to the appointment and back again. They help me follow any advice I am given. It makes me feel very safe.’’

Staff knew how to safely support people when using other services. Staff recorded professionals’ advice in daily records, and this was used to update people’s care plans. The management and staff team had produced documents to give to health professionals explaining how best to support people when they attended appointments.

People were not always safeguarded from abuse as the management team were not always effectively reviewing incidents that happened and recording actions to safeguard people. Incidents were not always reported to the local authority or to CQC when they needed to be. People were living with specific support needs which put them at risk of harm and by not reviewing potential safeguarding concerns effectively people may have been put at risk.

However, staff had a good understanding of safeguarding and how to report potential signs of abuse both at the service and to external organisations. People felt safe using the service. Their comments included, ‘‘I feel safe, and the staff always reassure me too. The staff know what worries me and make sure I feel comfortable and safe.’’ and, ‘‘I 100% feel safe and the staff are my ‘security blanket’ both in and out of the house.’’

People’s risk assessments and care plans were not always as detailed as they could have been to guide staff how to support people safely. People were living with specific support needs and there was sometimes limited information about how best to support people with these or the signs staff needed to look out for which may indicate a person needed support. When changes happened which impacted people’s support these were not always recorded clearly in people’s care plans or were kept in other documents. This may have made it harder for staff to be aware of how best to support people if their needs had changed. Some people’s risk assessments stated they needed 1 to 1 support from staff to help them if they felt upset. This would not have been possible at all times of the day with the staffing levels in place at some of the supported living settings. This had not been considered or reviewed by the management team. Following our inspection the management team took immediate action to review staffing levels and people’s care plans and risk assessments. They sent us evidence of this to help assure us improvements would be made and sustained.

Staff knew people well as individuals and how to best support them with any risk they faced. They told us they felt care plans and risk assessments were well detailed and guided them how best to support people. Staff told us if they noted changes, they would bring this up with the management team. People felt staff supported them safely and in line with their risk assessments. One person said, ‘‘No matter the situation, staff are there to help me. They never make me feel like anything is my fault and the support they give me makes me feel good.’’ People also told us they were involved in discussing and having input into their care plans and risk assessments. One person said, ‘‘[Staff] sit down and go through my care plan with me all the time. I get to say what is in it.’’

Staff supported people to keep their homes safe. They completed health and safety checks of the environment including areas such as fire safety. Audits were in place to make sure health and safety checks were completed and any actions were taken to help improve the safety of the environment. One person said, ‘‘Staff keep the home very safe and secure. We have things like security cameras and lights. They check all the fire extinguishers as well. We have fire drills, so we know what we are doing if there is an emergency.’’ Another person told us, ‘‘I love it here. The living rooms and gardens are nice and spacious, and my bedroom is perfect for me.’’

Staffing levels were not being effectively monitored to make sure they were safe. The management team did not have information about how many hours of support people required to be supported in all aspects of care they needed. Hours were not being monitored to make sure people got the right amount of staff support for their care needs. At some times of the day 1 staff member was available to support a large number of people who needed dedicated 1 to 1 support from a staff member at times when they felt upset. This meant if a person needed 1 to 1 support from a staff member other people who may need support would not have this available. The provider and registered manager told us in these circumstances they or another member of the management team would go and support. However, this support was not being monitored or recorded. Some staff worked across several ‘supported living setting’s and the support they were giving to people was also not being monitored to help ensure they had enough support to achieve their desired goals and outcomes. The provider and registered manager told us staffing levels were safe however they did not have audits to show this to be the case. They also told us staffing levels were higher before our inspection, however they also told us staffing levels were safe at these reduced levels. It was not clear how this was safe as no audits were taking place to monitor staffing levels. Following our assessment, several new staff started working at the service.

Despite our findings people raised no concerns about staffing levels. One person said, ‘‘There is always someone about to help and other people come in to take us out for activities.’’ Staff also told us there were enough staff to support people and they felt safe with current staffing levels. Staff were recruited safely in line with legislation. The provider told us they were recruiting new staff and sent us evidence of the positive impact this would have for people.

Staff supported people to keep their homes clean and followed effective Infection Prevention and Control (IPC) practices. They supported people to do this independently as much as they wished to. People’s homes looked clean and were free from unpleasant odours. One person said, ‘‘I like cleaning. Staff do a lot of the housework but support us to help out as much as possible. After all it is our home.’’ IPC audits were completed to make sure the environments were being kept clean and free from infection.

Staff supported people safely with their medicines and had their competency to do this checked regularly. Where people were prescribed ‘as and when required’ medicines protocols were in place to guide staff how to administer these medicines safely. The management team completed audits to help make sure medicines were administered safely. Some people were supported to manage their own medicines. One person said, ‘‘I like having all my medicines locked away in a cabinet, so the staff help me with this. They help me get the right medicines out and I do them myself whilst the staff watch to make sure everything is OK. I always wanted to do this and its great I can do it here.’’