Bionicare (Domiciliary Care Agency)

On this page

• 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

The service was not always well-led. We found a breach of regulation in relation to good governance at the service and notifiable incidents not being reported to the CQC in line with legislation. Audits were not being completed or were not always effective in monitoring the quality of the service, particularly in relation to safe staffing levels and how people were being supported to achieve their goals and aspirations. It was more difficult for the management and staff team to learn lessons and improve because of this. Incidents and accidents were also not always being effectively monitored to see where improvements could be made.

The registered manager and management team were dedicated and passionate about the service and their job roles. They started to take immediate action to improve the service following on from this inspection. Staff enjoyed their jobs and felt well supported by the management team. People were happy using the service and were positive about how well led the service was.

This service scored 57 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

There was not always a clear direction and culture at the service. The provider told us people were supported to use the service and then move on to live independently. However, there was no evidence this had been discussed with people and some people had been using the service for an extended period of time. As discussed earlier in this report the provider was involved in some aspects of the landlord business who owned people’s homes which was a potential conflict of interest. Some aspects of the service including how people were being supported in line with RSRCRC and to achieve their outcomes were not being effectively monitored and audited. One service had some aspects similar to a care home such as a keypad which people used to leave the house, but did not know the combination to. People were happy with this arrangement, but this had not been formally discussed or recorded with them. This is not in line with RSRCRC or living in a supported living setting.

Despite our findings there was a positive culture at the service. People and staff described using or working at the service as being part of a family. In discussion with the staff and management team it was clear they were passionate about supporting people and put them at the centre of everything they did. People enjoyed living at the service. One person said, ‘‘The staff are amazing, and they go above and beyond in all of their duties. I know it sounds dramatic, but I really do not think I would be here as happy as I am if it was not for [service].’’

Some aspects of the service were not being effectively audited and monitored. For example, incidents and accidents, the way in which staff were deployed and the way in which people were being supported to set and make progress towards their individual goals and aspirations to achieve positive outcomes. The management team had not been notifying CQC or the local authority about some incidents that needed to be notified to us.

However, people and the staff team told us the registered manager, provider and the wider management team were compassionate and inclusive. Staff told us they felt well supported and could call the management team for support at any time. They described the management team as having an ‘open door policy’ and gave examples of when the management team had helped them support people in a variety of ways. Other aspects of the service such as medicines management and the effectiveness of staff training was being well monitored. People’s comments included, ‘‘I get on really well with the management team. They are so kind and always just a phone call away.’’ and ‘‘The management team are just as kind and caring as the staff team and we can speak with them about anything. They really care about how we are getting on.’’

People knew how to speak up if they had any concerns. They were also supported to feed back about their care and support regularly through meetings and more informal discussions. One person said, ‘‘I have never had a problem here but if I did, I know I could speak with any of the staff or management team, and it would be sorted out quickly.’’ Another person told us, ‘‘[Staff] are always checking in to make sure I am OK and listen to how things are going.’’ Staff also felt confident to speak up about any concerns they had and told us the management team took any feedback seriously. The registered manager reviewed and monitored any complaints and concerns about the service and made sure actions were taken to improve where necessary.

Staff felt well supported in their job roles. They told us the registered manager and provider supported their wellbeing in various ways such as supporting flexible working hours or helping them if they had questions about their job roles. They also told us they could request extra support or training, and this was organised quickly. The providers recruitment process was fair and equitable.

The registered manager and management team were completing audits to monitor the quality of the service. However, audits were not being completed in some key areas such as the monitoring of staffing levels to make sure people’s support needs were being met, incidents and accidents being reported to the local authority or CQC and ensuring people were consistently supported to discuss and achieve their goals and objectives. Whilst the management and staff team understood most principles of RSRCRC and supporting people in a supported living context not all of these principles were being followed. One setting had some similarities to a care home, and the nominated individual was involved with the ownership of some of the buildings people lived in. RSRCRC and people’s quality of care was not always being audited or discussed with the staff team. People’s care plans were not always updated clearly when changes happened. Daily records completed by the staff team were being reviewed, however audits did not identify where incidents happened and had not always been reported. The registered manager and provider acknowledged their auditing and monitoring systems needed improving and sent us evidence assuring us, they would action this.

Other aspects of the service such as staff training and supervisions and medicines management were being monitored and audited effectively. The registered manager was working hard to introduce new audits to effectively monitor the quality of the service. Staff told us the management team were visible and visited them and people regularly to make sure everything was going well at the services.

The management and staff team had built good working relationships with health professionals and supported people to see them when needed. They also supported people to go in to the community to follow their interests. One person said, ‘‘We do lots of things here and staff take us out whenever we want to do something.’’ In the past people had been supported to be a part of the community in ways such as having jobs. One person said, ‘‘I used to be employed but had to stop. Staff are helping me think about maybe starting this again. It is something I am interested in doing.’’ The registered manager and provider supported people using the service to be a part of a community and be friends with each other if they chose to be. They organised group activities and opportunities for people. One person said, ‘‘Its great [using service] and we all get on well together. We are all true friends now.’’

There were some areas for improvement that had not been identified by the management teams audits and quality monitoring. They had not identified the areas needing improvement we found during this assessment. This included the monitoring of staffing levels, the application of the principles of RSRCRC and people being supported in line with ‘supported living’ and the reporting of incidents and accidents. Audits were not always effective in updating and making sure care plans and daily records were as clear as possible. We were not shown any service improvement plans as part of this assessment. This made it more difficult for the management team to improve the service. Following our assessment the registered manager took immediate action to start implementing and sustaining improvements and sent us evidence reassuring us this would happen in a timely manner.

Despite our findings, the service was supporting people to have good experiences and people told us their lives had improved significantly since living at the service. Their comments included, ‘‘I do not know where I would be right now if I did not live here. I owe who I am today to the support from the staff team.’’ And, ‘‘Everyone here is amazing. They treat us with the utmost dignity and respect, and you could not ask for a better service.’’ The registered manager and management team were keen and passionate to improve the service. They started making improvements during and after our assessment to reassure us improvements would be made.