Bosworth Homecare Administrative Offices

Bosworth Homecare Administrative Offices is a domiciliary care agency, providing personal care to people in their own homes. At the time of inspection, 122 people were using the service. 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.

People's experience of using this service and what we found.

The provider and registered manager had addressed a significant number of the concerns we previously identified. Care plans and risk assessments were being regularly reviewed, health specific care plans and risk assessments were now in place to ensure that staff had information to safely monitor need and respond to risk. Medicine practice was now safe. Staff stayed for the length of time they should at care calls. Systems and processes had been put into place to improve the oversight at the service.

People and their relatives were very satisfied with the personal care staff provided. They said they were treated with respect and dignity and staff had a caring and friendly approach to them. They said they had very good relationships with staff. Staff respected people's privacy and encouraged them to maintain their independence and do as much for themselves as they wanted to.

Timely calls were largely in place to provide people with the personal care they needed. The registered manager swiftly followed up this issue with a small number of people.

Safe recruitment practices were in place to ensure only suitable staff worked at the service.

Details of how to reduce risks to people's safety were included in people's care plans. Care plans reflected people’s individual needs. Enough staff were employed to meet people's needs. People and relatives said safe care was provided, with people protected against abuse, neglect and discrimination.

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.

People and relatives were aware of how to approach the registered manager to raise concerns or complaints. The registered manager understood their responsibilities and worked in an open and transparent way.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Why we inspected

The inspection was to follow up the Warning Notices we issued to the provider following the last inspection. We have found evidence that the provider has made improvements.

The overall rating for the service has improved to good based on the findings of this inspection.

Rating at last inspection

This is the 4th inspection for the service. The last inspection was in May 2022 when the service was rated requires improvement. There were breaches of Regulation 12 Safe care and treatment, and Regulation 17 Good governance, of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Follow up

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

Bosworth Homecare Administrative Offices is a domiciliary care agency providing the regulated activity personal care to people living in their own homes. At the time of our inspection there were 139 people using the service.

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.

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

Care plans and risk assessments were not regularly reviewed. Health specific care plans and risk assessments were not in place. This meant staff did not always have information and guidance available to them to safely monitor need and respond to risk.

Staff administered medicines but we found some instances where practice was not always safe.

Improvements had been made to staffing levels, however staff did not always stay for the length of time they should at care calls.

Systems and processes were not effectively used to ensure the service ran efficiently and safely all of the time.

The service did not have a registered manager. A new acting manager was in post who was working hard to make improvements at the service and promote positive changes.

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 good (published 25 May 2019).

Why we inspected

We received concerns in relation to care calls being delivered late or missed; staffing levels and poor management oversight. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Bosworth Homecare Administrative Offices on our website at www.cqc.org.uk.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to how people received safe care and treatment, and how the service was managed at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

What life is like for people using this service:

People felt safe with the staff team who supported them.

The management and staff team were aware of their responsibilities for keeping people safe from avoidable harm.

Risks associated with people’s care and support had been assessed, managed and monitored.

There were sufficient numbers of staff available to meet people’s needs.

A robust recruitment process was followed, and new staff had received a comprehensive induction into the service.

Staff had received training in medicines management and people were supported with their medicines safely.

The registered manager made sure lessons were learned when things went wrong.

People’s needs were assessed prior to their care package commencing and support plans were developed.

New staff had been recruited appropriately. They had been provided with a comprehensive induction into the service and had the skills and knowledge to meet people’s needs.

People were protected by the prevention and control of infection. The staff team had received training in infection control and the appropriate protective equipment was provided.

People were involved in making decisions and choices about their care and support and their consent was always obtained.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

The staff team were kind and caring and treated people with dignity and respect.

A complaints process was in place and people knew what to do if they were unhappy with the service they received.

People’s thoughts on the service were regularly sought.

Monitoring systems were in place to check the quality and safety of the service being provided.

The management team worked in partnership with others and continually looked at ways to improve the service.

More information is in the detailed findings below.

Rating at last inspection: Good (report published 22 July 2016) all the key questions were rated Good and the service was rated as Good overall.

Rating at this inspection: The rating for this service has not changed and the service remains Good.

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

Follow up: Going forward we will continue to monitor this service and plan to inspect in line with our re-inspection schedule for those services rated Good.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The service had a registered manager. 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.

People told us they felt safe with the staff team from Bosworth Homecare Administrative Offices. They told us they were looked after well and their relatives agreed. Support workers had received training on how to keep people safe and they knew what to do if they felt that someone was at risk of harm. The management team were aware of their responsibilities for keeping people safe.

Risks associated with people’s care and support had been assessed. This was so that support workers could provide people’s care and support in the safest possible way.

An appropriate recruitment process had been followed to make sure as far as possible that only suitable people worked at the service. Once recruited, new members of staff had been provided with a comprehensive induction into the service and relevant training had been completed.

Support workers we spoke with felt supported by the registered manager and the management team. They told us that there was always someone available to speak with should they need any help or advice both in and out of office hours.

People’s needs had been assessed at the start of their care and support package. They had been involved in deciding what care and support they needed and had been involved in the development of their plan of care. Plans of care included people’s likes and dislikes and their personal preferences in daily living.

People were asked for their consent before their care and support was offered. Training on the Mental Capacity Act 2005 (MCA) had been provided during the staff team’s induction into the service and both the management team and the support workers we spoke with understood its principles.

Support workers were aware of what they could and couldn’t do with regards to medicines. They only supported people with medicines that were recorded on their medicine administration record. Training in medicine management had been provided and this had been updated on an annual basis.

People told us that the staff team were kind and caring. They told us that they were provided with choices when they were being supported and their care and support was provided in a way they preferred.

People told us that they had regular support workers who visited them. They told us that the support workers knew them well, they always turned up and stayed for the right amount of time. Nobody felt rushed by the support workers who supported them.

People using the service and their relatives knew what to do if they were unhappy with the service they received. They knew who to speak with if they had a concern and were confident that any concerns would be dealt with properly.

People had the opportunity to be involved in how the service was run. They were asked for their opinions of the service on a regular basis. This was through visits to people’s homes and through the use of surveys.

The management team monitored the service being provided on an on-going basis to ensure that the care and support that people received, was the best that it could be.

We were supported on this inspection by an expert-by-experience. This is a person who has personal experience of using or caring for someone who uses this type of care service.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask. This is a summary of what we found:

Is the service safe?

People told us that, overall, they felt safe with the care workers who supported them and that they were treated well. One person explained: 'Safe? With the regular three, yes, I don't like it when it's different people.' Another person told us: 'I feel very safe, yes.'

Risk assessments were in place and these had been reviewed on a regular basis. Those checked on the day of our visit showed us that the risks associated with people's care had been assessed and measures had been put into place to reduce those risks. This showed us that people's health and welfare was, wherever possible, protected.

Care workers and members of the management team knew what to do if they suspected that someone had been abused. One care worker explained: 'I would report it straight the way to my line manager and if nothing was done, I would take it to another manager.' Another care worker told us: 'I would report it, I have reported something in the past and they [the management team] dealt with it properly.'

Personal protective equipment was available for care workers to use including disposable aprons and gloves. This ensured that care and support was provided safely and in line with the services infection control policy.

There was an appropriate recruitment process in place. This ensured that only suitable people worked for the service.

Is the service effective?

We spoke with people who used the service and they told us that, overall, they were satisfied with the care and support they received. One person explained: 'I have raised concerns about the timings, [of the care calls] I am supposed to get a 6.30pm supper call but it's sometimes gone 7.15pm and I don't want to be eating that late.' Another person told us: 'They certainly care for me! We can have a bit of banter too.'

Care plans provided care workers with information about people's care and support needs and it was clear from speaking with both care workers and the management team, that they understood the needs of the people they supported. This ensured that people's needs were met.

Consent to the care and support that people received was obtained and this was reviewed on a regular basis. This ensured that people remained happy and in agreement with the care and support they received.

Is the service caring?

People who used the service told us that they were happy with the care and support they received. They told us that the care workers showed them respect at all times. They added that care workers provided their care and support in a kind and caring manner. One person told us: 'I can't better them, even the ones who come odd times are fine' Another person explained: 'They give me as much privacy as possible when washing, keep me covered, that sort of thing.'

A family carer told us: 'Yes, they treat us with respect; I think it helps with me being here. There have been small instances when they don't listen to him and I have had to say something. It's not often and not the regulars, but people should listen just because he's disabled that's no reason not to.'

Is the service responsive?

The provider had an effective complaints procedure that ensured complaints were taken seriously and thoroughly investigated. Everyone using the service had been given a copy of the procedure so that they knew what to do if they were unhappy with the service they received. People who used the service told us that they knew what to do if they weren't happy. One person told us: 'Yes, she, [the one who arranged the care], has said to ring if there's any problem and she's given me a phone number.'

Is the service well-led?

A robust quality assurance system was in place and the management team regularly assessed the service provided. This ensured that people received the care and support they needed, in a safe and effective way.

Care plans and risk assessments were reviewed at regular times to monitor people's needs. Where changes in people's health and welfare had been identified; the care plans and risk assessments had been updated to reflect this.

Care workers felt supported by the management team and told us that they felt able to talk to someone should they have a concern of any kind. One care worker explained: 'There's always someone available to talk to.' Another care worker told us: There's someone available twenty four seven.'

We were told that people were asked to give their consent before any care or support was provided. One person explained: 'Two different people came to see me, they fine-tuned my care plan and I signed it, they kept a copy and I kept a copy.'

We looked at the care plans and risk assessments for four people and found that though these documents were comprehensive, they hadn't always been completed in a timely manner.

People told us that they were provided with regular support workers and training records showed that the support workers were appropriately trained. This enabled them to carry out their role within the service safely and competently.

We found a number of monitoring systems in place including six monthly reviews with the people who use the service. This enabled the management team to monitor the quality of service that people received.

People told us that they were very satisfied with the care and support they received. They told us that they were treated with respect and the support workers were most helpful. One person told us: 'The carers are fantastic, I can't fault them.' Another explained: 'The carers are absolutely brilliant; I have built a rapport with them.'