Background to this inspection
Updated
23 October 2019
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
Inspection team
This inspection was carried out by one inspector.
Notice of inspection
This inspection was announced. We gave the service 48 hours’ notice of the inspection. This was because we needed to be sure that the provider or registered manager would be in the office to support the inspection.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.
The service had two managers in post who were registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
What we did before the inspection
Before the inspection, we looked at information we held about the service, including notifications they had made to us about important events. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
During the inspection
We visited the agency office on 18 and 26 September 2019 and spoke with the provider, one of the registered managers and a member of the human resources team.
We reviewed a range of records. This included six people’s care records, three staff files, recruitment, medicine records and other documents relating to the service delivery.
We spoke to two people, six relatives and a friend asking for their feedback about the service delivery. We also talked to three staff members working for the service.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at data relating to training and staff support.
Updated
23 October 2019
About the service: Best At Home Domiciliary Care Services Ltd is a domiciliary care agency and registered for ‘personal care’. The service provides personal care to older people who may be living with dementia and have physical disabilities. At the time of inspection, 40 out of 43 adults were receiving support with personal care from this 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:
There were no quality assurance processes in place for the registered manager to review the audits taking place. We made a recommendation about this.
Risks to people's health and safety were not always sufficiently assessed and more guidance was required for staff on how to mitigate the potential risks to people. Although care records reflected people’s preferences and choices, some additional information was required on how to support people with personal care and at the end stages of their lives.
Staff followed provider’s procedures if they noticed people being at risk to harm. People were assisted to manage their medicines safely. Staff were required to undertake appropriate checks before they were employed by the provider. Systems were in place to ensure hygienic care for people.
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 knew the actions they had to undertake should they noticed people’s health needs deteriorating rapidly. People were assisted with their meal preparations as necessary.
People felt respected by the staff that supported them. Staff encouraged people to maintain their independence skills where possible. People were provided with information, so they could make choices and decisions for themselves as necessary. Personal information about people was securely stored.
Staff encouraged people to engage in conversations and used their preferred ways of communication. People and their relatives felt confident to raise any concerns they had which were addressed by the service to the satisfaction of the complainant.
People and relatives told us there was good leadership at the service which ensured that their views were adhered to as necessary. We found the registered manager transparent and caring about people’s wellbeing. The staff team worked together with the families to ensure person-centred care delivery for people. Support and guidance was provided for staff to ensure they performed their duties well.
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 good (published 10 May 2017).
Why we inspected
This was a planned inspection based on the previous rating.
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.