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Inspection carried out on 30 April 2019

During a routine inspection

About the service:

Belgrave Care is a domiciliary care service offering personal care and support to people living in their own homes. At the time of our inspection there were 37 people using the service.

People’s experience of using this service:

Improvements had been made since the last inspection and the service was no longer in breach of regulation.

Improvements had been made to recruitment procedures. Further development was undertaken during the inspection. The recruitment policy was updated and any gaps in employment were explained and a risk assessment put in place where required.

Improvements had been made so that people’s privacy and dignity was respected. People now received care and support from their preferred gender of carer. Staff promoted people’s independence where possible. People received care and support from regular staff that understood their needs well and were kind and caring.

Improvements had been made so that systems for checking on the quality and safety of the service were effective. Policies and procedures and the service’s Statement of Purpose had been updated. The systems used for sharing rotas with staff and the work they completed had improved.

Staff had undertaken induction training and shadow shifts as well as training relevant to their role. They told us they felt well supported in their roles through supervision and team meetings.

Risks to people were identified, and clear guidance was available for staff to reduce risk. People were protected from the risk of abuse or harm. Staff had received safeguarding training and felt confident to raise any concerns.

Medicines were administered and recorded by trained and competent staff that followed best practice guidelines. Staff had completed infection control training, understood how to reduce the risk of infection being spread and had access to personal protective equipment (PPE).

An assessment of people’s needs was completed and a care plan was put in place to meet those needs identified. People received effective care and support to meet their needs and choices Staff understood the principles of the Mental Capacity Act (MCA) and respected people’s right to make their own decisions.

More information is in the detailed findings below.

Rating at last inspection:

At the last inspection the service was rated Requires Improvement (Report published June 2018). The rating of the service has improved to Good.

Why we inspected:

This was a planned inspection based on the rating of the last inspection.

Follow up:

We will continue to monitor all intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received, we may inspect sooner.

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

Inspection carried out on 3 May 2018

During a routine inspection

This inspection took place from the 3 May 2018 to the 14 May 2018 and was announced.

This service is a domiciliary care agency that provides personal care to people living in their own houses and flats in the community [and specialist housing]. It currently provides a service to older adults. Not everyone using Belgrave Care receives 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 the inspection we were informed that 43 people received regulated activity.

The service had a Registered Manger who was registered on the 09 February 2017. 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.

We found that some improvements were required to the service in regards to management, staffing and quality oversight which meant that there was a breach of the regulations.

You can see what action we told the provider to take at the back of the full version of the report.

The management team were open and approachable in the way they managed the service. There were quality monitoring processes in place but these were not robust enough to fully address all aspects of the service such as monitoring the time, length and reliability of calls. Staff felt under pressure as they were not always given travel time in between visits.

The registered provider was in the process of recruiting staff fill their current vacancies. In the meanwhile, this meant that people were not always supported by a consistent group of staff who arrived on time or knew them well. Processes were in place to ensure that staff recruited was of suitable character but references were not always available or concerns acted upon. We made a recommendation that processes around recruitment are reviewed to ensure they comply with the regulations.

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. However, decisions were sometimes made by people who did not have the legal authority to do so which was not in line with the Mental Capacity Act. We made a recommendation that this practice was reviewed.

People received safe care delivered by staff who understood their role in safeguarding the people in their care. Risks to people's safety were assessed and a management plan put in place to keep them safe. People who received medicines were supported in a safe way as staff had the necessary training to administer medicines safely.

Care plans were comprehensive and person centred. Staff had the right information available to ensure that they provided care in line with a person’s needs and wishes.

Where people were supported with their nutritional needs, staff showed a good awareness of their dietary needs and where to get further support should this be required. Staff worked with people, their relatives and health professionals to manage people's health needs, making appropriate referrals for advice when necessary.

People told us that the staff were caring and kind. People commented that they were treated with dignity and respect and their privacy was maintained. When staff supported people at the end of their life, they worked to ensure their wishes were acted upon and supported their relatives during this time.

People were aware of how to raise concerns and complaints. Not all complaints were recorded and a record kept of actions taken.

The staff had knowledge of the Equality Act and did not discriminate against people in their care. Staff was supported