About the service
'Bromley' is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to older adults. Two people were using the service at the time of our inspection.
People’s experience of using this service and what we found
The provider had failed to ensure that medicines were managed safely. There was no guidance in the care plans for staff to know how or when to support people to take medicines which had a specific administration process. Staff had completed online training in the safe administration of medicines. However, assessments to ensure staff were competent to handle medicines had not been completed.
The provider had not displayed the previous inspection rating on their website and in their office.
The provider had failed to maintain a record of decisions made in people’s best interests. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. We have made a recommendation about ensuring the provider follows the principles of The Mental Capacity Act (2005).
The provider’s quality assurance systems had failed to identify the concerns we found at this inspection.
People were supported by effectively deployed staff. One relative told us, “We have not had any missed visits. The carers turn up on time and let my [loved one] or myself know if they are delayed.”
The provider carried out satisfactory background checks for all staff before they started working. However, one external consultant’s recruitment checks were not available, and this required improvement.
The registered manager completed risk assessments and risk management plans included guidance for staff for people who used the service.
People and their relatives gave us positive feedback about their safety and told us staff treated them well. One relative told us, “I definitely feel my relative is safe in the hands of the carers.”
The registered manager and staff understood what abuse was, the types of abuse, and the signs to look for. Staff knew the procedure for whistle-blowing and said they would use it if they needed to. The provider had a system to manage accidents and incidents to reduce the likelihood of them happening again.
People were protected from the risk of infection. One person told us, “They [staff] wear aprons and gloves.” One relative said, “I know the carers wear protective gloves.”
People and their relatives confirmed staff obtained consent from them before delivering care to them. People’s needs were assessed to ensure these could be met by the service.
The provider trained staff to support people and meet their needs. One relative told us, “The carer is very good and very professional.” Staff supported people to eat and drink enough to meet their needs. People were supported to maintain good health.
Staff supported people and showed an understanding of equality and diversity. One relative told us, “They [staff] contacted the priest for us who now visits. I did not know could be done, and it has made me very happy.” People’s care plans included details about their ethnicity, preferred faith and culture. People and their relatives had been involved in making decisions about their care and support. People were treated with dignity, and their privacy was respected.
The provider had a policy and procedure to provide end-of-life support to people. However, no-one using the service required end-of-life support at the time of our inspection.
We saw some good practice at the service, they had an on-call system to make sure staff had support outside office working hours and staff confirmed this was available to them. One person told us, “I can recommend the company because they [staff] are kind and not intrusive.” On relative said, “I think the service is good and well managed.” There was a positive culture in the service, where people and their relatives’ opinions were sought to make service improvements. The provider remained committed to working in partnership with other agencies and services to promote the service and to achieve positive outcomes for people.
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 requires improvement (published 29 November 2018) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, enough improvement had not been made and the provider was still in breach of regulations. This is the second time the service has been rated as requires improvement.
Why we inspected
This was a planned inspection based on the previous rating.
We have identified continuous breaches in relation to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 at this inspection. The systems and processes for managing people’s medicines were not always safe.
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.
We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.