Archived: Bright Care Agency

Bright Care Agency is a domiciliary care agency providing personal care to people in their own homes. The service is registered in Weston-Super-Mare, North Somerset. However, at the time of the inspection, the service was operating from premises in Northampton. This was not a registered location. Bright Care Agency was providing care to people who lived in the Northampton area.

As a result of concerns identified at our previous inspection in October 2020, we imposed conditions on the provider’s registration. Conditions are used to limit, or restrict, what a provider can do. One of the conditions placed on the provider’s registration meant the service should only be providing a regulated activity to one person. However, we found a further two people were receiving a service from Bright Care Agency. This meant the provider was not working in accordance with the conditions placed on their registration.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is to 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

People received poor quality care as there was widespread and significant failings across all aspects of the service. Bright Care Agency was not well-led and managed. There was a lack of oversight and governance. This put people's safety at risk and did not ensure people received a caring service. The registered managers had failed to address any previous shortfalls, resulting in a lack of improvement.

The registered managers did not follow safe recruitment procedures. Risks to people were not identified and risk guidance was not in place in people's care records. Systems to monitor and administer medicines had not improved. Infection control risks were not mitigated. Staff were not being regularly tested for COVID-19 in line with guidance. People were not safeguarded from potential abuse and neglect.

Staff did not receive a sufficient induction or consistent supervision to enable good quality care practices to develop. Staff had completed training. However, this was not always received before delivering care or in line with published guidance.

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

People did not always receive a caring and person-centred experience. We received mixed feedback about how staff cared for people. Care records did not always contain full information around communication, equality characteristics and people’s interests. People did not always have a care plan.

Complaints were not identified or responded to. The provider had failed to display their current CQC performance assessment. Notifications were not always submitted to CQC as required.

The provider had a disregard for legislation and guidance and had failed to adhere to the conditions on their registration. There was no required insurance in place which put people and staff at risk. Action had not been taken from previous inspections to progress and monitor improvements.

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 inadequate (published 30 November 2021) and there were multiple breaches of regulation. Following the inspection, CQC took enforcement action.

Why we inspected

This inspection was carried out to check, if improvements had been made and the provider was working in accordance with conditions placed on their registration.

We have not found any evidence the provider has made improvements.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Bright Care Agency on our website at www.cqc.org.uk.

Enforcement

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We had identified seven repeated breaches of regulation and a further five breaches at this inspection. This demonstrated significant and widespread failings.

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.

At the last inspection it was recognised that the provider had failed to display their performance assessment rating and continued to do so after this was reported. This was a breach of regulation and we issued a fixed penalty notice in March 2021. The provider accepted a fixed penalty and paid this in full.

Follow up

We will continue to follow our enforcement procedures.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Bright Care Agency is a domiciliary care agency providing personal care to people in their own homes. The provider did not give accurate information about the number of people the service was supporting. We ascertained the service was supporting eight people at the time of the inspection.

Not everyone who used the service received personal care. The Care Quality Commission (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 service was not well-led and managed. There was a lack of oversight and governance in all areas. This put people’s safety at significant risk. The provider had failed to address previous shortfalls and improvements were not sustained.

The provider did not follow safe recruitment procedures. Staff did not receive a sufficient induction or suitable training to enable them to be skilled and competent in their role.

Risks to people were not identified and risk guidance was not in place in people’s care records. Systems to monitor and administer medicines were not safe.

Infection control risks were not mitigated. People’s care was not delivered on time. People were not safeguarded from potential abuse and neglect.

The provider had failed to display their current CQC performance assessment and had failed to notify the commission of significant events when required.

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 23 March 2020). This was a targeted inspection following up on enforcement action in response to a comprehensive inspection conducted in September 2019. At this inspection in October 2020 we found improvements had not been made or sustained and the provider was still in breach of regulations.

Why we inspected

We received concerns in relation to staffing. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make significant improvement. 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 Bright Care Agency on our website at www.cqc.org.uk.

Enforcement

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified seven breaches of regulation at this inspection in relation to safe care and treatment which includes medicines, infection control and risk assessing, staff training, safe recruitment, protecting people from abuse, governance, failure to display rating and failure to notify.

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.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within six months to check for significant improvements.

If the provider has not made enough improvement within this timeframe, and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Bright Care Agency is a domiciliary care agency providing personal care to 15 people in their own homes. Not everyone who uses this kind of service receives 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

The provider had taken steps to improve the service and ensure people received safer care. Quality assurance systems had been designed to ensure people had safe support with their medicines and improvements were made to the timeliness of their care. People and staff told us they had seen some improvements but there were still further improvements to be made.

People were supported by the same carers more regularly which enabled them to build relationships together. Staff told us this was an improvement and they were able to get to know people better and understand their needs. People had been asked to provide their feedback about the service, and we saw that feedback of the service was improving.

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 Requires Improvement (published 22 November 2019).

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains Requires Improvement.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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.

Bright Care Agency is a domiciliary care agency providing personal care to 16 people in their own homes. Not everyone who uses this kind of service receive 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

People felt the service lacked organisation and improvements were required to the management of the service. People did not receive care from consistent carers and care was regularly untimely.

The management and oversight of the service was insufficient. The service had been reliant on the local authority for support and had been unable to identify the required actions of a good service. Management structures were weak and ineffective contingency plans were in place to ensure the running of the service in the event the nominated individual and registered manager were unavailable.

Quality assurance processes were ineffective. There were some auditing systems in place however they had failed to identify concerns with medication or the timings of people’s care.

Improvements were required to ensure the management team reflected on when key aspects of the service went wrong, to learn, and ensure repeated concerns did not reoccur. The culture within the service did not promote person centred care.

Medication systems were unclear and unsafe and required improvement. Medication administration records were inconsistently recorded and not reviewed in a timely way.

People’s risk assessments were insufficient. They were not always in place for people’s identified risks and those that were recorded were not adequately reviewed and updated at regular intervals.

The timing of people’s care required improvement. People told us care was regularly not at the time they expected it, and staff did not stay for the required length of time. People felt they were well treated but were unable to build relationships with staff as they did not have regular members of staff. People also told us of the difficulties they had when staff did not have a good understanding of the English language.

People’s care plans were not sufficiently updated, and complaints were not adequately investigated and resolved.

People were supported to have their care in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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 25 February 2019).

Why we inspected

The inspection was prompted in part due to concerns received about the management of the service and the quality of the care people received. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the Safe, Caring, Responsive and Well-Led sections of this full report.

Enforcement

We have identified breaches in relation to the management and quality assurance procedures of the service. We also identified breaches in relation to the risk assessments of people, and how people’s medicines were managed.

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.

This was the first comprehensive inspection carried out at Bright Care Agency since the provider registered with the Care Quality Commission (CQC) in June 2017.

Not everyone using Bright Care Agency received a 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 consider any wider social care provided. At the time of the inspection the provider confirmed 14 people received the regulated activity ‘personal care’.

The provider was also the registered manager for the service. 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 and associated Regulations about how the service is run.

The provider had submitted notifications of other events and incidents in a timely way to the Care Quality Commission (CQC). However, the provider had moved to a new business and location address in September 2018 and had not notified CQC of the change of address. The Care Quality Commission (Registration) Regulations 2009, requires providers to notify CQC, of any changes to their registration. The failure to notify CQC of the change of address meant the provider was in breach of a condition of their registration.

People felt safe. Staff received safeguarding training to enable them to recognise the signs and symptoms of abuse and how to report abuse. Individualised risk management plans promoted people's safety. Staffing numbers were appropriate to keep people safe.

Safe recruitment practices were followed to ensure staff employed were suitable to work at the service. Medicines were managed safely and in line with best practice guidelines. Infection control procedures were followed to protect people from spread of infection risks.

People's diverse needs were identified at assessment, and the care and support was provided in line with their assessed needs. Staff received training based on best practice guidelines and received support and supervision to further develop their skills and knowledge.

People were supported to eat and drink sufficient amounts; to access health support services and attend health appointments as and when required.

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.

People's choices were respected, and their privacy and dignity was maintained. Staff provided support in a caring and supportive way. People were involved in the planning of their care which was person centred.

People were supported to raise any concerns or complaints about the service.

Governance systems were used to oversee, improve and drive continuous improvement across the service.