Bella Home Care

Bella Home Care is a is a community-based care provider that provides personal care to people living in their own homes. At the time of inspection there were 67 people in receipt of the regulated activity of personal care.

Everyone who received support at the time of our inspection 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

At our last inspection, we found some improvements were required as some people's health risks were not always reviewed and some people's care records not always updated. Quality assurance systems were not operated effectively to identify, where the service required improvement. We identified a breach of the regulations.

Following the last inspection, we formally requested the provider sent us a monthly action plan telling us what they had improved and where improvements continued to be made at the service, with timescales. At this inspection, we found the action plan had driven some improvements and some risks associated with people’s care were managed safely. Audits and checks had been improved which meant the provider was no longer in breach.

People were pleased with the service they received. People received their care calls at their agreed time slots and on occasions when staff were running late, people were notified.

People and relatives confirmed they received their care and support from a regular staff team who knew them well. People’s feedback showed they valued the support they received.

There were sufficient staff employed to undertake care calls to people and to ensure people received support from the same staff team. Staff told us they were not rushed.

Staff were recruited in a safe way. Staff were trained to support people, so they had the knowledge and confidence to meet people’s individual needs. Staff knew how to care for people in a safe way because risks had been assessed and were known by staff. Staff told us they regularly supported the same people, so they knew them well.

Staff recognised the signs of abuse or poor practice. Staff knew how to report any concerns they might have. The registered manager knew what to do and was confident to tackle poor practice. Where incidents had occurred, we were notified.

People received their medicines as prescribed. People had individual plans of care and staff provided personalised care and support.

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.

Since our last inspection, the owner had unexpectedly passed away. The business was currently in a transitional phase. Some improvements the new registered manager wanted to make were unable to be implemented at the present time.

The registered manager’s audit systems had been strengthened and increased, yet some checks were not always as up to date as they wanted. Some minor issues we found at this visit had not yet been identified through their own audits. The registered manager was committed to driving those changes and had plans to continuously improve.

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 25 December 2021). Following this visit, the provider sent us an action plan telling us how they would improve. At this visit we found sufficient improvement and the provider was no longer in breach of the regulations.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well Led which contain those requirements.

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 requires improvement to good. This is based on the findings at this inspection.

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

Follow up

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

Bella Home Care is registered to provide personal care to older people and older people who may have a cognitive impairment. Care and support is provided to people who lived in their own homes at prearranged times. At the time of this inspection visit, Bella Home Care provided personal care to 60 people. Care calls ranged from 15 minutes to three hours in duration. 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

The service does not currently have a registered manager in post which is a condition of registration. The provider confirmed an application to put a registered manager in post was underway.

The provider’s systems and processes were not always effective to ensure checks were completed at the required intervals. The quality and safety of the service people received was monitored by the provider and through checks from senior staff and an external consultant. However, limited records for some checks did not always support this and some checks had lapsed during the COVID-19 pandemic. The provider assured us these would be reintroduced and tighter controls over quality audits, especially when delegated to others, would be improved.

Risks related to people’s care were recorded but these were not descriptive enough to tell staff, how and what worked well, to manage specific risks. There were some instructions for staff to follow to manage identified risks. However for some risks, such as risks related to risks of falling or people whose actions could cause them or others distress, these needed to be more personalised. Audit systems had not identified this.

People’s plans of care were sufficient for staff to provide safe care, however these required a thorough review to ensure staff continued to provide consistent care. In some examples, there was conflicting information between the support people used to have and what was required now following a change in their overall health and well-being.

The majority of people and relatives spoke positively about the service they or their relative received, however some people told us about some concerns related to staffing, care call management and the effective management of the service. People's feedback through annual surveys had not taken place, although the provider said telephone reviews did happen. Not everyone we spoke with confirmed this.

People were safe because staff were recruited safely, however some improvements to the storage of those files and the evidence kept on file, would help demonstrate the checks that had been undertaken.

Staff and the provider knew how to keep people safe and protected from abusive practice by referring to the relevant agencies. We reminded the provider about their legal requirement to notify us which had not always happened, although the local authority had been kept informed.

People said staff teams were usually the same cohort of staff, were responsive and if changes were required, these were put in place and staff knew what to do. People were cared for by staff who attended training relevant to their roles. Staff also benefitted from further developmental opportunities which they could undertake if they wanted to expand their care knowledge. Conversations with staff showed intervention by a GP, psychiatrist and occupational therapists had been sought to help ensure, people’s health and welfare was maintained.

Staff followed infection control procedures in line with national guidance for reducing the spread of COVID-19. People and relatives said staff wore PPE throughout their care calls.

Staff said there was limited or no reliance on agency staff, which meant the staff team understood each other and each other’s strengths, plus people’s preferred routines. Staff said they worked well as a team and enjoyed working at the service.

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 04 January 2018).

Why we inspected

This was a focussed inspection. The inspection was prompted in part due to concerns received about staffing and a lack of managerial oversight. A decision was made for us to inspect and examine those risks.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Bella Home Care 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 monitor the service to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to Regulation 17 good governance at this inspection. For requirement actions of enforcement which we are able to publish at the time of the report being published; please see the action we have told the provider to take at the end of this report.

Follow up

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.

Bella Home Care is a domiciliary care agency, registered to provide personal care and support to people living in their own homes. The service operates across Leamington Spa, Warwick and Kenilworth. The service provides care to elderly people, and people with disabilities. There were125 people using the service at the time of our inspection.

We previously carried out an announced comprehensive inspection of this service in September 2016 when we found two breaches of the legal requirements and the service was rated Requires Improvement overall. We returned in April 2017, when we conducted a focussed inspection in the key areas of Safe and Well-led to check what action the provider had taken in respect of the breaches. At that inspection we found the provider had taken sufficient action to meet the regulations but further improvements were still required to ensure people always received their scheduled calls. The service therefore remained rated as ‘Requires Improvement’ overall. You can read the report from our last two inspections by selecting the ‘all reports’ link for ‘Bella Home Care’ on our website at www.cqc.org.uk.

Since our inspection in April 2017 we have reviewed and refined our assessment framework, which was published in October 2017. Under the new framework certain key areas have moved, such as support for people when behaviour challenges, which has moved from Effective to Safe. Therefore, for this inspection, we have inspected all key questions under the new framework, and also reviewed the previous key questions to make sure all areas were inspected to validate the ratings.

The service is required to have a registered manager in post. 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. At the time of our inspection there was an experienced registered manager in post. We refer to the registered manager as the manager in the body of this report.

On this inspection visit we found sufficient improvements had been sustained to people’s care and safety and in the governance of the service for the provider to meet the regulations, and for the service to be rated Good in all areas.

Staffing levels had been increased and people told us they received their calls on time. All necessary checks had been completed before new staff started work to make sure, as far as was possible, they were safe to work with the people in their own homes. People were supported by a staff team that knew them well, as the provider did not use temporary staff.

Staff received training and had their practice observed to ensure they had the necessary skills to support people. Staff treated people with respect and dignity, and supported people to maintain their privacy and independence.

People had been consulted about their wishes at the end of their life. Plans showed people’s wishes about the medical interventions they had agreed to.

People received their medicines as prescribed to maintain their health and wellbeing. People were supported to access healthcare from a range of professionals, and received support with their nutritional needs. This assisted them to maintain their health.

People told us they felt safe with the staff who supported them and that staff were kind and attentive to their needs. Prior to using the service people were assessed to ensure the service could meet their needs and people told us they felt involved in decision-making about their care and support.

Staff enjoyed working at Bella Home Care and were complimentary about the support they received from their managers. Staff felt supported by the management team through regular meetings. There was an ‘out of hours’ call system in place to provide management support and advice to staff at all times.

Managers and staff understood the principles of the mental Capacity Act 2005 (MCA) and the Depravation of Liberty Safeguards (DoLS). Mental capacity assessments had been completed for people who needed them. These showed what decisions people could make for themselves, and which decisions needed to be made in their ‘best interests’. Staff respected the decisions people had made and gained their consent before they provided care.

There were systems in place to gather people’s feedback through annual surveys. The information had been analysed and action had been taken in response to feedback. People knew how to make a complaint and there were systems to manage complaints and look for trends and patterns, which could highlight improvements.

The provider had effective quality assurance procedures to assess and monitor the quality and safety of the service people received. Risk assessments managed the risks associated with people’s safety, health and well-being.

We previously carried out an announced comprehensive inspection of this service in September 2016, when we found two breaches of the legal requirements. This was because of staffing levels and the governance of the service. As a result of the breaches and the impact this had on people who used the service, we rated the key questions of ‘Safe’ and ‘Well-led’ as ‘Requires Improvement’. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for ‘Bella Home Care’ on our website at www.cqc.org.uk.

After the comprehensive inspection, the provider sent us an action plan to say what they would do to meet the legal requirements in relation to each breach. We undertook a focused inspection on the 5 April 2017 to check they had followed their plan and to confirm they now met the legal requirements. We gave the provider 48 hours’ notice of our inspection. This was to make sure we could meet with the manager of the service and talk with staff on the day of our inspection visit.

The service is required to have a registered manager in post. 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. At the time of our inspection there was an experienced registered manager in post. We refer to the registered manager as the manager in the body of this report.

On this inspection visit we found sufficient improvements had been made to people’s care and safety and in the governance of the service for the provider to meet the regulations. Staffing levels had been increased, and the majority of people received their calls on time.

The provider had introduced a number of quality assurance systems and processes to check the quality of service they delivered, which included staff monitoring systems and medicines checks.

However, the feedback we received from people was not consistently good, and improvements needed to be sustained and developed, to ensure people always received their scheduled calls.

Although the provider is now meeting the regulations, the service continues to be rated ‘requires improvement’ in the areas ‘Safe’ and ‘Well-led’.

Bella Home Care is registered to provide personal care and support to people living in their own homes. The service operates across Leamington Spa, Warwick and Kenilworth. There were 120 people using the service at the time of our inspection.

A requirement of the provider’s registration is that they have a registered manager. A registered manager is a person who had registered with the Care Quality Commission to manager the service. Like registered provider’s 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. At the time of our inspection there was a registered manager who was also the provider for the service. The registered manager was supported by a care manager to run the service. We refer the registered manager as the manager in the body of this report.

The service was last inspected on 30 September 2015 when we found the provider was not meeting the required standards. We identified two breaches in the legal requirements and regulations associated with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to improve their staffing arrangements and ensure that risks were assessed and monitored relating to the health, safety and welfare of people who used the service.

The provider sent us an action plan which stated all the required improvements would be completed by 1 April 2016. During this inspection we checked whether the improvements had been made. We found not all improvements had been made and sufficient action had not been taken in response to the breaches in regulations.

The provider had not ensured that effective quality assurance procedures were in place to assess and monitor the quality and safety of the service people received. Risk assessments were in place to manage the risks associated with people’s safety, health and well-being. However, audits and checks were not always effective to identify where people’s needs had changed. Therefore, we could not be sure people were kept as safe as possible. People’s care records were not always personalised to give staff guidance on how people preferred their care and support to be provided.

People’s experiences of being supported by consistent staff were mixed. People told us there were not always enough care staff to meet their needs because staff did not always arrive at the agreed times. We identified the deployment of staff had not been sufficiently improved since our previous inspection to meet people's need to care for them.

We received mixed feedback from people about how the service was run because a manager was not always available when they needed them, and they did not feel their requests were always listened to and acted upon promptly.

Staff completed training to meet people’s needs but we identified not all of the training was effective. Despite the provider taking some action since our last inspection medicine administration records required further improvement, because records were not completed correctly. This meant we could not be sure people received their medicines as prescribed.

The provider’s recruitment procedures made sure staff were of suitable character to care for people in their own homes. Staff completed an induction when they first started work at Bella Home Care. They completed training and knew how to raise concerns and safeguard people from potential harm. Most people thought staff had the skills and knowledge they needed to provide the care and support they required.

People told us they felt safe with the staff who supported them and the staff were kind and attentive to their needs. Prior to using the service people were assessed to ensure the service could meet their needs and people told us they felt involved in decision-making about their care and support.

Staff enjoyed working at Bella Home Care and were complimentary about the support they received from their managers. Staff felt supported by the manager through regular meetings. There was an ‘out of hours’ call system in place to provide management support and advice to staff at all times. However, staff were not always provided with the equipment they required to gain this support.

There were systems in place to gather people’s feedback through annual surveys. The information had been analysed and action had been taken in response to this feedback. People knew how to make a complaint and there were systems in place to manage complaints about the service provided. However, we could not be sure all complaints had been responded to and investigated thoroughly.

People made everyday decisions for themselves, which helped to maintain their independence. Staff respected the decisions people made and gained their consent before they provided care. People told us staff respected their right to privacy and explained to us how the staff supported them to remain independent. People who required support with eating and drinking were provided with foods they enjoyed.

Managers and staff understood the principles of the mental Capacity Act 2005 (MCA) and the Depravation of Liberty Safeguards (DoLS). The managers had improved their knowledge in relation to community DoLs since our last inspection. Mental capacity assessments had been completed for people who needed them. This showed us what decisions people could make for themselves, and which decisions needed to be made on their behalf in their ‘best interests’.

We found two breaches of the Health and social care Act 2008 (Regulated activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Care staff knew people well and people who used the service told us they had no concerns about their care and they received very good quality care.

We met with the provider on 5 September 2013 to discuss the actions we required them to make. They agreed to review all their care plans by the 8 November 2013.

We visited Bella Homecare on 29 November 2013. We reviewed three care plans and found the provider had carried out a full review of people's care.

In February 2013, at our request, the provider sent us an action plan telling us how they were going to improve. They told us they would be compliant by 7 April 2013.

When we visited on 20 August 2013 we found the provider had made improvements to the records of the care worker files but had not made improvements to the care records of people who used the service.

During our visit we spoke with the manager, deputy manager, compliance manager, care manager, four care staff.

We spoke with two relatives and 19 people who received a service from Bella Home Care to obtain their views.

People and their representatives said they were happy with the care provided. We saw the care plans held at the office. These did not always contain important information about people the service looked after.

Comments from people received included 'I am happy, otherwise I would not use them' and one relative said "They look after X well."

People told us they felt their relative was safe and would make a complaint if it was

necessary.

Staff told us they had meetings with the manager, but that these were not always documented. They told us they had received mandatory training.

The agency had some quality checks in place to ensure they provided a good service.

Systems were in place allowing people and their relatives to communicate their experiences. The manager said that the last 'service user satisfaction survey' had taken place in April 2012. People told us that they felt able to express their views and felt confident when doing so. Some comments made by people were: 'There is a feedback reporting process in place' and ' We verbally fed back that we were pleased with the care.'

We saw people's needs had been assessed, risks identified and personalised support plans developed. Two people's records confirmed that reviews of care plans and risk assessments had taken place. We found some gaps in two people's records as the information had not been collected and written down. This could put the person at risk if a person's records are not complete.

Staff confirmed that recruitment processes were robust. The provider may like to note that we saw there had been some shortfalls in their recruitment practice. The care workers said they felt supported by the manager and their team. They said they had received appropriate training and development and confirmed a system of supervision and appraisal was in place. We were told of the staffing contingency plans which were in place.