Be Caring Manchester

Be Caring Manchester is a domiciliary care agency providing personal care to people in their own homes. The service was supporting 131 people at the time of the inspection, including older people, those living with dementia, people with a physical disability and younger adults.

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.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

People’s experience of using this service and what we found

Support plans identified people's support needs. There were varying levels of detail in the guidance for meeting these needs and managing identified risks. The interim manager was aware of this and was supporting the assessors to include the required level of detail. We have made a recommendation to have a robust plan to ensure this is completed in a timely way. People and their relatives had been involved in agreeing and reviewing the care and support plans.

There were enough staff to complete the required calls. Staff said they were able to get to calls on time. Most people or their relatives also said staff were on time. Staff were safely recruited and received the training required for their role. Staff were positive about working for the service and felt well supported by the management team. Consistent staff supported each person so they knew people’s needs well.

People received their medicines as prescribed. People were supported to maintain their health and nutritional needs, where applicable.

A quality assurance system was in place. Improvements had been made where issues had been identified. Communication between people, their families, the staff teams and the management team were good. Any issues raised were resolved.

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.

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 30 June 2022). There were no breaches of regulations.

Why we inspected

We undertook this focused inspection to check they had followed their action to plan to make further improvements. This report only covers our findings in relation to the Key Questions safe, effective and well-led.

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 from 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 Be Caring Manchester 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.

Be Caring Manchester is a domiciliary care agency providing personal care to people in their own homes. The service was supporting 120 people at the time of the inspection, including older people, those living with dementia, people with a physical disability and younger adults.

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 and what we found

At this inspection we found the service had taken positive steps and implemented systems to improve the quality and safety of the service provided.

Call monitoring of people's support had vastly improved. Further improvements in this area were taking place to ensure people’s call times lasted the allocated time they were commissioned for.

Risks to individuals were assessed and monitored. When incidents took place, the management team reflected on the events to ensure learning was embedded for future practice. This included sharing experiences in staff meetings and during supervision of staff.

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. However, further work was required in this area. Decision specific mental capacity assessments had not always been carried out or completed in sufficient detail to establish if people had the ability to make informed decisions.

Medicines were administered in a safe manner. Systems were in place, which monitored how the service operated and ensured staff delivered appropriate care and treatment.

Complaints were now responded to appropriately. People told us they were aware of how to make a complaint and were confident they could express any concerns which would be addressed.

People felt safe with staff who knew how to recognise and report any concerns, including concerns around their health, wellbeing, risk of abuse or neglect.

The provider completed a full-service review of their training resources provided to staff. Feedback from staff during the inspection indicated the training on offer was much improved. One staff member told us, “The training is phenomenal, it was a full week including moving and handling, medication, abuse, how to look after the service users, reporting, CPR and choking.”

People benefited from an improved quality assurance system being in place. This meant that the registered person's oversight of all the service's functions, including recruitment, training, complaints, medicines management and care planning was now more robust. People were encouraged to give feedback on the service and the provider made changes from feedback received.

We have made a recommendation about using accessible formats for the people they support.

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 inadequate (published 9 December 2021).

This service has been in Special Measures since 9 December 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating of inadequate. As part of this inspection we also assessed whether the provider had taken the actions necessary to meet the regulation breaches identified at the last inspection.

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

Follow up

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

Be Caring Manchester is a domiciliary care agency providing personal care to people in their own homes. The service was supporting 219 people at the time of the inspection, including older people, those living with dementia, people with a physical disability and younger adults.

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 and what we found

People were not safe. Staffing levels and rota systems were unsafe. People's calls were significantly late, early, short or missed. People and their relatives told us staff were often late or missed calls completely. One person commented, “They [care workers] are supposed to come to give me a shower at 10am, they are late every time, sometimes they arrive at 12 or 12:30pm.” Care workers rotas were unclear and inconsistent, which meant staff were not able to stay at people’s homes long enough to safely meet their needs. More than half of people’s planned care time had not been delivered.

People were not always safeguarded from the risk of abuse, particularly neglect, due to late, early, short and missed calls. People and their relatives were unable to rely on the service to provide essential care. One person commented, “I have three calls a day. Last week no-one came all day and the next day a carer came for one call.”

Medicines were not managed safely. There was a lack of oversight of medicine administration and medicine records were not always complete. We were not assured people always received their medicines as prescribed.

Risks to people's health and wellbeing had not always been assessed, monitored or mitigated effectively. People were at risk of harm because staff did not always have the information, they needed to support people safely.

People's care and support was not person centred and frequently provided at times not to their preference. Care teams were not consistent, so people were supported by multiple care staff they did not know. People's support plans did not always contain detailed or accurate information to help staff support people safely.

People's complaints were not dealt with appropriately, so people had lost confidence in sharing their concerns or feedback with the service. People did not feel involved in their care and support.

People were not always 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.

The provider had not established an effective system to ensure people were protected from the risk of abuse. Accidents and incidents were not appropriately reported, and actions were not always taken to ensure the safety of people.

The provider's systems to assess, monitor and improve the quality and safety of service being provided were inadequate. Senior staff and governance systems had not recognised or responded to the significant and widespread issues in a timely manner. A poor culture had developed at the service. Shortcomings in care, poor practice and a failure to meet people's needs were not always challenged but accepted. CQC had not been notified of all significant events which had occurred, in line with the registered provider's legal obligations.

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

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.

Why we inspected

This was a five key question responsive inspection based on CQC receiving concerns and complaints. Prior to the inspection CQC received concerns about late and missed calls, lack of leadership and safeguarding concerns. The information shared with CQC indicated potential concerns about how people were being supported and risks being managed.

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 breaches in relation to people receiving safe care and treatment, management oversight of the service, need for consent, person centred care, keeping people protected from abuse, staffing and the suitability of people working in the service.

Follow up

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 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 of 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.