About the service BBC Care Service Limited is a domiciliary care agency in Chertsey providing support with personal care to people who live in their own houses and flats. At the time of the inspection the agency supported 12 people in different geographical areas of Surrey. Both older and younger adults living with physical support needs, some of whom also live with dementia, learning disabilities and/or autism were supported by the agency.
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 told us they did not always receive their care as planned, care visits were late or missed, or did not last as long as they should have. People felt overall safe with staff but did not feel they received personalised care, as not all staff knew their needs. Not all staff provided caring and compassionate support.
New staff pre-employment checks were not always carried out as per legal requirements. Not all staff who supported people with their medicines received appropriate training and competency checks.
People did not always feel their feedback and complaints were welcomed and listened to or acted upon. The registered manager failed to have a good oversight of the care people received and to action concerns raised effectively.
The governance systems and processes in the service were not implemented successfully to enable continuous improvement of the service. Hence, people’s feedback was not always actioned putting people at risk of distress and harm.
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.
The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.
Right support: Model of care and setting maximises people’s choice, control and Independence;
The level of care was determined by people’s support needs and to compensate what was currently being provided by family and other professionals. However, the agreements on when people would receive care and for how long were not always adhered to by the agency.
Right care: Care is person-centred and promotes people’s dignity, privacy and human rights;
People had individual care plans in place and some of their wishes and preferences were recorded and known to staff. However, people’s care records were not always detailed enough and robust to ensure all their personal needs were considered by staff when supporting them. Due to that and the issues with staff attendance on the care visits, people did not always receive personalised care.
Right culture: Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives
People’s experience of care was inconsistent, some told us they did not feel listened to by the registered manager when they raised concerns or suggestions. There was limited assurance on how the registered manager monitored the quality and safety of the care people received on a day to day basis.
We found no evidence that people were harmed but these shortfalls put them at increased risk. We discussed these concerns with the registered manager who was responsive to feedback and started making changes to how the care was monitored and organised to improve it for people.
Staff received basic training and felt supported by the manager but further training specific to people’s individual needs was required as not all people felt staff were competent for their roles and knew their needs well.
People had care plans in place but those did not always consistently assess and address their specific needs, wishes and preferences.
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.
People overall felt staff asked for their consent before providing care. However, we identified improvement needs in how the service implemented Mental Capacity Act 2005 guidance to protect people’s rights.
Staff knew how to protect people from the spread of the infections. The service worked in partnership with other health and social care services.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
This service was registered with us on 11 March 2020 and this is the first inspection.
Why we inspected
The inspection was prompted in part due to concerns received about the timeliness and quality of the care visits provided by the agency and partly as the service had not been inspected since its registration. A decision was made for us to continue with the inspection as planned and to inspect and examine those risks.
Enforcement and Recommendations
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 and will take further action if needed.
We have identified breaches in relation to staffing, fit and proper persons employed, assessing risks to people and safe use of medicines, need for consent, person-centred care, receiving and acting on complaints and good governance at this inspection.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.
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 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.