Archived: Better Healthcare Services (Luton)

Better Healthcare Services (Luton) is a domiciliary care service. The service provides personal care to people living in their own homes. At the time of the inspection, the service provided support to 158 people, of which 142 were in receipt of personal care.

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 always safe and were left without care at the time they required it due to the large number of missed and late care visits.

People had risk assessments in place. However, these had not been consistently reviewed and did not provide staff with relevant information to keep people safe.

Medicines were not always administered to people at the times prescribed. The many missed and late care visits meant that medicines were not being managed safely. One person told us, “Sometimes the timings of calls mean that medicines are not regularly spaced out between doses.” Audits were inconsistent and there was minimal information available of actions which had been taken to address areas of concern.

The quality assurance processes were not robust and did not drive improvements in the service. There was a lack of management oversight and leadership within the service.

The provider had an infection control policy in place which had been updated to include information relating to COVID-19. Staff were provided with an adequate supply of face masks, gloves and aprons.

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 11 December 2019).

Why we inspected

We received concerns in relation to missed and late care visits, the management of medicines and the leadership of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

We asked the provider how they intended to improve following our visit to the service. They provided enough information to assure us they would take action in response to our most urgent concerns.

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 Better Healthcare Services (Luton) 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 two breaches of the Health and Social Care Act 2008 in relation to safe care and treatment and good governance of the service at this inspection.

Follow up

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.

Better Healthcare Services (Luton) is a domiciliary care service supporting people living in their own homes. At the time of the inspection, 125 people were being supported by the service.

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 happy with the level of care and support they received from staff. People found staff to be kind, caring and friendly. Some people told us they enjoyed having regular staff because they had been able to form good relationships with them.

However, improvements were needed in how staff managed people’s medicines so that people received effective treatment. More time was needed to ensure the systems introduced by the registered manager were embedded in staff practice. Staff said the new system was much better at helping them to improve.

People were protected from harm by staff who were trained to identify and report concerns. People were safe because potential risks to their health and wellbeing had been managed well. There were enough staff to support people safely. Lessons were learnt from incidents to prevent recurrence. Staff followed processes to prevent the spread of infections.

Detailed care plans ensured staff had information to help them to meet people’s assessed needs. Where needed, people had been supported to have enough to eat and drink. People had been supported to access healthcare services when required to maintain their health and well-being.

People told us staff were respectful in how they interacted with them and supported them. People felt able to make choices and they said staff acted on these. 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.

The provider had systems to assess and monitor the quality of the service. The registered manager and staff were motivated to support people the best service they could. The provider was motivated to continuously improve the service. They used people and staff’s comments to improve.

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 5 July 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We have found evidence that the provider needs to make improvements. Please see the Well-led section of this full report. We will return to visit as per our re-inspection programme. If we receive any concerning information, we may inspect sooner.

At the last inspection, the service was rated Good.

At this inspection we found the service remained Good.

The service has a Registered Manager in place. 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 2008 and associated Regulations about how the service is run.

The service took safeguarding concerns seriously and followed the local authority policy and guidance when dealing with safeguarding people from harm.

Where appropriate the service had attended and contributed to safeguarding discussions and meetings.

There was a robust recruitment procedure to help ensure the staff recruited were suitable to work with the people using the service.

Staffing levels were sufficient to provide the level of care required.

Risk assessments were in place and were regularly reviewed and updated.

Staff were trained to administer medicines safely. Regular checks were undertaken to help ensure on-going competency in this area.

There was a robust induction programme, which included mandatory training, shadowing and buddying with an experienced worker. Staff demonstrated a good understanding of their roles and responsibilities.

Supervisions were undertaken and Professional Development Reviews (PDR) were held annually to ensure learning was reviewed and training needs were met.

Care files were clear and comprehensive and contained relevant health and personal information. The service was flexible and responsive to changing needs, desires and circumstances.

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.

Confidentiality was respected and independence was promoted. Communication with relatives was on-going throughout the duration of their relative’s involvement in the service.

Comments were encouraged formally and informally and there was a complaints policy in place. Literature given out to families gave the information and opportunity for people to raise concerns or make suggestions.

Feedback was regularly sought from families and users of the service. The service listened and took action to address any concerns and suggestions put forward by people who used the service and their families.

Team meetings were regularly undertaken, giving staff the opportunity to discuss any issues and to share good practice examples. The meetings were used as a forum to share current best practice guidance and keep staff up to date with new methods and innovation.

A number of audits were undertaken, results analysed and lessons learned from these to drive continual improvement in service delivery.

Further information is in the detailed findings below.

One inspector from the Care Quality Commission (CQC) conducted this inspection. We gathered evidence against the standards we inspected to help answer our five key questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found. The summary is based on what we found at the inspection by looking at records and what people told us about their experiences of the service. We spoke with eight people using the service, relatives of two people, six care staff, the manager, the services' client services director and the operations director. At the time of our inspection Better Healthcare Services (Luton) provided care and support to 77 people who used the service.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People who used the service told us they felt safe. We found people's needs had been assessed, and care plans and risk assessments were in place to ensure that they were provided with appropriate and safe care. However, these did not always accurately reflect people's changing needs.

However, we found the provider had made recent improvements to ensure that people were supported by a consistent group of staff to ensure continuity of care.

Is the service effective?

Detailed care plans were in place to provide guidance to staff on how to deliver appropriate and effective care. However, the service did not always identify changes to people's health needs to ensure that appropriate referrals were made to other health and social care professionals. This did not ensure prompt and effective care and treatment for people who used the service. The high turnover of staff may have also had an impact on the effectiveness of the service.

Is the service caring?

People we spoke with told us that the staff were caring and met their care needs. However, they did not always arrive on time and this meant that care was not always provided at the agreed times.

Is the service responsive?

We found the service was not responsive because they did not always act promptly to respond to people's changing needs. Two of the people supported by the service's health had deteriorated, but we did not see evidence that prompt action had been taken to refer them to other health or social care professionals.

Is the service well-led?

The service had no registered manager in place and therefore had lacked consistent leadership until a new manager was appointed recently. We found that this lack of consistent leadership meant that there was no consistent guidance and support for the staff to enable them to provide safe and appropriate care.

During this inspection, we found improvements had been made to ensure people's safety and welfare. We saw that people were supported by staff who were appropriately trained and received regular supervision. The provider had also improved their quality monitoring systems, and they were responsive to people's concerns.

In this report the name of a registered manager appears who was not in post and not managing the regulated services at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

The provider had systems in place to ensure staff recognised and reported safeguarding concerns to the local authority safeguarding team.

We found the provider had robust recruitment processes in place.

Most people we spoke with were not satisfied with the quality of the service they received. A number of people commented about the impact of late visits on their care and welfare. One person told us the service they received was "unsatisfactory" and another person said, "I always have to phone the office to check what time the carers will get here. They tell you they will phone you back, but no one does."

Staff supervision was not always completed when due and some staff told us they felt unsupported by the manager who was often difficult to contact.

The provider's quality monitoring systems were not adequate to ensure that people received safe and appropriate care.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.