This inspection took place on 10 and 11 February 2016 and was announced. The provider was given 24 hours’ notice because we wanted to be sure there would be someone at the office when we called. This was their first inspection since registration with the Care Quality Commission.Better Healthcare Services (London) is a domiciliary care agency which provides live in care for people in their own homes. This service is managed from the head office based in London, but also receives support from its regional offices located throughout the United Kingdom. The service received support from regional offices in Brighton, Bedford, Cambridge, Colchester and Norwich. At the time of our visit the service was providing support to 15 people.
There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.
People and their relatives told us they felt safe using the service and care workers understood how to protect people from abuse. All staff had received training in safeguarding adults from abuse and had a good understanding of how to identify and report any concerns. Staff also felt confident that any concerns would be investigated and dealt with.
People’s risks were managed and care plans contained appropriate risk assessments which were updated regularly when people’s needs changed. The service had a robust recruitment process and staff were subject to the necessary checks to ensure they were suitable to work with people using the service. People were given the same care worker for the duration of their live in shift to ensure they received consistent levels of care. The provider could also rely on care workers from their regional offices to cover shifts at short notice if required.
People who required support with their medicines received them safely and all staff had completed training in the safe handling and administration of medicines. When recording errors were identified they were addressed appropriately.
Care workers received an induction training programme to support them in meeting people’s needs effectively and received regular supervision from management. They told us they felt supported and were happy with the supervision they received.
Staff understood the principles of the Mental Capacity Act 2005 (MCA) and issues relating to personal choice. Care workers respected people’s decisions and gained people’s consent before they provided personal care.
Care workers were aware of people’s dietary needs and food preferences. Care workers told us they notified the registered manager or a care coordinator from a regional office if they had any concerns about people’s health and we saw evidence of this in the weekly reports. We also saw people were supported to maintain their health and well-being through access to health and social care professionals, such as GPs, speech and language therapists and social services.
People and their relatives told us care workers were compassionate and caring and knew how to provide the care and support they required. Care workers we spoke with knew the people they supported and their life histories due to the amount of time they were able to spend with them.
Staff treated people in a way that respected their privacy and dignity and promoted their independence.
People were involved in planning how they were cared for and supported. An initial assessment was completed from which care plans and risk assessments were developed. Care was personalised to meet people’s individual needs and was reviewed if there were any significant changes, with health and social care professionals being contacted to support the changes in care received. However there were concerns that not all staff handovers in the person’s home were detailed enough.
People and their relatives knew how to make a complaint and said they felt comfortable contacting the registered manager if they had to. There were surveys in place to allow people and their relatives the opportunity to feedback about the care and treatment they received.
The service promoted an open and honest culture and care workers felt well supported by the registered manager and were confident they could raise any concerns or issues. Care workers were also supported by their regional offices however the level of support varied between offices.
There were processes in place to monitor the quality of the service provided and understand the experiences of people who used the service. This was achieved through regular communication with people and care workers, supervision and a programme of other checks and audits. However the registered manager failed to notify the CQC about an incident involving the police and a safeguarding concern that had been raised which is a legal requirement of the provider’s registration.
We identified one breach of the Regulations in relation to notifications and you can see what action we told the provider to take at the end of the full version of this report.