Archived: Better Healthcare Services (Norwich)

Updated 7 April 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection took place on 1 March 2017 and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service. The management team sometimes spends time away from the office supporting staff and the people who use the service. Notice was given to ensure the management team was available to assist our inspection. The inspection was carried out by one inspector.

Before we carried out the inspection we reviewed the information we held about the service. This included statutory notifications that the provider had sent us in the last year. A statutory notification contains information about significant events that affect people’s safety, which the provider is required to send to us by law. Before the inspection, the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.

During the inspection we visited the service’s office, spoke with three people who used the service and three relatives. We also spoke with the regional manager, manager, the care coordinator and one care staff member. A second care staff member provided us with written feedback.

We looked at the care records for all four people who used the service. We also viewed records relating to the management of the service. These included quality monitoring audits, three staff recruitment files, training records and quality monitoring questionnaires.

Updated 7 April 2017

The inspection took place on 1 March 2017 and was announced.

Better Healthcare Services (Norwich) provides a domiciliary care service to people living in their own homes. At the time of the inspection they were providing a service to four people.

There was a manager in post who, at the time of this inspection, had applied to be registered with the Care Quality Commission. Their application was being processed. 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.

We inspected this service in February 2016 where we found that the service was not meeting the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Six breaches of legal requirements were found and the provider was required to send us a plan to tell us about the actions they were going to take to meet these breaches. This was received in the specified time.

A further inspection was carried out in August 2016 where we found that sufficient improvements had not been made and the service was in breach of five regulations, four of which were repeated breaches. We served a notice of decision to impose conditions on the service’s registration. This meant they were unable to take on any new packages of care or extend any existing ones. This action was implemented in order to help drive improvement in the quality of the service. Following this inspection in August 2016, the service also lost its contract with the local authority to provide care and support to people in Norfolk.

This service was also placed in Special Measures following the inspection in August 2016. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe.

During this inspection, carried out in March 2017, the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Shortly before this inspection, the service had applied for the conditions that had been imposed following our inspection in August 2016, to be removed. Following this planned inspection, the application was processed and due to the sustained improvements seen, the imposed conditions were removed.

The service had implemented a number of quality monitoring systems following the inspection in August 2016. These had driven improvement following close assessment and monitoring of the service delivery. Action plans had also been employed and systematically completed. Care records, staff’s ability to perform their role and the quality of the service had all been regularly monitored and analysed.

People told us that the service had improved. People had continuity of care and saw the same group of staff. Staff turned up at the agreed time and stayed for the approved amount of time. Both the people who used the service, and staff, received rosters in good time so they knew planned arrangements in advance.

People received care and support that was individual to them and tailored to meet their personal preferences, needs and routines. The service took into account people’s choices, life histories and personalities when designing care plans. Care plans were person centred and people’s needs had been regularly reviewed.

Staff demonstrated a courteous, warm and respectful approach when supporting people. People’s dignity was maintained and staff understood the importance of encouraging and promoting people’s independence. People spoke of a service that was professional and caring.

Complaints had been thoroughly recorded, investigated and answered. The service used them to further develop and better the service. Whilst those we spoke to had no concerns in regards to the service they received, they told us they were confident that the service would respond appropriately should they have in the future.

Staff had received training in safeguarding and processes were in place to help reduce the risk of people experiencing abuse. The risks to those using the service had been identified and managed in order to help protect from avoidable harm. Consideration had been given to the impact adverse events could cause on the continuity of the service. Processes were in place to adequately manage accidents and incidents.

People received their medicines safely and the service had processes in place to monitor this. People spoke of a service that was responsive in regards to monitoring people’s health needs. Where applicable, people’s nutritional needs were met.

Recruitment processes were in place to help reduce the risk of employing staff not suitable to work in the service. Staff received training in a variety of forms, supervisions, appraisals and continued support. Their ability to effectively perform their role was checked.

The CQC is required to monitor the Mental Capacity Act (MCA) 2005 and report on what we find. The service was complaint with the MCA and staff were able to explain its purpose and application in how they supported people.

Staff worked well as a team and morale was good. They told us they felt supported, valued and listened to. The service had an open culture and communication was regular and effective. People spoke highly of the manager and the improvements they had made to the service. All the people we spoke with told us that they would recommend the service.