Archived: Better Healthcare Services

About the service

Better Healthcare Services is a domiciliary care service registered to provide the regulated activities of personal care and treatment of disease, disorder or injury to people living in their own homes. Not everyone who used the service received regulated activities. CQC only inspects where people receive regulated activities. For people who receive care from this provider, this is help with tasks related to personal hygiene, eating and treatment of disease, disorder or injury which should be overseen by an appropriate health professional. Where they do we also consider any wider social care provided. At the time of our inspection, there were 24 people receiving regulated activities.

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

Right Support

People did not always have current care plans to meet their health and well-being needs and manage risks. The provider did not ensure people always received their medicines safely.

Right Care

The provider had not ensured all safeguarding concerns were shared with CQC. People did not always receive their care at the right time or for the right duration, and the provider had not monitored this. People did not always have their treatment effectively overseen by a medical practitioner, which increased health-related risks to them.

Right Culture

There was not always a positive culture in the service, as staff did not always feel well supported by the provider. Lessons could not always be learnt from accidents and incidents as these were not always recorded. There were no established systems and processes for the provider to maintain quality standards and to continuously improve the service people received. However, the staff did feel supported by the manager, and there were systems in place to seek regular feedback from people, relatives and staff.

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 requires improvement (published 2 April 2020).

Why we inspected

This inspection was prompted by a review of the information we held about this service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. 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 inadequate. 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 Better Healthcare Services on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to people’s safety and good governance at this inspection. 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.

Follow up

We will work alongside the provider and local authority to monitor the service and continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

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.

Better Healthcare Services is a domiciliary care service supporting people living in their own homes. At the time of the inspection, 39 people were receiving 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 said staff changes meant they were not always supported by consistent staff. They said there were not always enough staff at weekends which meant the care visit times were inconsistent. This had an impact on their daily routines. However, people were happy with the quality of care and support they received from staff. People said staff were kind, caring and friendly. Some people commented positively about some of the staff who did more to support people with their needs. People said they had also formed good relationships with some of the staff.

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. Lessons were learnt from incidents to prevent recurrence. Staff followed processes to prevent the spread of infections. There was guidance for staff about the new coronavirus infection to help them protect themselves, people, and members of the public.

Detailed care plans ensured staff had information they needed to meet people’s assessed needs. Staff were trained well to improve their practice. When required, people had been supported to have enough to eat and drink. People were 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 respected 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.

There were systems to manage complaints received by the service. Improvements had been recently made in how complaints were responded to. People said staff were responsive to their needs and they provided person-centred care.

The provider’s systems to assess and monitor the quality of the service had not been effectively used since the registered manager left the service in October 2018. Changes in managers had destabilised the service, and there was a risk people might not receive consistently safe, effective and good quality care. The new manager had made improvements in the short time they had been at the service. People, relatives, staff, and the local authority representative confirmed this. However, the provider needed to support them to make sure the improvements they had made were fully embedded into the culture of the service.

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 20 September 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We found evidence that the provider needs to make improvements. Please see the Safe and Well-led sections 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.

Although the provider had made improvements to their systems to keep accurate and up to date records of people's medicines when we inspected them in August 2016, we found they needed a longer period for this to be fully embedded and followed by staff. During this inspection, we found no concerns with the quality of people's records.

There was no registered manager in post. A new manager who had recently been employed by the service had not yet registered with the Care quality Commission. 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.

People were safe because the provider had effective systems to keep them safe, and staff had been trained on how to safeguard people. There were individual risk assessments that gave guidance to staff on how risks to people could be minimised. People’s medicines were managed safely and administered in a timely manner by trained staff. The provider had effective recruitment processes in place and there was sufficient numbers of staff to support people safely.

Staff received effective training, support and supervision that enabled them to provide appropriate care to people who used the service. Staff understood their roles and responsibilities in ensuring that people consented to their care and support, and that this was provided in accordance with the requirements of the Mental Capacity Act 2005 (MCA). Where required, people were supported to have enough to eat and drink.

Staff were kind and caring towards people they supported. They treated people with respect and supported them to maintain their independence as much as possible. People were happy with how their care was provided and they valued staff’s support. People had developed friendly relationships with staff who supported them regularly.

People’s needs had been assessed and they had care plans that took account of their individual needs, preferences and choices. Care plans had been reviewed annually or when people’s needs changed. Staff were responsive to people’s needs and where required, they sought appropriate support from healthcare professionals. The provider had a system to manage people’s complaints and concerns.

The manager provided stable leadership and supported staff to carry out their roles effectively. The provider had systems to assess and monitor the quality of the service. They encouraged feedback from people, relatives, staff and external professionals to enable them to continually improve the service.

This was a breach of regulation 12 (1) (2) (a)(b)(g) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We found that the quality control and auditing systems were not always used and did not always drive improvement.

This was a breach of regulation 17 (2) (a) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

This report only covers our findings in relation to the outstanding breaches of regulation. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Better Health Care Limited on our website at www.cqc.org.uk.

This inspection was announced and took place on 18 August 2016.

During this inspection, we found that improvements had been made to the systems in place within the service, to ensure that MAR sheets were filled out and audited correctly. All staff had been re-trained in medication administration.

While improvements had been made we have not revised the rating for the key questions; to improve the rating to 'Good' would require a longer term track record of consistent good practice. We will review our rating for safe and well led at the next comprehensive inspection.

This inspection took place on 19 July 2016 and was announced. Prior to this inspection we had received concerns in relation to the care people were receiving and the management and administration of medications within the service. We therefore needed to ensure that people's care was being delivered in line with the fundamental standards.

The service did not have a registered manager. They had a manager in post that was going through the registration process. 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.

Staff had an understanding of abuse and the safeguarding procedures that should be followed to report abuse and people had risk assessments in place to enable them to be as independent as possible. The staff we spoke with were able to demonstrate what they would do should they have any concern that abuse was taking place.

Staffing levels were adequate to meet people’s current needs. The staff recruitment procedures ensured that appropriate pre-employment checks were carried out to ensure only suitable staff worked at the service. Staff induction training and on-going training was provided to ensure they had the skills, knowledge and support they needed to perform their roles.

Management of medicines was inconsistent and staff did not always follow the provider’s policy in the recording of medication. Medication administration records were not always fully completed and there were no adequate systems to audit these records to highlight any errors or omissions.

Staff were well supported by the manager and senior team, and had regular one to one supervisions, and spot checks. The staff we spoke with were confident that the support they received enabled them to do their jobs effectively.

People's consent was gained before any care was provided and the requirements of the Mental Capacity Act 2005 were met. Everyone we spoke with told us that staff members always gained their consent before carrying out any care tasks.

People were able to choose the food and drink they wanted and staff supported them with this. If required, staff supported people to access health appointments. We saw that people had information about their likes and dislikes with food and drinks, and dietary requirements recorded within their files.

Staff treated people with kindness, dignity and respect and spent time getting to know them and their specific needs and wishes. People were involved in their own care planning and were able to contribute to the way in which they were supported.

The service had a complaints procedure in place, but it was not being used according to the provider’s own policy. We found that complaints had been made verbally, but no evidence was found that these complaints were recorded and acted upon appropriately.

Quality monitoring systems were in place but were not always used and not always effective. We found that some people’s records were not being audited for quality, and when audits were being conducted, there was no evidence that actions were taken to address mistakes and drive future improvement.