Archived: Bespoke Care At Home

Updated 2 June 2023

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

The inspection was carried out by 3 inspectors and 1 Expert by Experience. An Expert by Experience (EXE) is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was not a registered manager in post.

Notice of inspection

We gave the service 48 hours’ notice of the inspection. This was because we needed to be sure that the provider would be in the office to support the inspection.

Inspection site visit activity started on 20 and 21 February 2023 and ended on 1 March 2023. Day 1 of the inspection was attended by two inspectors and days 2 and 3 was attended by 1 inspector. We visited the office location to see the provider and office staff to review care records, records relating to the management of the service, policies, and procedures. The EXE made telephone calls on 1 and 2 March 2023. An inspector made calls to staff on 23 February 2023.

What we did before inspection

We reviewed information we had received about the service since the last inspection. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We sought feedback from local authority Commissioners and health and social care professionals.

During the inspection-

We spoke with the provider about the improvements they had made since our last visit.

We spoke with 8 people and five relatives, 9 care workers, an office administrator who was also the champion for risk management, field care supervisor who was also the champion for DoLS, safeguarding lead who was also the training coordinator, operations director, and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We viewed 4 care plans in detail, 10 staff files in relation to recruitment, induction and supervision records, training data, policies and procedures and a variety of records relating to the management of the service.

We received feedback about the service from a relative shortly after our inspection.

We sought clarification from the provider to validate evidence found. All information received was used as part of our inspection process.

Updated 2 June 2023

About the service

Bespoke Care at Home is a domiciliary care agency. The service delivers personal care to people with mental health needs, people living with learning disabilities, autistic people and people with dementia. At the time of the inspection there were 63 people who received the regulated activities.

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

Most people said they felt safe from harm, but we found unsafe work practices that amounted to abuse. A person told us, “One of the carers was showing another carer what to do, and when [the staff] left the house, they left my door wide open. That’s not safe. When I complained, they just had to apologise”.

The provider used illegal restrictive practices and was not aware of their responsibility to identify and report potential abuse. The provider did not do all that was reasonably practicable to mitigate risks to people’s health and safety. Systems in place to assess the deployment of staff were ineffective and unsafe recruitment practices meant the provider did not always protect people from unsuitable staff. Medicines practices were safe. We have made a recommendation relating to infection control.

The provider did not ensure the design and delivery of care and support was delivered in line with current evidence-based guidance, standards, best practice, legislation. The provider did not make sure all staff were appropriately skilled, knowledgeable, and qualified to ensure people’s care and support needs could be met. The provider worked with external agencies, we saw some good examples but this was not consistent. People’s nutritional needs were met.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

People were not always treated with dignity and respect. Their preferences for care and support were not always met. People said they were involved in making decisions about care and support, but we found actions taken, and outcomes achieved were inconsistent. People said staff knew them well and electronic care records provided more information about people’s lives.

The provider did not always meet the care and support needs of people with learning disabilities and people with dementia. People had expressed dissatisfaction with call times and duration of care call visits. We found the provider’s complaints systems were ineffective as the provider was unable to appropriately address them.

Quality assurance systems used to assess, monitor and improve service delivery were inadequate. The nominated individual and senior management did not have all the necessary skills and knowledge to become compliant with the regulations and associated legalisations.

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. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

Right Support:

People were not supported to have maximum choice and control of their lives. Not all staff had not received appropriate training to support autistic people, people with learning disabilities and people with dementia. Staff failed to design and deliver care and support relevant to their learning disability needs and protected characteristics as outlined under the Equality Act 2010.

Right Care:

People were not always treated with dignity and respect. The provider did not have enough appropriately skilled and knowledgeable staff to meet people’s individual needs. Especially when they were communicating a need when distressed or anxious.

Right Culture:

People were supported by staff who did not always understand best practice in relation to the wide range of strengths, impairments or sensitivities people with a learning disability and/or autistic people may have. This meant people did not always receive compassionate and empowering care that was tailored to their needs.

Rating at last inspection and update

The last rating for this service was inadequate (published 1 October 2022) and there were breaches of regulations. The provider sent us action plans on a monthly basis, to show what work they had undertaken to become compliant with the regulations.

At this inspection we found the actions taken by the provider was not enough to become compliant with the regulations and therefore, they remained rated inadequate.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

The overall rating for the service has remained 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 Bespoke Care at Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified continued breaches in relation to person-centred care, dignity and respect, safe care and treatment, safeguarding service users from abuse and improper treatment, receiving and acting on complaints, good governance, staffing, fit and proper persons employed, duty of candour and notifying the Commission of notifiable incidents. We found a new breach in relation to need for consent.

Please see the action we have told the provider to take at the end of this report.

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

The overall rating for this service is ‘Inadequate’ and the service remains 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.