Archived: Better Healthcare Services

At our previous inspection in August 2017, we found three breaches of regulation. We found that improvements were needed to assessing risks, staffing levels and governance of the service. The service was rated overall Requires Improvement. Following the inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions Safe and Well-led to at least good. The provider told us that they would review care records and auditing systems to improve the guidance to staff and reduce risks to people. They also said they would provide training to staff, including the registered manager, to ensure staff knew what they needed to change and why. During this inspection we found that improvements had been made and the service is now rated as Good.

Better Healthcare Services is a domiciliary care agency that provides personal care to people living in their own houses and flats in the community. It provides a service to older adults. At the time of our visit 39 people were using the service.

Not everyone using Better Healthcare Services receives a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

There was a registered manager at this service 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 knew how to respond to possible harm and how to reduce risks to people. Improvements were made to risk assessments, which meant staff had guidance to reduce risks to people. Lessons were learnt about accidents and incidents and these were shared with staff members to ensure changes were made to staff practise to reduce further occurrences. There were enough staff who had been recruited properly to make sure they were suitable to work with people. Medicines were administered safely. Staff used personal protective equipment to reduce the risk of cross infection to people.

People were cared for by staff who had received the appropriate training and had the skills and support to carry out their roles. Staff members understood and complied with the principles of the Mental Capacity Act 2005 (MCA). People were supported to have maximum choice and control of their lives. Staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People received support with meals, if this was needed.

Staff were caring, kind and treated people with respect. People were listened to and were involved in their care and what they did on a day to day basis. People’s right to privacy was maintained by the actions and care given by staff members.

There was enough information for staff to contact health care professionals if needed and staff followed the advice professionals gave them. People’s personal and health care needs were met and care records guided staff in how to do this.

A complaints system was in place and there was information available so people knew who to speak with if they had concerns. Staff were supported to care for people at the end of their lives if this became necessary.

Staff worked well together and felt supported by the management team, which promoted a culture for staff to provide person centred care. The provider’s monitoring process had improved and looked at systems relating to the care of people, identified issues and staff took the appropriate action to resolve these. People’s views were sought and changes made if this was needed.

Further information is in the detailed findings below

The service has a registered manager in post. 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.

At the last inspection in January 2017, we required the provider to take action to make improvements to their medicines management. During this inspection we found that there had been some improvements to this, although there remained concerns in the recording of medicines.

People usually received their medicines when they needed them, although records were not always completed to show this. Staff members who administered medicines had been trained to do this safely. Staff members received other training, which provided them with the skills and knowledge to carry out their roles. Staff received adequate support from the registered manager and senior staff, which they found helpful.

Staff did not always assess individual risks to people and take action to reduce or remove them.

There were not always sufficient numbers of staff available to meet people’s needs and this meant that care was sometimes provided late or sometimes staff did not visit at all.

The quality of the service and risks to people were monitored, although records of these findings were not always accurate and did not identify actions to ensure improvement in the service.

Staff were aware of safeguarding people from the risk of harm and they knew how to report concerns to the relevant agencies.

People felt safe receiving care and staff supported them in a way that they preferred. Recruitment checks for new staff members had been made before they started work to make sure they were safe to work with people using the service.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and to report on what we find. The service was meeting the requirements of the MCA. Staff had the knowledge and skills to apply the principles of the MCA if this was needed.

Staff supported people so that they received enough food and drink to meet their needs. Information was available for staff members about health professionals involved in people’s care and staff worked with them to make sure people received the care they needed.

Staff were caring, kind, respectful and courteous. Staff members knew people well, what they liked and how they wanted to be treated. They responded to people’s needs well and support was always available. Information in care plans was not always detailed enough to guide staff in meeting all of people’s needs. People were happy using the service and staff supported them to be as independent as possible.

A complaints procedure was available and people knew how to and who to go to, to make a complaint.

There was not an adequate overview of the quality of the service or the risks to people using the service. This lack of effective governance put people’s safety at risk of harm.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

You can see what action we told the provider to take at the back of the full version of the report.

This announced inspection took place on 12, 13 and 16 January 2017.

The service had a registered manager in place. 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.

Arrangements were in place to make sure that people, where needed, were supported with the management of their prescribed medicines by staff. However, accurate records to document people’s medicine administration were not always in place. Staff did not always notify the registered manager when a person’s medicine was about to, or had, run out. There was no clear recorded guidance for staff on who was responsible for the ordering, collection and disposal of people’s prescribed medicines. Detailed guidance for staff on how, why and when to administer ‘as required’ medicines was not always in place.

People were supported by staff in a kind, caring and respectful manner. People’s privacy and dignity was respected by staff when assisting them with their personal care. However, some written language, used by staff when recording in people’s daily notes to describe the care call they attended, was not always dignified and respectful to the person they were supporting.

People had care and support plans in situ which provided staff with the information that they needed when providing care and support to people. The plans detailed information such as how people wished to be assisted and what was important to them. People were involved in the setting up and agreement of their plans of care.

Plans were put in place to minimise and manage people’s identified risks and to assist people to live as independent life as possible and remain in their own homes. Plans and risk assessments sometimes had limited guidance for staff around people’s individual identified health conditions. Risk assessments did not always include guidance for staff on how they were to manage the potential risks associated with some people’s health condition and what they should do in the event of a concern.

The registered manager sought feedback about the quality of the service. They had in place quality monitoring checks to identify areas of improvement needed. However, these checks had not always effectively identified the areas of improvement required to drive forward improvements.

Staff meetings took place and staff were encouraged to raise any suggestions or concerns that they may have had and provide feedback on any improvements to be made. Staff understood their responsibility to report any poor care practice or suspicions of harm.

Pre-employment recruitment checks were undertaken before new staff were employed. This was to make sure that they were suitable to work with the people they were supporting. Documented evidence showed that there was a sufficient number of staff available to support people with their care calls.

Staff received training and the majority of staff understood the basic principles of the Mental Capacity Act 2005 (MCA). Not all referrals had been made to the local authority to request them to formally assess people’s capacity where required. This meant that there was a risk that any decisions made on people's behalf by some staff would not be in their best interest and as least restrictive as possible.

There was an ‘open’ culture within the service. People and their relatives were able to raise any concerns that they might have with staff and the registered manager. Records showed that these were responded to and resolved, where possible, to the complaints’ satisfaction.

People were supported to access external health care professionals where needed, and were assisted to maintain their health and well-being. Where this support was required, people’s health and nutritional needs were met.

Staff were trained to provide effective care which met people’s individual support and care needs. However, not all training, such as how to use specific specialised equipment and catheter care training, was documented within the provider’s records as having been completed and this was confirmed by staff we spoke with.

Staff were supported by the registered manager to develop their skills and knowledge through supervisions, observation checks to review their competency and training.

Notifications are information on important events that happen at the service that the provider is required to notify us about by law. The registered manager was aware of all of the important events they needed to notify the Care Quality Commission about.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

There was no registered manager in place during this inspection. There was a deputy manager in place whilst arrangements were being made for them to fill the registered manager post. 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 Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and report on what we find. No one being supported by the service lacked the mental capacity to make day-to-day decisions. Staff demonstrated to us that they respected people’s choices about how they would like to be supported. However, not all staff were able to demonstrate a sufficiently robust understanding of MCA. The lack of understanding increased the risk that any decisions made on people's behalf by staff would not be in their best interest and as least restrictive as possible.

Records were in place for staff to monitor people’s assessed risks, support and care needs. Plans were put in place to minimise people’s identified risks and to assist people to live as safe a life as possible whilst supporting their independence. Records lacked guidance for staff around people’s specific health care conditions.

Arrangements were in place to ensure that where needed; people’s medicines were managed and administered safely. Accurate records regarding the administration of people’s prescribed medicines were not always kept.

People’s nutritional and hydration needs were met. People who required this assistance, were supported to access a range of external healthcare professionals to maintain their health and well-being.

People were supported by staff in a kind and respectful manner. People’s care and support plans gave guidance to staff on any individual assistance a person required. Records included how people wished to be supported, and what was important to them. These records and reviews of these, documented that people and/or their appropriate relatives had been involved in this process.

Staff understood their responsibility to report any poor care practice or suspicions of harm. There were pre-employment safety checks in place to ensure that all new staff were deemed suitable and safe to work with the people they supported. There was a sufficient number of staff to provide people with safe support and care.

Staff were trained to provide care and support which met people’s individual needs. The standard of staff members’ work performance was reviewed during supervisions, and checks via observation to make sure that staff were confident and competent to provide care and support. Not all staff had received an appraisal.

The manager sought feedback about the quality of the service provided from people and their relatives. People and their relatives felt listened to and they were able to raise any suggestions or concerns that they had with the manager and staff.

Staff meetings took place and staff were encouraged to raise any concerns or suggestions that they may have had. Quality monitoring processes to identify areas of improvement required within the service were in place. However, not all quality monitoring was effective in identifying and driving improvements.

We spoke with four people who used the service and one relative. We also spoke with the manager and three other members of staff. We looked at written records, which included copies of people's care records held in the office, staff personnel files and quality assurance documentation.

Below is a summary of what we found. The summary describes what people using the service, relatives and staff told us, what we observed and the records we looked at.

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

Is the service safe?

We saw that care plans and risk assessments were informative and up to date. Staff we spoke with were familiar with their contents, which enabled them to deliver appropriate and safe care. People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent it from happening.

People were protected by safe and effective recruitment practices. People were cared for by staff who were properly trained and supported to develop professionally.

Is the service effective?

People we spoke with were satisfied with the care and support they received and were highly complimentary about the care workers. This was consistent with mostly positive feedback reported in the provider's own annual quality assurance survey. People were given information and support to help them understand the care and support available to them.

Is the service caring?

We spoke with four people who used the service and one relative. One person said to us, "I am more than satisfied; I have never been treated with such kindness in my life." Another person said, "My carers are first rate. I'm very lucky and have nothing to complain about." One relative said, "The care staff are wonderful. They arrive on time, do what they are supposed to and leave everything clean and tidy."

Everyone we spoke with was highly complimentary of the service provided.

Is the service responsive?

People were consulted about and involved in their own care planning and the provider acted in accordance with their wishes. Care plans and risk assessments were regularly reviewed.

One person who used the service and two staff members told us that the manager was approachable and they would have no difficulty speaking to them if they had any concerns about the service. The provider took account of complaints and comments to improve the service.

Is the service well led?

Staff said that they felt well supported by the manager and they were able do their jobs safely. The manager had a range of quality monitoring systems in place to ensure that care was being delivered appropriately by staff, that the service was continuously improving and that people were satisfied with the service they were receiving.

During this inspection on 24 February 2014, we found that the provider had taken remedial action and had made the improvements required.

Effective staff recruitment was now in place and safety checks undertaken to make sure that people using the service received safe care and support from suitable and knowledgeable staff.

We spoke with four people who used the service and they had positive comments about the quality of the care provided. One person told us that their care was, "Very good". Another person told us that they were, 'So happy with them (Better Healthcare Services).'

People's standard of health and welfare was maintained. Staff had access to detailed care records to ensure that they provided people with safe, appropriate, individual care and support.

When we reviewed the provider's staff recruitment files we found that reasons for employment history gaps and risk assessments had not always been documented as part of the safety checks undertaken. This meant that there were not adequate staff recruitment systems in place to ensure that people who used the service received support and care from suitable staff.

There were effective staffing levels in place to ensure the safety and well-being of people who used the service.

We saw that Better Healthcare Services had an effective quality assurance system in place. This was because the provider generated action plans using the results from surveys and quality monitoring to improve the quality of the service delivered.