Bloomfield Care Limited

Bloomfield Care Limited is a domiciliary care service providing personal care to people at home. Not everyone who uses the service receives 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. There were 12 people using the service at the time of the inspection receiving a regulated activity of personal care.

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

We found significant improvements had been made to the service since our last inspection.

After our last inspection the registered manager stopped providing regular hands on care to focus on their role and responsibilities. This meant they were able to ensure service delivery was consistent by overseeing systems and processes, embedding them into the service and ensuring they were sustained.

All staff had completed comprehensive training and knew how to safeguard people from abuse. Through pre assessments and ongoing care planning, the service had identified potential risks to people and had detailed, person centred plans in place to mitigate risk of harm. People told us staff were kind and caring and they felt safe. One person told us, "I am very happy with the carers. They are on time or will contact me if they will be late. They have never missed a call. I feel very safe."

Medicines were managed safely and lessons were learned when things went wrong. Staff had their competencies checked to ensure they worked in a safe way.

Staff told us they felt supported and had enough up to date training to fulfil their roles. Staff told us they knew they could speak with their registered manager and felt confident they would be listened to and their concerns acted upon.

People had access to healthcare professionals and people told us staff assisted them to access this support when needed.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Staff understood how to treat people with dignity and respect and people's experience of their care confirmed this.

Care plans were personalised and met people's needs in a variety of ways, both practically and emotionally. The service used an electronic logging system which meant that they could respond if staff were held up or going to be late. People knew how to make a complaint and the service's policy supported that.

Systems and processes to ensure the consistent safe delivery of good quality care had been established and embedded into the service. The registered manager and provider understood their roles and responsibilities and had changed the structure of the service to ensure improvements were made and sustained. People thought the service was well led and staff told us they were proud to work for Bloomfield Care Limited.

We received compliments about the support and leadership of the service. People and staff told us they felt the service was organised and well-led. One relative said, "I think the company is well managed and organised. I do not have any complaints and I would recommend them." The service worked well with other organisations and professionals.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update.

The last rating for this service was inadequate (published 29 September 2021) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 22 September 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an announced comprehensive inspection of this service on 2 August 2021. Four breaches of legal requirements were found and three Warning Notices were served. The provider completed an action plan after the last inspection to show what they would do and by when to improve safeguarding of vulnerable adults, safe care and treatment, staffing and good governance.

We undertook this focused inspection to check whether the Warning Notices’ we previously served in relation to Regulation 12, Regulation 13 and Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met and to check they had followed their action plan to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective, Responsive and Well-led which contain those requirements.

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 Inadequate to Good. 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 Bloomfield Care Limited on our website at www.cqc.org.uk.

Bloomfield Care Limited is a domiciliary care service providing personal care to people at home. Not everyone who uses the service receives 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. There were 17 people using the service at the time of the inspection, 13 people were receiving personal care.

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

Most people we spoke with told us they felt safe and were happy with the care Bloomfield Care Limited provided. However, we found some risks to people’s health and welfare had not always been assessed. Where some risks had been identified they had not been kept up to date, reviewed and some did not have clear instructions to tell staff how to mitigate risks to people. This meant people’s needs were at risk of not being identified and people were at risk of avoidable harm.

Medicines were not managed safely. Medication administration records had not been transcribed correctly and they did not show medicines had been administered as prescribed. Medicines had not been audited to ensure medicines were administered by trained staff as prescribed. Not all staff had completed safe administration of medicines training. This put people at risk of harm

Staff we spoke with knew how to safeguard people from abuse, however the service had not ensured all staff had completed mandatory training. This meant staff may not be aware of best practice to safeguard people. The service had failed to notify external bodies of incidents where people were at risk of safeguarding concerns. This meant external scrutiny was not always possible to ensure people were safeguarded from abuse.

The service had sought consent from people with capacity however, we found that people who lacked capacity had not always been assessed and reviewed within the principles of the Mental Capacity Act 2005 (MCA). This meant, 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.

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 autistic people.

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right support:

People’s choice, control and independence was not always considered or reviewed in line with the principles of the mental capacity act 2005.

Right care:

Care staff were not provided with up to date and correct information in order to provide person-centred care to people using the service.

Right culture:

The registered manager and provider wanted to do their best for people using the service and sought to improve where possible. However, they did not have the consistent systems and processes in place to ensure the safe delivery of person-centred care in the least restrictive way.

This put people at risk of not having their care needs met and at risk of harm. The service was working with health and social care professionals and were working towards improving, in order to provide good outcomes for people using the service.

Staff training was inconsistent. Four members of staff had not completed their full induction before the 12-week deadline. This meant staff were not always provided with the up to date skills and knowledge to carry out their duties. Some staff had not completed training in specialist areas including Epilepsy. Staff told us they would not know what to do if a person they were supporting had epilepsy. The service was supporting people who had epilepsy, this placed these people at risk of harm.

Bloomfield Care Limited used an electronic care planning system that was not always accessible to all staff. This meant staff were unable to read up to date care plans and unable to record their daily notes in a timely manner.

Care plans were sensitively written however, we found care plans did not always contain enough information or missed important information to meet people’s needs. This meant care staff were not provided with the information they needed and put people at risk of not having their needs met.

Systems and processes to provide oversight and monitor the safe delivery and quality of care provided to people were inconsistent. Audits were not always completed and when they were, they were not always effective at highlighting areas of improvement.

People told us they liked the staff as they were very caring. Comments from people included, “The carers are probably the best I have ever had” and “They are a very nice bunch”. The registered manager and provider spoke passionately about providing care to people in their own homes. They had an ethos that staff should stay for the entire call and if tasks were completed before this time then staff were to stay with the person and provide companionship time. The service had started during a pandemic and with that had to manage the additional challenges this brought. The registered manager and provider told CQC they had already started to make changes in order to improve the service, this will be reviewed when we next visit to ensure improvements have been made and are sustained.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

This service was registered with us on 5 June 2020 and this is the first inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, responsive and well-led sections of this full report.

Why we inspected

The inspection was prompted in part due to concerns CQC received about missing risk assessments and care plans, the safe administration of medicines and poor governance and oversight of the service. This service was also an unrated service.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to the safe care and treatment, safeguarding people from abuse, the safe administration of medicines and good governance.

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 request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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 six months to check for significant improvements.

If the provider has not made enough improvements 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 of 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.