This inspection took place on 4 October 2018 and was announced. We gave the registered manager two working days’ notice of the inspection because the service is small and we wanted to be sure they would be available to meet with us. Business Services Bromley is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to older adults. Eight people were using the service at the time of our inspection.At our last inspection in August 2017 we asked the provider to take action to make improvements in order to keep people safe because risks to people had not always been adequately assessed. This action had not been completed. Identified risks to people had not always been assessed and people’s care plans did not always contain sufficient information for staff on how to manage identified risks safely. This amounted to a continued breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
At our last inspection in August 2017 we asked the provider to take action to make improvements in order to keep people safe because the provider’s systems for monitoring the quality and safety of the service were not effective in identifying issues or driving improvements, and records at the service contained inaccurate information. This action had not been completed. Whilst improvements had been made to address the recording issues we had previously identified, the provider’s systems for monitoring the quality and safety of the service remained ineffective. This amounted to a continued breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
At our last inspection in August 2017 we asked the provider to take action to make improvements to ensure they followed safe practice when recruiting new staff. This action has been completed. The provider followed safe recruitment practices.
At this inspection we found the provider’s induction and training programme was not robust and the registered manager was not always able to demonstrate that staff had received training in the areas considered mandatory by the provider. This was a breach of regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
At our last inspection in August 2017 we found improvement was required to ensure people’s medicines were consistently managed safely. At this inspection we found the administration of people’s medicines had not always been accurately recorded and there was no guidance in place for staff on the support they should give to people who had been prescribed medicines to be taken ‘as required’. This was a breach of regulation 12 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. 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.
The service had 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 this inspection we found improvement was required to ensure that the registered manager was aware of the responsibilities of their role and had a better understanding of the legal requirements associated with the provision of domiciliary care. We also found further areas requiring improvement because people’s needs had not always been holistically assessed when they started using the service, and to ensure that people received effective, joined up care when supported by different services. We have made a recommendation about carrying out assessments.
People were protected from the risk of abuse because staff were aware of the provider’s procedures for reporting abuse allegations. The service deployed sufficient staff to safely meet people’s needs. Staff worked in ways which reduced the risk of the spread of infection. Staff also knew to report any accidents and incidents, and the registered manager reviewed accident and incident records to ensure appropriate action had been taken to maintain people’s safety.
People received support from staff to maintain a balanced diet, where needed. They had access to a range of healthcare services in order to maintain good health. Staff were supported in their roles through regular supervision and an annual appraisal of their performance. Staff sought people's consent when offering them support. 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.
Staff treated people with care and compassion. People were involved in decisions about their support. Staff treated people with dignity and respected their privacy. People received care which reflected their individual needs and preferences. They had been involved in the planning of their care. The provider gave people a copy of their complaints procedure when they started using the service. People knew how to complain and had confidence that any issues they raised would be addressed. No one was being supported at the end of their lives.
The provider had systems in place for seeking people’s views and they acted to make service improvements based on the feedback they received. People, their relatives and staff spoke positively about the registered manager and the management of the service. The provider displayed their rating in the registered office location. The provider held regular staff meetings to discuss service developments and to ensure staff were aware of the responsibilities of their roles. Staff told us the service had a positive working culture and they worked well as a team. The provider worked openly with other agencies including with social work professionals from the local authority.
This is the second consecutive time the service has been rated Requires Improvement.