BBC Care Service Limited

At the time of the inspection, the location did not care or support for anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.

About the service

BBC Care Service Limited is a domiciliary care agency providing personal care to 5 people at the time of the inspection. The agency supported people with different physical and health related support needs, older people and people living with dementia.

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

Right Support

The provider did not always follow effective processes around safeguarding people. However, staff knew how to recognise and report concerns to the registered manager and people’s relatives told us they trusted staff and felt their loved ones were safe with staff.

People were not always supported to have maximum choice and control of their lives. Staff supported people in the least restrictive way possible and in their best interests. The policies and systems in the service supported good practice but were not yet fully embedded into practice. Staff did not always follow the MCA Code of Practice when obtaining people’s consent or assessing their mental capacity.

People received support around their individual risks and needs and staff knew them well. Staff supported people with their medicines in a safe way and knew how to protect people from infections. Where needed, staff knew how to support people around their eating and drinking or contacting healthcare services.

Staff were recruited safely and visited people to provide care as planned. Staff received appropriate training and support and continued to develop their skills. People’s relatives found staff to be professional and competent.

Right Culture

The registered manager worked on improving the service and their oversight of the quality and safety of the care people received with assistance from an external and independent support. Not all changes had been successfully embedded. The provider did not always identify outstanding actions and possible concerning issues. For example, around how safeguarding was considered when analysing events in the service, what information was missing from people’s care plans to ensure person-cantered care or how effective was their monitoring of staff attendance on care visits.

Staff and people using the service represented by their families were complimentary about the culture of the service. They told us they felt involved and listened to. The service worked with healthcare professionals and social services to ensure people received the support they needed timely.

Right Care:

People received personalised support, but areas such as life stories, wishes around advanced care planning or their interests and preferences had not been fully assessed in their care plans yet.

People’s relatives told us staff knew people well and treated them in a caring and kind way. Staff respected people’s homes, families and their individual capabilities and treated them with kindness. Staff knew how to communicate with people effectively.

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 13 January 2023).

At this inspection we found some improvements had been made but the provider remained in breach of regulations.

This service has been in Special Measures since 31 May 2022. During this inspection the provider demonstrated that some 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

This inspection was carried out to follow up on breaches of the regulations identified at the last inspection. We have found evidence that the provider needs to make further improvements.

Enforcement

We have identified breaches in relation to safeguarding, how the provider adhered to the Mental Capacity Act 2005 requirements 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 meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

BBC Care Service Limited is a domiciliary care agency providing personal care to older and younger people with physical and health related care and support needs, some of whom live with dementia or learning disability. At the time of our inspection there were 5 people using the service.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

At the time of the inspection, the location did not care or support for anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.

Right Support:

People’s care plans had significant discrepancies and lacked information around their individual risks, needs and preferences. The registered manager was not always able to explain to us those discrepancies to identify people’s needs correctly. The risks to people were mitigated by the fact they were supported by consistent staff who knew them well. However, should staff or people’s individual needs changed, people could be at risk of avoidable harm or receiving poor quality care. Despite these shortfalls, people told us their day-to-day care had overall improved and they felt care was now person-centred.

People were not always 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. Although people and their relatives told us they were asked for their consent for care, the registered manager did not always follow Mental Capacity Act 2005 (MCA). The registered manager had limited knowledge and understanding of MCA and people’s records lacked information on how their rights were protected.

Right Care:

People did not receive safe support around their medicines and their care plans lacked information around individual risks which put people at risk of avoidable harm. People’s experience of care and support had overall been improved as the registered manager ensured support was provided by a consistent staff team who knew them well and had previous experience working in social care.

Staff received support with additional training, supervision and observations of practice. Staff told us they felt supported by the registered manager and valued. People told us staff were kind, caring and patient when providing care. People and their relatives felt involved in their care. Staff supported people to eat and drink well and to do what they wanted when needed. Staff knew how to help people to access healthcare and social care services.

Right Culture:

The registered manager had not implemented effective governance systems and processes. Multiple shortfalls around safe medicines management, quality of people’s care and risk management plans, MCA or staff pre-recruitment checks were not identified within the audits and checks implemented since the last inspection. This placed people at risk of harm as shortfalls around their care would not be identified by the registered manager and addressed in a timely way to mitigate risks.

The culture of the service was supportive, and the registered manager worked in an open and transparent way, both with people, their representatives as well as with staff and other stakeholders. The registered manager worked in partnership with people’s supporters, social services and healthcare services in the local area and sought support from local social care networks.

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 1 June 2022).

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 some improvements had been made and the provider was no longer in breach of regulation 18 (Staffing), regulation 16 (Complaints) and regulation 9 (Person-centred care) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we found the provider remained in breach of regulation 12 (Safe care and treatment), regulation 17 (Good governance), regulation 11 (Need for consent) and regulation 19 (Fit and proper persons employed) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At our last inspection we recommended the provider reviewed their responsibilities under the Accessible Information Standard. At this inspection we found the provider made improvements in this area.

Why we inspected

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

Enforcement and Recommendations

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 monitor the service and will take further action if needed.

We have identified continued breaches in relation to safe care and treatment, good governance, how people’s capacity to give consent was assessed and how staff’s suitability for their roles was checked 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 meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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.

BBC Care Service Limited is a domiciliary care agency in Chertsey providing support with personal care to people who live in their own houses and flats. At the time of the inspection the agency supported 12 people in different geographical areas of Surrey. Both older and younger adults living with physical support needs, some of whom also live with dementia, learning disabilities and/or autism were supported by the agency.

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 told us they did not always receive their care as planned, care visits were late or missed, or did not last as long as they should have. People felt overall safe with staff but did not feel they received personalised care, as not all staff knew their needs. Not all staff provided caring and compassionate support.

New staff pre-employment checks were not always carried out as per legal requirements. Not all staff who supported people with their medicines received appropriate training and competency checks.

People did not always feel their feedback and complaints were welcomed and listened to or acted upon. The registered manager failed to have a good oversight of the care people received and to action concerns raised effectively.

The governance systems and processes in the service were not implemented successfully to enable continuous improvement of the service. Hence, people’s feedback was not always actioned putting people at risk of distress and harm.

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.

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: Model of care and setting maximises people’s choice, control and Independence;

The level of care was determined by people’s support needs and to compensate what was currently being provided by family and other professionals. However, the agreements on when people would receive care and for how long were not always adhered to by the agency.

Right care: Care is person-centred and promotes people’s dignity, privacy and human rights;

People had individual care plans in place and some of their wishes and preferences were recorded and known to staff. However, people’s care records were not always detailed enough and robust to ensure all their personal needs were considered by staff when supporting them. Due to that and the issues with staff attendance on the care visits, people did not always receive personalised care.

Right culture: Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives

People’s experience of care was inconsistent, some told us they did not feel listened to by the registered manager when they raised concerns or suggestions. There was limited assurance on how the registered manager monitored the quality and safety of the care people received on a day to day basis.

We found no evidence that people were harmed but these shortfalls put them at increased risk. We discussed these concerns with the registered manager who was responsive to feedback and started making changes to how the care was monitored and organised to improve it for people.

Staff received basic training and felt supported by the manager but further training specific to people’s individual needs was required as not all people felt staff were competent for their roles and knew their needs well.

People had care plans in place but those did not always consistently assess and address their specific needs, wishes and preferences.

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.

People overall felt staff asked for their consent before providing care. However, we identified improvement needs in how the service implemented Mental Capacity Act 2005 guidance to protect people’s rights.

Staff knew how to protect people from the spread of the infections. The service worked in partnership with other health and social care services.

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 11 March 2020 and this is the first inspection.

Why we inspected

The inspection was prompted in part due to concerns received about the timeliness and quality of the care visits provided by the agency and partly as the service had not been inspected since its registration. A decision was made for us to continue with the inspection as planned and to inspect and examine those risks.

Enforcement and Recommendations

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 monitor the service and will take further action if needed.

We have identified breaches in relation to staffing, fit and proper persons employed, assessing risks to people and safe use of medicines, need for consent, person-centred care, receiving and acting on complaints and good governance at this inspection.

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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.