Date of assessment: 24 February 2025 to 10 March 2025. Bowtree Homecare Ltd is a domiciliary care agency registered to provide personal care to people in their own homes. At the time of our assessment there were 23 people receiving support with 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. At the last inspection the provider had failed to ensure robust systems and process were in place and actioned to effectively manage the service and to ensure safe recruitment procedures were followed. At this assessment the provider had made the necessary improvements and was no longer in breach of regulations. People’s needs were assessed prior to them receiving a service. Care plans provided guidance for staff to ensure people received safe and responsive care and support. Risks were assessed and mitigated to keep people safe. 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. Medicines were managed safely. Staff received training in medicines administration. There was a positive culture within the service. Staff said they felt supported by the management team and could approach them for advice and guidance. The service worked in partnership with other social and health care professionals. Feedback from health professionals we contacted was positive. Systems were in place to monitor the quality of the service. Accidents, incidents and safeguarding concerns were reviewed to help keep people safe and ensure appropriate action was taken. People and staff had the opportunity to provide feedback.
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Bowtree Homecare Ltd received an overall rating of Requires Improvement on its first inspection, with regulatory breaches identified in recruitment (Regulation 19) and governance (Regulation 17) due to unsafe hiring practices and insufficiently robust quality assurance systems. Care was nonetheless found to be safe in most respects, with kind and person-centred staff delivering good outcomes for people, and the registered manager was responsive to findings and took prompt corrective action.
Concerns (8)
criticalGovernance: “We found the medicines audit, care plan audit and recruitment process could be more robust to identify the issues we found in the safe and responsive domain.”
criticalStaff competency: “One person did not have a Disclosure and Barring Service (DBS) check in place before their employment commenced. A risk assessment had also not been appropriately carried out.”
moderateStaff training: “Training compliance rates needed to be improved. There was no training in place relating to learning disabilities and autism, which is a requirement.”
moderateSupervision / appraisal: “Staff were supported through supervision, however supervisions were not happening in line with the providers policy.”
moderateRecord keeping: “Some elements of people's care plans would benefit from further information adding. People with diabetes did not have enough information recorded.”
minorCare planning: “People with diabetes did not have enough information recorded to ensure staff had a full awareness of the condition.”
minorIncident learning: “Systems around how this information was shared with staff needed to be improved.”
minorConsent / capacity: “Records relating to consent needed to be clearer... records did not explicitly state that consent was given.”
Strengths
· People felt safe and spoke positively about care staff, describing them as kind, compassionate and professional.
· Medicines were managed and administered safely with trained staff and competency checks in place.
· Staffing levels were safe with no missed visits reported by people using the service.
· The service promoted a positive, open culture with a whistleblowing policy and transparent management.
· People's equality and diversity needs were respected and staff supported independence, privacy and dignity.
Quality-Statement breakdown (21)
safe: Staffing and recruitmentRequires improvement
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Using medicines safelyGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongRequires improvement
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Ensuring consent to care and treatment in line with law and guidanceGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Staff working with other agencies to provide consistent, effective, timely careGood
caring: Ensuring people are well treated and supported; respecting equality and diversityGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
responsive: Planning personalised care to ensure people have choice and controlGood
responsive: Meeting people's communication needsGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Engaging and involving people using the service, the public and staffRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: How the provider understands and acts on the duty of candourGood