B & H Care, a domiciliary care provider in Ipswich, received an overall rating of Requires Improvement at its first inspection in May–June 2022, with two regulatory breaches identified under Regulations 12 and 17 relating to unsafe risk assessments, contradictory medicines records, and ineffective governance audits. Strengths included safe recruitment, adequate staffing, good staff training, positive feedback from people and professionals, and effective multi-agency working.
Concerns (5)
criticalCare planning — “People's care plans did not clearly identify people's specific needs and how they were met. There was limited information provided to staff in how to provide the care and support required.”
criticalMedication management — “One person's records stated they did not need assistance with their medicines, however, they did state in another part that care workers were to prompt the person to take their medicines.”
criticalGovernance — “An audit in people's care records completed in April 2022 rated them as 100% compliant. The audit had not picked up the shortfalls we had identified in care plans and risk assessments.”
moderateRecord keeping — “Records were contradictory in parts, did not always identify how risks were mitigated and did not provide enough detailed information to guide staff in how people's needs were to be met.”
moderatePerson-centred care — “People's care plans were not always detailed enough to guide staff in how people's specific needs were to be met... not specific to identify what areas people required assistance with.”
Strengths
· People told us they felt safe with their care workers, confirmed by relatives.
· Staff received training and had competency assessed for medicines support; medicine tasks were electronically enforced to reduce missed doses.
· Safeguarding systems, policies, and staff training were in place with appropriate referrals made to local authority safeguarding teams.
B & H Care received an overall rating of Requires Improvement at its first inspection, with breaches of Regulations 9, 17 and 18 identified relating to non-person-centred care records, weak governance systems, and staff not remaining for the full duration of scheduled care visits. Strengths included safe recruitment, positive feedback on staff compassion and leadership, and effective complaints handling, but significant improvements are needed in visit monitoring, care planning accuracy and governance oversight.
Concerns (9)
criticalStaffing levels — “27% of visits were less than half the planned time and 50% of visits were less than 70% of the planned time.”
criticalMissed or late visits — “27% of visits had no travel time provided... staff did not always spend the assessed length of time with people, as planned.”
criticalCare planning — “A person's care plan referred to them as the name of another person using the service... a male was referred to as he, she, him and her.”
criticalPerson-centred care — “People's care records were not always person centred and did not always identify the person's individual needs. This placed people at risk of receiving inappropriate care.”
criticalGovernance — “Systems were not robust to assess, monitor and mitigate risks to the health, safety and welfare of people using the service. This placed people at risk of harm.”
moderateRecord keeping — “A person's care records stated they did not have a DNACPR decision in place. However, on the person's 'grab sheet'... it stated there was a DNACPR in place.”
moderateCultural competency — “We received concerns about all staff not understanding how to support people with the preparations of their meals... cultural training to staff.”
moderateEnd-of-life care — “From the training records only 10 of 23 staff had completed specific end of life training.”
moderateIncident learning — “The action plans implemented following the audits did not identify the outcomes to the actions.”
Strengths
· People and relatives reported feeling safe and receiving a caring service, with staff treating people with dignity, respect and compassion.
· Recruitment was undertaken safely, including right to work and DBS checks, with competitive pay to retain staff.
· Medicine audits were undertaken to identify and address shortfalls, and staff received medicines training with competency checks.
· Staff received a broad induction including the Care Certificate, face-to-face training and one-to-one supervision meetings.
· Complaints were investigated and addressed promptly, with records showing improvements driven by feedback.
Quality-Statement breakdown (22)
safe: Staffing and recruitmentRequires improvement
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Using medicines safelyRequires improvement
safe: Systems and processes to safeguard people from the risk of abuse; Learning lessons when things go wrongGood
safe: Preventing and controlling infectionGood
effective: Supporting people to eat and drink enough to maintain a balanced dietRequires improvement
effective: Staff support: induction, training, skills and experienceGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the law
Good
effective: Staff working with other agencies to provide consistent, effective, timely careGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
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
caring: Respecting and promoting people's privacy, dignity and independenceGood
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesRequires improvement
responsive: Meeting people's communication needsGood
responsive: Supporting people to develop and maintain relationships to avoid social isolationGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringRequires improvement
well-led: How the provider understands and acts on the duty of candourGood
well-led: Engaging and involving people using the service, the public and staffRequires improvement
well-led: Working in partnership with others; Continuous learning and improving careGood