Archived: Baxter Life Care Limited

Updated 24 August 2017

We carried out this comprehensive inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection visit took place across three dates, 20, 21 and 28 June 2017 and was announced.

The inspection team consisted of one adult social care inspectors and an expert-by-experience. This is a person who has personal experience of using or caring for someone who uses this type of care service. The expert-by-experience had a domiciliary care background.

We spoke with a range of people about Baxter Life Care Limited. They included seven people who used the service, three relatives, the registered manager, the manager, a care manager and five staff members. Prior to our inspection visit we contacted the commissioning department at Lancashire County Council. In addition we contacted Healthwatch Lancashire. Healthwatch Lancashire is an independent consumer champion for health and social care. This helped us to gain a balanced overview of what people experienced accessing the service.

The provider returned the completed Provider Information Return (PIR), within the requested timeframes. A PIR is a form which asks the provider to give us some key information about the service, what the service does well and improvements they plan to make. We reviewed this information as part of the inspection.

We looked at care records of nine people, staff training records, medication documentation and records related to the management of the service. We looked at recruitment procedures and checked staffing levels.

Updated 24 August 2017

Baxter Life Care Limited is a domiciliary care agency that supports people to remain independent in the comfort of their own home. The services are designed around people they support and people have the freedom to choose who provides their care, and when they want it. Care is planned around people’s personal needs. At the time of our inspection 44 people were receiving a personal care service.

The last inspection of this service took place over two days on 08 and 09 April 2015. The service was awarded a rating of 'Good’ and we identified no concerns at this inspection.

This inspection visit at Baxter Life was undertaken on 20, 21 & 28 June 2017 and was announced. The service was given 24 hours’ notice prior to the inspection so we could be sure someone would be available to provide us with the information we required.

The registered manager of the service was present throughout our inspection. 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.

During our last inspection we found concerns with how people’s care packages and risk assessments were recorded. We looked at risk assessments during this inspection and found risk assessments were not always completed on an individual basis and did not always contain adequate information. There was not always information on how to mitigate risks and there was missing information to help guide staff if the said risk occurred. We looked at nine people’s care plans and found gaps in information regarding the administration of medicines. For example, we saw no support plans to guide staff when giving medicines, which could have put people at risk of medication mismanagement.

We also saw missing signatures on Medicine Administration Records (MARs) for one person however; we could not easily see what action was taken from this. The risk management and medicines management issues identified amounted to a breach of Regulation 12 safe care and treatment of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We looked at how the service gained people’s consent to care and treatment in line with the MCA. We found the principles of the MCA were not consistently embedded in practice. The service does provide a service to people who may have an impairment of the mind or brain, such as dementia. We found people’s capacity to consent to care had not always been assessed. In addition the information in relation to consent was at times conflicting. This failure to follow the code of practice amounted to a breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Need for consent).

We found care plans did not always have enough detail considering the complex needs of the adult cared for. Information was not always available, in four of the files, there was minimal information. These shortfalls in maintaining accurate and complete records amounted to a breach of breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Good governance).

We asked the registered manager to tell us how they monitored and reviewed the service to make sure people received safe, effective and appropriate care. Systems were in place to demonstrate regular checks had been undertaken looking at care files and daily records. However, checks were not always robust and effective. The provider had not ensured the processes they had to monitor quality and identify areas for improvement were effectively implemented. We found examples of audits which had been completed in April 2017 however the actions documented had not yet been acted on. We found three examples where the audit had identified missing care documentation in people’s files. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014.

We have made a recommendation about the auditing of accidents and incidents.

We have made a recommendation around involving people in the care planning process.

We have made a recommendation with regards to ensuring care files are completed and up to date with regards to people nutrition and hydration needs.

The service had a complaints procedure which was made available to people they supported and their family members. People we spoke with told us they had raised some concerns but these were not always addressed. The registered manager informed us a system for recording and managing informal concerns would be put in place.

We looked at staffing levels, geographical rotas and how staff are deployed. People we spoke with did tell us that sometimes there were timing issues with calls. A new rota system had recently been introduced to help with the travel time for carers. However, we did see that some calls were back to back which meant carers did not always have time to travel. This allocation of time impacted on staff as they were not always able to travel between calls which resulted in them being late. The registered manager told us this would now be reconsidered.

We reviewed how the service continued to ensure people were safeguarded from abuse during this inspection. We found people were protected from the risk of abuse because staff understood how to identify and report it.

Staff we spoke with said the training was very good and was ongoing throughout the year. People we spoke with told us staff were well trained. Comments included, “They are very attentive and have a good knowledge.” And, “I think they are very competent, they are really good carers.”

Staff told us they felt well supported by management and we saw evidence regular supervisions were being held.

We observed positive interactions during the inspection. Staff approached people in a caring, kind and friendly manner. We observed staff speaking with people who used the service in a respectful and dignified manner.

We received consistent positive feedback about staff and about the care people received. Everyone we spoke with who received care and support, told us they were treated with kindness by the care staff who supported them.

People were supported and encouraged to take part in activities of their choice. We saw evidence of people who had been supported to access their favourite shops and local eating and drinking establishments.

We found the management team receptive to feedback and keen to improve the service. The managers worked with us in a positive manner and provided all the information we requested.

You can see what action we told the provider to take at the back of the full version of the report.