Beaumaris Healthcare Limited

Beaumaris Healthcare Limited is a domiciliary care agency. It provides personal care to people living in their own homes. At the time of our inspection 24 people received care from the service.

People’s experience of using this service:

Since our previous inspection, improvement had been made in all areas of the service.

Quality assurance systems had been improved and now effectively monitored the quality of the care provided.

People’s medicines were safely managed, and they received them when they needed them. They were safely supported by staff who understood any risks to the person and how to help reduce them. Staff had been trained to recognise and report any safety concerns, including abuse.

Staff had been safely recruited, to help ensure they were suitable to work with people in their own homes.

Staff training was monitored to ensure it was relevant and up to date. Staff were observed in their roles to ensure they were competent.

People were supported to maintain good health and staff worked with other healthcare professionals where necessary.

People were asked for their consent their right to make their own decisions about their own care and treatment were supported by staff.

People were supported by staff who were kind and caring. People were involved in their own care and treated with dignity and respect.

People received individualised care which was regularly reviewed with them to ensure it met any changing needs.

People’s feedback about their experience of care were sought and improvements were made, where necessary.

Rating at last inspection:

At the last inspection the service was rated requires improvement (report published 20 June 2018)

At the last inspection, we had imposed conditions onto the provider’s registration. The conditions meant the provider had to send us monthly quality reports.

Why we inspected:

This was a planned inspection to ensure the provider had made the required improvements.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit, as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This service is a domiciliary care agency. It provides personal care to people living in their own homes in the community. It is registered to provide a service to older adults who may have dementia, mental health concerns or a sensory impairment. At the time of our inspection 48 people were using the service.

Not everyone using Beaumaris Healthcare Limited receives a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

The service is required to have a registered manager in post. The current manager had been in post since 1 November 2017 and had submitted their application to register with us. 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.

In January 2017 the provider and location changed their name from Tender Care (Newport) Limited to Beaumaris Healthcare Limited. The provider of the service did not change. The last inspection referred to throughout this report was completed when the location and provider was called Tender Care (Newport).

This is the second consecutive time the service has been rated as Requires Improvement.

At the last inspection in September 2016, we found that the provider was in breach of a regulation in relation to the governance of the service. We had found that people were not always protected by effective quality assurance systems. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question of well-led to at least good.

At this inspection we found that improvement had been made to the service with regards to the consistency of care the service provided. However, areas we had identified as requiring improvement at the last inspection had not been improved on sufficiently. We found there was a continuation of the breach of regulation in relation to the governance of the service. This was because the provider’s quality monitoring systems were not effective in identifying and resolving improvement needed. We also found continuing concerns with the management of people’s medicine and the management of risk and found the provider to be in breach of the regulation relating to safe care and treatment.

Sufficient improvement had not been made since the last inspection in relation to how people’s medicines were managed. Although people told us they received their medicines when they needed them, records did not always accurately describe the level of support people needed with their medicines and staff did not fully understand their responsibilities. We also found gaps in the recording of medicines where staff had not signed to confirm people had taken their medicines.

At our last inspection we had identified that risk assessments were in place but were not always specific to people’s individual needs. At this inspection, we found the same and it was not always clear how risks to people were to be managed. Although safety measures were in place to protect people, it was not always documented why equipment to restrict people’s movement had been considered and agreed as the best option. However, staff understood how to keep people safe within their own home environment and in relation to their individual needs.

Improvement had not been made since the last inspection to monitor whether people received their care calls as planned. The service relied on people and their relatives informing them if staff did not attend their care call. Although a new call management system was due to be rolled out this was not established at our inspection.

People felt that staff treated them fairly and felt safe with the staff that supported them. Staff had received training in and understood how to protect people from any abuse or discrimination. Staff knew how to and were confident in reporting any concerns they may have about a person’s safety.

Employment and identity checks were completed on potential new staff to make sure they were suitable to work with people in their own homes.

Staff had received training to understand and support people's individual needs. These skills were kept up to date through regular training and staff were also supported in their roles by managers and their colleagues.

Staff asked people’s permission before they helped them with any care or support and involved them in decision making. Where people were unable to make their own decisions, staff and the manager understood their responsibilities in ensuring people’s rights were protected.

Staff encouraged people to eat and drink enough and supported them to make their own choices about what they wanted to eat and drink. Where responsible, people were supported with their health needs and staff worked with other professionals to make sure effective care was provided.

Improvement had been made to the consistency of care people received and they were supported by staff who knew them well and had good relationships with them. Staff made sure people were involved in their own care and treated people with dignity and respect.

People felt involved in the planning of their care but not everyone thought their care had been reviewed regularly. Staff knew people’s preferences and wishes in regard to their care and support but this was not reflected in their care records.

People were happy with the care and support they received and gave positive comments about the staff and management at the service.

People knew how to raise complaints and concerns and were able to give their opinions of the service. They were happy with how their concerns were dealt with and resolved and felt listened to.

The service had a positive culture where staff spoke positively about the improvements made to the consistency of people’s care. Staff were happy in their work and were clear about their roles and responsibilities; they felt supported by management and involved in the development of the service.

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.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

People did not have their needs assessed and a plan in place to ensure their medicine was administered as prescribed. People did not always receive support from sufficient numbers of staff. Risks to people were not always managed and information about people’s risks was not always available to staff providing the support. People told us they felt safe and staff understood how to keep people safe from abuse.

People did not always receive support from staff that had up to date training and the knowledge to provide them with effective support. People were not always supported in line with the principles of the Mental Capacity Act. People had support to meet their nutritional needs. People had support to access health professionals and monitor their health.

People had developed good relationships with staff and they were positive about the support they received. People were able to choose for themselves and express their preferences about how their care and support was delivered. People received support in a way, which protected their dignity and privacy.

People were not always supported by staff who understood their needs and preferences. People were involved in developing their care plan. People understood how to make a complaint and these were responded to appropriately.

There were quality audits in place but these did not always identify areas where improvements were required. People told us they felt the service was open and transparent and they could approach the registered manager when they had concerns.

The provider was not meeting the regulations regarding effective management. You can see what action we told the provider to take at the back of the full version of the report.

People who used the service understood the care and treatment choices available to them, and were involved in decisions about their care. Comments included, 'All the staff are very good. I have no complaints', 'They are wonderful', 'You can ask me as many questions as you like but they are all marvellous and do a wonderful job' and 'The staff are courteous and helpful; they always ask if there's anything else they can do'. A health care professional we spoke with told us, 'This is the best agency I work with'.

There were effective care planning arrangements in place in the service, which included up to date care plans and risk assessments.

There was a complaints policy and procedure in place. People we spoke with told us they knew who to raise any concerns with and they felt confident their concerns would be addressed.

The provider sought people's views periodically and completed assessments of risks to assess and monitor the quality of service provision.

People told us that they had been involved in the preparation of their care plans and that the staff listened to and respected their views. We found that the staff consulted relatives if the person receiving a service lacked capacity to make decisions for themselves.

We found that care plans were person centred and contained all the information the staff needed to provide good consistent care.

We found that the provider had suitable arrangements in place to help keep people safe. Staff we spoke with understood the provider's safeguarding procedures.

We were satisfied that the provider made all the appropriate checks on staff before their full employment started.

We found that the provider had a suitable complaints procedure in place and that complaints were properly recorded and responded to.