About the service Bhandal Care is a domiciliary care service providing the regulated activity of personal care to people living in their own homes in and around Derby. The service provides support to older and younger adults, who may also be living with physical and sensory disabilities, dementia and mental health or learning disability and/or autism. At the time of our inspection there were 29 people using the service.
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.
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
Staff recruitment records did not record that all the required pre-employment checks for care staff had been completed. There were not enough care staff to safely meet people’s needs. Systems to ensure safeguarding referrals were made to help keep people safe were not effective. Care staff did not always use personal protective equipment (PPE) safely. Not all people’s care needs were included in their care plans and risk assessments. Not all people were confident medicines were managed safely, and medicines administration record (MAR) charts had not always been completed in line with the provider’s policies. Systems to ensure lessons were learnt when things went wrong were not fully in place.
The provider had not registered their office location correctly with CQC and had not always submitted statutory notifications in a timely manner. There was a lack of contingency planning for when the registered manager was unavailable. The registered manager had not always provided clear leadership on the risks associated with infection prevention and control. Records were not always complete, accurate or developed at the time care had been provided. The provider’s policies for recruitment, complaints and records had not always been followed. Audits and spot checks were not effective at assessing quality performance and identifying improvements in care. We were not assured the duty of candour had been followed as there were no details of how complaints had been managed and responded to.
People and staff felt involved, but it was not always clear how people's feedback had been used to make improvements. The service worked in partnership with relatives and other professionals involved in people's care.
Not all training provided to care staff had been effective in providing staff with the knowledge and skills they needed in their job role.
Systems to manage complaints and improve the quality of care in response to complaints were not operated effectively. People’s preferences for call times were not always met.
Relatives had mixed feelings on whether the service was caring. Some relatives did not feel their family members had always been well-treated.
Other relatives commented that care staff were caring. People’s equality and diversity needs were respected, and steps were taken to promote people’s independence, privacy and dignity. People and relatives were involved in care planning.
Care staff found working with a more experienced member of staff to gain experience when they first started was helpful. Assessment processes were in place to help understand people’s care needs, including when they needed help with food and drinks. People’s equality characteristics were considered as part of the assessment process to help prevent discrimination. People were supported to live healthier lives and access the healthcare they needed when this was provided by other agencies.
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’s care choices were respected, and their communication needs met. People’s relationships with their families were supported.
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
This service was registered with us on 21 December 2020 and this is the first inspection.
Why we inspected
This was a planned inspection based on the date of registration.
We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well-led sections of this full report.
Enforcement and Recommendations
We have identified breaches in relation to staff recruitment practices, staffing numbers, staff skills and competence, safe care, complaints management and the management and governance of the service.
Please see the action we have told the provider to take at the end of this report.
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 request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.