Bell View Help at Home Ltd

Bell View Help at Home is a domiciliary care agency providing personal care to people in their own homes. At the time of our inspection there were 103 people using the service. There were 88 people in receipt of 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

At the time of the inspection, the location did not care for or support anyone whose primary support need was their learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.

Right Support: 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.

Staff supported people to make decisions following best practice in decision-making. People’s relatives helped people express their needs and wishes if they could not do so themselves. Multidisciplinary healthcare teams were involved in decisions about people’s health when needed.

Staff knew people well, and provided person-centred care. Care documentation included clear guidance on how to care for people.

Medicines were managed safely. Some records were not in line with best practice guidance but action was taken immediately to rectify this.

Right Care: Staff understood how to protect people from poor care and abuse. The service worked with other agencies when needed to provide the most appropriate care. Staff had training on how to recognise and report abuse.

Risks to people were assessed and regularly reviewed when people's needs changed. The service had enough appropriately skilled staff to meet people's needs and keep them safe.

Right Culture: There was a positive culture in the service. Staff said the management team were supportive. Managers held regular supervisions with staff. Staff worked effectively with visiting professionals.

People, their relatives and healthcare professionals were involved in planning their care.

Quality assurance and monitoring systems were in place and effective. The registered manager was continuously improving the service. Lessons had been learnt from incidents.

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

Rating at last inspection

The last rating for this service was good (published 4 May 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service, and the length of time since the last inspection.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Following the inspection the provider submitted an action plan outlining improvements they planned to make. At this inspection we found improvements had been made and the provider was no longer in breach of regulations and we have rated it good.

Bell View Help at Home Ltd provides personal care and support for people living in their own homes in the North Northumberland area. At the time of our inspection, the service provided care and support to 60 people. The service had close links with Bell View Care Ltd which provides day care; meals; home support; assisted shopping trips and a transport service. Bell View Care Ltd is not regulated by CQC as its services are out of scope of the Health and Social Care Act 2008 Regulations.

The service had a registered manager. They had registered with the Commission in October 2017. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Improvements had been made to the management of medicines. Staff were aware of the procedures to follow and ensured there were suitable gaps between doses by ensuring appropriate times were allowed between visits. Medicine records we saw were completed accurately.

At the last inspection robust procedures were not in place for the safe management of people’s finances. At this inspection we found improvements had been made. A small number of people required support with finances and receipt books and records were in place. Staff were clear about the procedures to follow.

There were suitable numbers of staff on duty and safe recruitment procedures were followed. People told us they valued having regular staff that got to know them well.

Staff had received training in the safeguarding of vulnerable adults and knew the procedures to follow in the event of concerns of a safeguarding nature.

Individual risks to people were assessed and an assessment of the person’s home environment was carried out before the service commenced. Staff followed the correct procedures when providing personal care or service food to avoid the spread of infection. Gloves and aprons were readily available.

Staff received regular training, supervision and appraisals. The registered manager and senior care staff carried out supervision and spot checks. Staff told us they felt well supported by the registered manager and office staff. People told us staff were competent and appeared well trained.

All new staff were enrolled on the Care Certificate. The Care Certificate assesses the fundamental skills, knowledge and behaviours that are required by people to provide safe, effective, compassionate care.

People were well supported with eating and drinking. Clear instructions were available to staff about the level of support people required and any risks such as choking were identified.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. The service was operating within the principles of the MCA.

People and their relatives spoke very positively about the staff and management of the service. They described kind caring and dedicated staff. We saw numerous examples of kind and courteous care during our inspection.

At our last inspection we found care plans and assessments varied in quality and detail. At this inspection we found there had been an improvement in all care documentation. Care plans were personalised which meant the individual needs of people were addressed and staff knew their routines and preferences.

People were aware of how to make a complaint and told us they had not found it necessary to do so. A complaints procedure was in place and the small number of complaints received were dealt with in line with this.

At the last inspection we found governance systems to monitor the quality and safety of the service were not effective. At this inspection we found improvements had been made. The board of trustees held regular meetings with the registered manager who provided them with regular reports. They felt up to date and informed. The registered manager told us they felt well supported by the board.

Staff told us they were happy working for Bell View Help at Home and morale appeared good.

The service provides personal care and support for people living in their own homes in the North Northumberland area. At the time of our inspection, the service provided care and support to approximately 50 people. Their office is located in a purpose built resource centre in Belford. The service had close links with Bell View Care Ltd which provides day care; meals; home support; assisted shopping trips and a transport service. Bell View Care Ltd is not regulated by CQC as its services are out of scope of the Health and Social Care Act 2008 Regulations.

A registered manager was in post. 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.

At our last inspection in January 2015 we found some concerns with medicines management regarding certain administration and recording procedures. Whilst we saw some improvement measures had been taken, shortfalls remained in the management of medicines. Risks related to medicines had not always been assessed, and information had not been provided to staff about how to mitigate risks. Records showed medicines had not always been administered in line with prescribed instructions.

Staff had been trained in safeguarding people from abuse and staff we spoke with were clear on their responsibility. However procedures to reduce the risk of financial abuse and to maintain the security of people’s homes were not robust.

Contingency plans were in place to ensure the provider could maintain the service in the event of poor weather, and risks within people’s homes had been assessed.

Safe recruitment procedures had been followed and there were enough staff to deliver the service.

People told us staff were sufficiently skilled to care for them and meet their needs. Staff training was monitored and kept up to date. Staff were given opportunities to further develop their skills and knowledge. Records we looked at showed staff met regularly with their manager in supervisions sessions to discuss their practice; however two staff told us they had not yet attended these meetings. Appraisals had not been carried out. The registered manager acknowledged improvements should be introduced by forward planning meetings with staff to ensure they were able to discuss their roles.

Care Quality Commission (CQC) is required by law to monitor the application of the Mental Capacity Act 2005 (MCA), and to report on what we find. MCA is a law that protects and supports people who do not have the ability to make their own decisions and to ensure decisions are made in their ‘best interests’. The registered manager advised us all of the people who used the service had capacity to make their own decisions, he was aware of the process which should be followed if this was not the case.

People were supported to access healthcare services such as GPs.

People and relatives told us the staff were very warm and caring. Staff told us they enjoyed their jobs, and described to us occasions where they felt they had ‘gone the extra mile’ for people.

People had been involved in planning their care, and staff were very knowledgeable about people’s preferences and care needs.

Staff had received training to help them support people at the end of their lives, and a community matron we spoke with praised staff who provided this care.

Care plans and assessments of needs were varied in detail. We saw some records were very person-centred with specific information describing how the person should be cared for. However, we saw other examples which were simply descriptions of a task to carry out. One person’s records did not contain any information which showed how their needs had been assessed.

People described the service as ‘consistent’ and ‘reliable’ and told us their care was delivered by a small team of staff who knew their needs well. People told us they knew how to complain, but had no cause to.

The system to monitor the quality of the service provided was not robust. Audits had not been carried out by the registered manager. The provider had carried out some quality assurance checks, and taken steps to improve the service, however issues identified by the provider in June 2016 still remained at the time of this inspection.

We were unable to access some records as the registered manager told us he could not find them. Records we did view were sometimes incomplete or out of date.

The service had a strong community focus which aimed to improve the lives of people living in rural areas, and helped to signpost people towards other services and events to address social isolation.

We found two breaches of the Health and Social Care Act 2008. These related to Regulation 12: Safe care and treatment and Regulation 17: Good governance. You can see what action we told the registered provider to take at the back of the full version of the report.