LightBulb Bespoke Care

LightBulb Bespoke Care is a domiciliary care service providing personal care to people living in their own homes in the community. The service provides support to older and younger adults who may be living with a physical disability, mental health needs, a sensory impairment or dementia.

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. At the time of our inspection there were 14 people receiving personal care at the service.

People’s experience of using this service and what we found

People and relatives were happy with the support given by the staff team. One person told us, ‘‘I am very happy with how things are going. The staff are all wonderful.’’

People felt safe being supported by the staff team. The registered manager had assessed risks to people and put measures in place to mitigate risks as far as possible. There were enough staff to support people safely. People told us there had been no missed care visits and staff arrived on time for their care visits. Staff supported people safely with their medicines and followed good infection and prevention control (IPC) measures when supporting people. Systems were in place to learn lessons if things went wrong.

Staff had training to support people effectively and the management team checked their competency to perform their job roles. People’s needs were assessed before they started using the service. Staff supported people to eat and drink if this support was needed. Staff supported people to see health professionals and followed professional advice to help support good outcomes for people. 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.

The registered manager and care co-ordinator were passionate about the service. People were positive about how the service had improved since the registered manager started in their job role. Systems were in place to audit and monitor the quality of the service. Actions were taken if improvements were identified. People, relatives and the staff team were engaged with and encouraged to feed back about the service. The staff team worked with other professionals to help support good outcomes for people. There had been significant improvements at the service since the registered manager started working there.

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

The last rating for this service was requires improvement (published 21 December 2021)

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

At our last inspection we recommended the provider review systems in place to safely recruit staff, support people in line with the Mental Capacity Act and collect feedback from people and the staff team about the service. At this inspection we found the provider had made improvements in these areas.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We carried out an announced unannounced comprehensive inspection of this service on 06 October 2021. Breaches of legal requirements around safe care and treatment, staffing and good governance were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve and updated us on their progress on a monthly basis.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Light Bulb Bespoke Care on our website at www.cqc.org.uk.

Follow up

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

Lightbulb Bespoke Care is a domiciliary care agency providing personal care to people living in their own homes. The service provides care visits or live in care for people. The service was supporting 22 people at the time of this inspection.

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

People were at risk of poor care and treatment because the registered manager did not have effective auditing and governance systems in place to monitor the quality of the service. Audits were not being completed in key areas of the service and had not picked up on areas for improvements. Actions put in place by the provider following our last inspection had not been completed meaning that the provider was unable to make and sustain improvements. People, relatives and staff were not always given the opportunity to feed back about the service. People were not always supported to communicate in ways that they understood. We have made recommendations about collecting feedback about the service.

The registered manager was not checking to ensure training completed by the staff team had been effective in preparing them for their job roles. Staff were not receiving supervision or competency assessments to help ensure they were providing safe care and support to people. This included in areas such as administering medicines, moving and handling and the Mental Capacity Act (MCA). In most cases staff’s previous experiences in other care settings had been relied upon and responsibility for ensuring this was effective had not been checked by the management team. Staff inductions were not completed fully when they started working at the service.

People’s support plans and risk assessments and policies and procedures were not being updated regularly. In some cases, risk assessments were hard to follow, and the risk of information not being recorded correctly was high. Staff recruitment checks did not all contain the necessary information in line with legal requirements. We have made a recommendation that staff files be reviewed to ensure they are in line with legal requirements.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice. Staff had variable knowledge about the MCA and the impact this has on their job role. We have made a recommendation around staff training in the MCA.

Despite our findings, people and relatives were positive about the support they received at the service. One relative told us, ‘‘[Staff] are very good. They treat [family member] with respect and know what is important to them.’’

People felt safe being supported by the staff team. There were enough staff to meet people’s support needs. Staff told us they had enough time to travel between people’s care visits and had enough time to support people in a calm and relaxed way. Staff understood their job roles despite the issues we found with training not being checked. Staff followed good infection control practices and felt well supported during the COVID-19 pandemic.

People’s needs were assessed before they started using the service. If people’s needs changed then assessments were completed again to ensure the correct support was put in place. People received support to eat and drink in their preferred way if this was needed. People were supported to see health professionals when this support was needed.

People told us that staff treated them with kindness and respect and knew them well as individuals. Staff spoke with passion and knowledge about the people they were supporting. People were supported to make choices in their day to day support and were supported to maintain their independence if this is what they chose to do. People were confident to make complaints, and these were responded to in a timely manner. Plans were in place to discuss care for people at the end of their life.

People and relatives were positive about the registered manager and care-coordinator at the service. Staff felt that they could approach the registered manager for support if this was needed. The staff team worked with external and health professionals to support people to achieve good outcomes.

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)

The last rating for this service was inspected but not rated as we completed a targeted inspection (report published 07 January 2021) and there was a breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on when the service first registered with us. We have found evidence that the provider needs to make improvements. Please see the safe, effective, responsive and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, staffing and good governance at this inspection. 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 for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

LightBulb Bespoke Care is a domiciliary care agency that, at the time of the inspection, was supporting 12 people living in their own homes within the local community; everyone who used the service received assistance with 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

Whilst people were happy with the service they received, the provider did not have effective and consistent quality monitoring and governance systems in place. This meant there was a risk that a decline in the service would not be promptly identified and addressed, potentially negatively impacting on the people who used the service. We have made a recommendation about the governance systems.

We could not be assured people received their medicines as prescribed as medicines management did not follow good practice guidance. Records were not consistently accurate and the monitoring system in place had failed to identify this. We have made a recommendation about the management of medicines.

People told us they felt safe using the service and that staff demonstrated the appropriate skills. They told us staff turned up on time and stayed the allotted time. One relative we spoke with said, “[Family member] feels safe. I think it’s getting regular staff – they are so nice. The same ones come in the morning and afternoon and [family member] is comfortable with them. [Family member] has never felt unsafe or uncomfortable with them.”

Staff told us they felt supported and that the registered manager and provider was responsive and listened to them. However, staff recruitment, induction, training and support was inconsistent, and a more robust system needs to be adopted to ensure staff deliver a consistently high-quality service.

The people we spoke with told us they would recommend the service due to the quality of the care they received and good communication with the service. We asked one person who used the service why they would recommend it and they told us, “I think because of the staff they have got, they have picked excellent carers.” A relative we spoke with said, “They listen to what our concerns are. They have adapted well to the changes we wanted. They worked very quickly to make this happen. They are quite adaptable.”

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

Rating at last inspection

This service was registered with us on 02 May 2019 and this is the first inspection.

Why we inspected

We undertook this targeted inspection to check specific concerns we had about safeguarding, medicines, staffing and governance.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question. As this was the service’s first inspection since registration, it remains unrated.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.