B & S Healthcare Limited is a domiciliary care service. It provides personal care mainly to older people living in their own homes in the Bristol area. Not everyone using B & S Healthcare Limited receives a regulated activity. CQC only inspects the service being received by people provided with personal care. This is help with tasks related to personal hygiene and eating. Where they do that we also take into account any wider social care provided.

The inspection took place on 26 and 27 September 2018 and was announced. This meant the provider knew we would be visiting.

At our last inspection, in July 2016, we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

Why the service is rated Good.

People felt safe with the staff who supported them. They were protected from avoidable harm. Staff received training and understood how to recognise abuse and who to report to if abuse was suspected.

Staffing levels were sufficient to provide safe care and recruitment checks ensured unsuitable staff were not employed. Staff were suitable trained and received regular supervisions and appraisals.

People received the support they needed with medicines. A review of medicines management was taking place at the time of our inspection. This showed the registered manager took opportunities to make improvements to the service people received.

Accidents, incidents and falls were recorded. Actions were taken to reduce recurrence.

People were supported to have maximum choice and control of their lives and the policies and systems in the service together with staff understanding, supported this practice.

Appropriate health and safety checks were carried out.

Staff were aware of people’s nutritional needs and people received the support they needed with food and fluids.

People using the service and relatives were complimentary about the service. They told us staff were kind, caring and respectful. Staff helped people to maintain independence.

People’s needs were assessed before they started to use the service. Care plans were written in a personalised way, taking into account people’s individual needs, wishes and choices.

A complaints procedure was in place and people told us they knew how to make a compliant.

People who used the service and their relatives were consulted about the quality of the service.

We undertook an announced inspection of B and S Healthcare Limited on 5 July 2016. When the service was last inspected in October 2013 there were no breaches of the legal requirements identified.

B and S Healthcare Limited provides personal care to people living in their own homes within the Bristol area. At the time of our inspection the service was providing personal care and support to 70 people.

A registered manager was in post at the time of the 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.

People felt safe with the staff at the service. The provider had ensured staff had been trained in identifying actual or suspected abuse and staff demonstrated they understood the reporting process well. There were sufficient staff to meet people’s assessed needs and recruitment procedures were safe. People’s risks were assessed and where required risk management plans were completed. People received the correct level of support with their medicines and incident and accidents were recorded.

Where required the service had involved and sought the advice of relevant healthcare professionals. People received support with their meals and drinks from staff as required and records clearly showed the level of assistance people needed. Staff understood the principles of the Mental Capacity Act 2005 and gave examples of how they applied these to their work. New staff were supported with an induction aligned to the nationally recognised Care Certificate and staff received regular training, supervision and appraisal.

People and their relatives told us the staff at the service were caring. We received positive feedback from people about the caring nature of the staff which was also reflected in the compliments the service had received. Staff understood the people they supported well, and gave different examples of people’s risks and daily preferences to demonstrate this. People had their privacy and dignity respected and staff explained to us how they achieved this.

The feedback from people as to the responsiveness of staff was positive. People’s records were personalised and detailed how people should be supported in order to meet their needs. Reviews of people’s care packages were completed and there were systems to ensure staff were aware of these changes and to monitor if they were implemented as required. There were systems to obtain the views of people during scheduled reviews and through an anonymous survey, and a complaints procedure was available for people to use if needed.

The registered manager was highly spoken of by the staff. People who used the service did not raise any concerns about the leadership of the service. Staff felt very supported in their roles and the management had sufficient systems to communicate with the staff. The service had volunteered to participate in a pilot apprenticeship scheme to support new staff in health and social care. Innovative training methods had been used where the need was identified.

The registered manager was actively involved in local and national organisations and schemes to ensure they are kept informed of current best practice, new research and developments. There were systems to continually monitor the quality of care provided and auditing systems to monitor records and documentation used by staff. Notifications had been sent to the Commission as required.

The people that we spoke with by phone as part of our inspection gave positive feedback about the agency. Examples of comments included, "they are very helpful and very willing to help with anything”.

Every person we spoke with had positive opinions about the staff who worked for the agency people told us “the staff are lovely” and “they are so kind”.

We found that the staff respected people as individuals and encouraged people to make decisions about their care and how their needs were met.

We found that care plans had been regularly updated to reflect that people’s needs had changed.

There were systems in place to monitor the quality of the service and this included gaining feedback from people receiving care from the agency.

During our inspection we spoke with six people who used the service, seven support workers, the provider and three other staff from the management team who were present at the inspection.

The people who used the service we spoke with told us staff treated them with respect and dignity. Staff gave us good examples of how they supported people to maintain their independence and dignity.

People said they received the care that they needed. One person told us, "The carers are alright and I am happy with the service." However we found that the provider did not review people's needs and plan their care so as to ensure that people received safe care. For example, there was no risk assessment and care plan to support a person with a disability who lived in an environment with an identified risk of falling.

People told us that they felt safe with the support workers who visited them. We found that systems were in place to ensure people were safeguarded from abuse.

People said that they were treated well by their support worker. One person said, "they have been good carers, so long as I have had the same ones." We found that staff were trained and supported to deliver care to an appropriate standard.

We found that the provider had an effective system in place to monitor the quality of the service, to ensure that people received safe care.