BGS Healthcare Ltd is a domiciliary care agency. It provides personal care to people living in their own homes in the community. They provide services in areas including Chippenham, Devizes, Calne and some surrounding areas. Not everyone using BGS Healthcare Ltd 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.

At the time of this inspection BGS Healthcare Ltd was providing a service to 115 people. The service also supports people on a short term basis who have been discharged from hospital. This inspection took place on the 17 April 2018 and was announced which means the provider had short notice that we would be visiting.

A registered manager was in post and available throughout 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. The registered manager was supported by two other directors, one of which was also present during our visit and, a team of office staff.

At the last inspection in March 2017 we found a breach of Regulation 17, Good governance. The service was rated as Requires Improvement. The provider sent a report of actions to us on how they would make the necessary improvements to meet this regulation. A recommendation was also made in relation to the provider ensuring they had a robust system in place for monitoring staff training and development.

At this inspection we found the service had met the previous breach identified, however we identified another breach of Regulation 12 Safe care and treatment in respect to the management and recording of people’s medicines. This is the second consecutive time the service has been rated Requires Improvement. We will be asking the service for a report of actions of how they will make the necessary improvements and the service will be re-inspected to check this has been done.

We have made a recommendation to the service that they seek advice, guidance and further training from a reputable source, in following the principles of the Mental Capacity Act and ensuring all staff understand their role and responsibilities in supporting people around this.

We have made a second recommendation that the service review the documentation of people’s care and support to reflect a person centred approach to the care being provided.

Risks to people’s personal safety had been assessed and plans put in place, however these did not always provide clear detail on how to minimise the risks. Risk assessments were in the form of tick boxes. Some risk assessments were incorrectly completed and this had not been identified during reviews.

People we spoke with told us they had not experienced any missed visits, however people consistently raised that the times of visits were varied and this caused frustration. We raised this with the management team.

Quality assurance systems were in place to monitor the quality of service being delivered. However, completed audits had not identified all of the concerns we found during this inspection.

The service had taken measures since our last inspection to improve the monitoring of call visits. There was now a system in place to monitor when staff arrived and left care visits. All staff had a work phone issued to them and received their rota’s and information by email which was password protected.

People told us they were happy with the care they received and spoke positively about the staff. We saw that staff were encouraged to spend time during care visits talking to people and one person’s care plan recorded that if staff had any spare time they should use

BGS Healthcare provides personal care and support to approximately 80 people in their own home.

We were made aware that the registered provider address had changed when we gave notice of a an inspection in July 2016. We decided to wait until the registration of the new address had been completed before we conducted an inspection to ensure the findings would not be related to the previous provider name and address which would be de registered. At the last inspection 4 June 2015, we rated the service good overall. However we rated the well led domain as ‘requires improvement’ because although the service carried out regular audits to monitor the quality of the service, there were no records to show these had taken place, or whether any improvements had been identified.

A registered manager was employed by the service who was present throughout the inspection. The registered manager is also one of three owners, two of whom were present throughout 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.

At this inspection we found the service required improvement overall.

We had not been notified as required of safeguarding alerts made to the local authority. Systems to identify if visits were missed or late were not robust.

Safe recruitment checks had been completed, however one record did not show the applicant’s full employment history.

The registered manager explained they had recognised that the recording of training was not robust and that this had prompted a review of their systems. However, as the system was not fully functioning, we could not see how effective it was.

People and relatives we spoke with were very complimentary about the standard of care and support they received, and were confident the staff had the skills and training in order to meet their needs.

There was a process in place for seeking consent to care, and staff were aware of the principles of the MCA.

The registered manager and staff were aware of what to do in order to keep people safe, such as how to make a safeguarding referral to the local safeguarding authority. People told us they received their medicines as prescribed.

Staff had developed positive relationships with people using the service and were described as being compassionate and kind.

Staff were passionate about providing good quality care and said they felt supported by the management team.

You can see what action we told the provider to take at the back of the full version of the report.