We inspected Bikur Cholim Limited on 17 April 2018. The inspection was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we needed to be sure that someone would be in. Our last inspection took place on the 24 November 2016 and we found one breach of regulation in relation to safe care and treatment. At this inspection we found some improvements had been made.

Bikur Cholim Ltd is a domiciliary care agency. It provides personal care to people in the Jewish Orthodox community living in their own houses and flats in the community. At the time of the inspection it was providing a service to 50 people.

There was not a registered manager at the service at the time of our 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 and associated Regulations about how the service is run. A new manager had started in the role and they had begun the process to apply for the position of the registered manager.

Risk assessments were in place which provided guidance on how to support people safely. However some risk assessments still lacked detailed. After the inspection the service sent us updated risk assessments which provided more detail. We have made a recommendation about assessing the risks to people.

People and their relatives told us they felt the service was safe, staff were kind and the care received was good. We found staff had a good understanding of their responsibility with regard to safeguarding adults.

Medicines were managed in a safe manner. There were sufficient numbers of suitable staff employed by the service. Staff had been recruited safely with appropriate checks on their backgrounds completed. Staff undertook training and received regular supervision to help support them to provide effective care.

Care plans contained detailed information and clear guidance about all aspects of a person’s health, social and personal care needs, which helped staff to meet people’s individual needs. Some of the care plans lacked detailed however staff had worked with people and their families for long periods of time and could describe in detail the care people needed. After the inspection the service sent us updated care plans which provided more detail.

Staff we spoke with had a good understanding of the Mental Capacity Act 2005 (MCA). MCA is law protecting people who are unable to make decisions for themselves. People who had capacity to consent to their care had indicated their consent by signing consent forms. However, where people lacked capacity to consent to their care the provider had not followed the principles of the Mental Capacity Act (MCA) 2005. We have made a recommendation about following the principles of the MCA.

People’s cultural and religious needs were respected when planning and delivering care. Discussions with staff members showed that they respected people’s sexual orientation so that lesbian, gay, bisexual, and transgender people could feel accepted and welcomed in the service.

The service had a complaints procedure in place. People and their relatives knew how to make a complaint.

Staff told us the manager and senior staff were approachable and open. The service had various quality assurance and monitoring mechanisms in place.

We inspected Bikur Cholim Limited on 24 November 2016. The inspection was announced. We gave the provider 48 hours’ notice to ensure the key people we needed to speak with were available. Our last inspection took place on the 3 February 2014 and we found that the provider was meeting all of the regulations that we checked.

Bikur Cholim Limited provides domiciliary and nursing services to people within the Orthodox Jewish community in their own homes. At the time of this inspection the agency was providing personal care and support to 50 adults and children.

The service had a registered manager. 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.

Staff knew and understood how to safeguard people from abuse and there were procedures in place for staff to keep people safe from abuse.

Relatives shared positive experiences about the care and support people received.

People’s medicines were not always safely managed and recorded. Staff had received medicines training but their competency was not regularly assessed.

Some staff had not received regular supervision and appraisals. Staff had received training relevant to their roles and a planned programme of up to date training was scheduled to take place.

People were supported with their healthcare and nutritional needs and this was recorded in their care records.

Risk assessments lacked detail and did not give staff sufficient guidance about action staff needed to take to make sure these risks were managed.

People received visits at the times they requested and were provided with care from the same staff so that they received continuity of care. Care and support was delivered by staff that were kind and caring and people’s wishes were respected and acted on.

Care plans and records required more personalised details and the providers audit identified this. Staff had received training to meet people’s diverse needs and relatives told us that these needs were met.

People had access to additional resources through the service for additional care. People’s views and experiences were sought through the use of surveys. People knew what to do if they were unhappy with the service provided.

Audit systems in place were not always operated effectively to monitor the quality of the service.

Staff had not completed training in relation to the Mental Capacity Act 2005 (MCA). Procedures and guidance in relation to the Mental Capacity Act 2005 (MCA) was followed which included steps that the provider should take to comply with legal requirements.

We found one breach of regulation in relation to safe care and treatment. You can see what action we asked the provider to take at the back of the full version of this report.

Bikhur Cholim Ltd was providing personal care and domestic support to 84 people. We spoke with four people who used the service and four relatives. People said they were very happy with the service they or their family member received. One person said, "they are amazing. The carers are lovely, they are like my friends. They do all they can to help you.” A relative told us, “they [the agency] is absolutely marvellous. They have helped so much. I haven’t a bad word to say about them.” Another relative said, “the level of care and dedication from the carers are pretty amazing. The carer gets support as well as the person.”

People’s needs were assessed and planned before they received care and any risks to them were taken into account to ensure their safety and welfare. People gave us examples of how the agency provided a personalised service to meet their specific individual and cultural needs.

We spoke with four care workers and the management team. Staff said they received relevant training and support to help them with their practice. The provider regularly contacted people who used the service and their relatives to ask them about the quality of service.

People who used the service knew how to comment or make a complaint. They were complementary about the service, had no complaints and told us the agency were efficient and promptly responded to any issues they had about their service.