Birchwood Homecaring Service is a domiciliary service providing personal care to vulnerable older people and younger adults in their own home. The service’s is run from an office located in the market town of Ripley, Derbyshire and provides level access for people.

Not everyone using the service received a regulated activity. CQC only inspects the service being received by people provided with ‘personal care’; such as help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided.

At our last inspection in November 2016, the service was rated as ‘Requires Improvement.’ This was because people were not fully protected from risks associated with unsafe, or ineffective care and treatment and complaints handling was not always effective, to ensure care improvements when needed. These were respective breaches of Regulations 12 and 16 of the Health and Social Care Act (Regulated Activities) regulations 2014. Following that inspection, the provider told us what action they were taking to rectify the breaches. At this inspection we found the required action was taken by the provider. Related care and service improvements were made to the standard of ‘Good.’

We carried out this inspection on 4, 12 and 27 July 2018. There were 199 people using the service when we visited the provider’s office on 4 and 12 July; during which we spoke with staff. We spoke with people and relatives on 27 July 2018. The provider was given 2 working days’ notice of our inspection as we wanted to make sure the registered manager was available to support our inspection.

There was a registered manager for the service. 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 personal have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People received safe care and support from staff who were safely recruited. The provider’s revised staffing, related management arrangements and risk management strategies for people’s care, helped to fully ensure this. The provider’s emergency and safeguarding contingency measures were revised and followed when required.

Potential risks to people’s safety relating to their health conditions or from unsafe care practice were regularly assessed, monitored and effectively accounted for. Staff understood any related risks and the care steps or reporting procedures they needed to follow for their mitigation. People were consistently and safely supported by staff, including to receive their medicines when required. This helped to ensure people were protected from the risk of harm or abuse.

People received effective care. Revised care planning measures helped to consistently ensure people’s care met with their assessed needs and choices. Staff understood people’s health conditions and followed their related personal care needs to help maintain their health and nutrition. This was done in consultation with relevant external health professionals when required.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff were trained and supported to help ensure this.

People continued to receive care from staff who were kind and caring. Staff followed the provider’s stated care principles and understood what was important to people for their care. This helped to ensure people’s dignity and rights when they received care.

People were informed and involved to agree and know what to expect from their care, and to access relevant advocacy if they needed to. Measures were implemented by the provider, to ensure people were provided with accessible care and service information, which they could understand.

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The inspection too place on 15 and 16 November 2016 and 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 available to speak with us. The service provided domiciliary care and support to people living in the Ripley area of Derbyshire. At the time of our inspection there were 209 people using the service.

There is a registered manager at the service. 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 told us they felt safe with the staff team from Birchwood Homecaring Services Limited. Staff had a good understanding of the various types of abuse and knew how to report any concerns.

People were not supported by a staff team that was consistent. People told us staff did not always arrive when they were expecting them and they were regularly not informed their calls were going to be late. Some people experienced missed calls. Some people were supported by regular staff who respected their privacy and dignity. However, some people told us they did not feel they were always treated with dignity by some staff.

People were supported to take their medicines safely. Staff had received the necessary and appropriate training to assist them to meet people’s needs.

The registered manager understood the principles of the Mental Capacity Act 2005 (MCA) and their responsibilities around this. People using the service told us staff always obtained their consent before they provided care and support. Staff we spoke with confirmed this.

Staff had a good understanding of people’s dietary needs. They were aware that different medical conditions meant people had to eat at regular intervals. This information was recorded in care plans. Staff ensured people’s physical well-being was supported and maintained and contacted health and social care providers when this was necessary.

People contributed to an assessment of their needs and received care that met their needs.

People felt able to raise concerns with the service. People were satisfied with the services response to their concerns. However, some people expressed the view that when they tried to contact the office their messages were not always returned. Information about how to make a complaint was included in the information sent to new service users.

The staff team had a good understanding of their roles and responsibilities.

At the last inspection there was a breach of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 systems and processes around Complaints. This relates to a breach of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Regulation 16 Receiving and Acting on Complaints. At this inspection we found there were adequate systems and processes in place to meet this requirement.

At this inspection there was a breach of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Regulation 12 Safe Care and Treatment. You can see what action we told the provider to take at the end of this report.

People told us that they were involved in making decisions about their care and support needs. Some people told us that they had a visit from Birchwood staff before they received a service from them to carry out an assessment. One person told us “The staff are aware of my needs. They talk with me, not to me, and take on board comments I have. They might not like what I say sometimes but at least they listen”.

People who used the service provided us with very positive feedback about the provider. All of the people spoken with said the care workers provided the support and assistance required. One person told us "I’m glad I moved to Birchwood. I had been with other providers before and they never quite did what I needed. Birchwood are meeting my needs now".

The provider was reporting potential safeguarding incidents correctly and responding appropriately. Staff were aware of types of abuse and what to do if they suspected abuse had taken place.

Staff were receiving appropriate supervision from the provider which supported them in their role. Staff also received comprehensive training which enabled them to carry out their role effectively.

The provider had a system in place to deal with comments and complaints. We saw that the provider responded to and investigated complaints received appropriately.

People we spoke with told us” the agency is good and they are satisfied with what they do for them.”

Several of the service users have been with the agency for a while and have said” they would not wish to be with any other, they help me and I would not be able to get out with out them.”

We were told “they keep good contact with people and the staff and have a good relationship with their carers.”

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

The initial inspection visit was announced and this meant the provider and staff knew we would be visiting the agency’s office 48 hours before we arrived. Our second visit was unannounced and we returned to follow up comments made by some people and to speak to more care workers. Our previous inspection was carried out in November 2013 and no breaches of regulations were found at that time.

Birchwood Homecaring Services provide personal care to people in their own homes in Amber Valley. At the time we visited the office there were 285 people using the service.

There was a registered manager for the service. 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.

People who used the service told us they felt safe and care workers were trained to look after people safely. Care workers knew what to do if they had any concerns about a person’s well-being. There were systems in place to protect people from risks to their health and safety and to ensure safe staff recruitment. Some people expressed concerns about the recent high turnover of staff at the agency and the effect it had on their care being provided late sometimes. We found there had not been any missed calls. Recruitment was on-going to ensure sufficient care workers were employed to meet needs.

Care workers were caring and knowledgeable about the people they supported. They treated them with dignity and respected their privacy. People’s specific care needs were assessed and care workers were made aware of these in plans of care. They alerted health care professionals if they had any concerns.

There was a clear staffing structure for the service. Systems were in place to supervise and manage staff. There were also arrangements in place to assess and monitor the quality of the service and this was being developed further by the registered manager.

Complaints were not fully investigated and resolved to people’s satisfaction. This was a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.