About the service: Bloomsbury Home Care is a domiciliary care agency. It provides personal care to 30 people living in their own houses and flats. It provides a service to older adults.

People’s experience of using this service:

¿ At our last inspection, there was a continued breach of regulation under the Health and Social Care Act, 2008 (Regulated Activities) Regulations 2014. This was because the provider did not have a robust oversight of medicines management, which could have placed people at risk of harm. Staff turned up to people late. Risk assessments had not always been updated. Systems were not in place, so learning could be shared when events had occurred. Assessments had not always considered how people’s needs were to be met. Staff had not always been given the training they needed. The service did not have a registered manager and systems were not in place to consider the retention and wellbeing of staff. Governance systems which monitored the quality of the service were poor, resulting in a breach of regulation 12 and 17 of the Health and Social Care Act, 2008; Safe Care and Treatment and Good Governance. At this inspection, improvements had been made in some areas.

¿ At this inspection, mixed feedback was received when people were asked if they got their medicines on time and in the right way. The registered provider had been working to update the care plans and risk assessment. Some of these documents still needed to be updated to ensure there was guidance for staff about how to manage these risks. This was a continued breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

¿ A registered manager had been recruited. There had been some occurrences where we had not always received all required notifications, these had been submitted following the inspection.

¿ When people had made a complaint, there was a lack of evidence that a representative of the registered provider had given a meaningful apology when they had been at fault.

¿ Because this is the third consecutive time the registered provider has been rated as requires improvement, this is a continued breach of regulation 17 of the Health and Social Care Act 2008.

¿ Overall, most people’s experience of the service had improved. People and / or their representatives told us they were supported by staff who turned up on time and stayed for the duration. Some people said they were supported by different staff and this had affected the quality of the care they received.

¿ People were supported to eat and drink in line with their assessed needs, and professional guidance had been obtained if people were supported with a textured diet. Whilst risk assessments for people who were at risk of choking had been put in place, they needed to have more information to ensure they were robust.

¿ Staff had been trained in mandatory subjects and had regular supervision and appraisals. New employees had been given an induction.

¿ The registered manager did not carry out an assessment of people’s needs, because this was the role of the team leader. Formal assessments were not used. We have made a recommendation about assessing people's needs.

¿ Care plans were completed and highlighted the areas people needed support with. Some people’s records had not been completed with enough detail.

¿ Complaints or concerns were not always resolved effectively, because when people had made a complaint they had not always been provided people with written outcomes. This was a breach of Regulation 16 of The Health and Social Care Act 2008 (Regulated Activities) Regulation 2014.

¿ People told us they were treated with dignity and respect. People and their relatives were positive about the staff and told us they had a caring attitude towards them.

¿ People were supported to have 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 practi

This inspection took place on the 10 September and the 11 September 2018 and was announced.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to older adults. On the day of our inspection, there were 33 people using the service, all of which received personal care.

At our last inspection on the 12 December 2017, we rated this service as requires improvement overall. We found breaches in regulation under the Health and Social Care Act, 2008. This was because risk assessments were not always in place. People’s medicines were poorly managed. People who were at risk of neglect, malnutrition and dehydration did not have robust person-centred care plans for staff to follow. The provider did not have robust governance processes in place to mitigate concerns about the safe running of the service.

This is the second consecutive time the service has been rated Requires Improvement. This was because the provider had not made the required improvements needed and breaches of regulations remain. The overall rating for this service is ‘Requires improvement.’ However, we are placing the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any key question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If enough improvement is not made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care service’s, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Whilst some progress had been made since the last inspection, the provider did not have a robust oversight of medicines management, which potentially could place people at risk of harm.

People told us staff would sometimes turn up late, but when they were there they stayed for the duration. Information we inspected reflected this feedback. Running up to the inspection, the provider had given back a number of care packages back to the local authority because they were unable to deliver the care that had been agreed with people and commissioners.

Risk assessments had not always been updated when a change had occurred. Which meant information in some people’s care plans was not always clear. Systems were not in place so that learning could be shared and used as a learning point, when events may have happened. We have made a recommendation about learning from events. Staff had access to PPE (personal protective equipment) such as gloves and aprons and equipment, whic

We inspected Bloomsbury homecare over two days. On the 11 December 2017 we carried out an announced inspection and we gave the provider 48 hours’ notice to ensure that they would be present. On the 15 December, we arranged to visit five people receiving a service from Bloomsbury home care within their own homes.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to adults who require a variety of care and support with personal care and everyday living across a number of locations. This included, Southend, Colchester, Clacton and Tendering areas and Ipswich.

During the last inspection in 2015, we rated the service good in all domains. However, during this inspection we found breaches in regulation under the Health and Social Care Act, 2008, and have rated the service as Requires Improvement overall.

A registered manager was in place at the time of inspection. However, following inspection the registered manager resigned and a the provider is recruiting to fill this post.

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 receiving care who had complex needs did not always have robust risk assessments and care plans in place for staff to have a full understanding of how to meet their needs safely.

Medicines were poorly managed and systems in place to ensure that staff were administrating medicines safely were significantly lacking. This was a breach in regulation 12 of the Health and Social Care Act.

Care staff had a good understanding of safeguarding vulnerable adults and knew who to contact if they had any concerns over people’s wellbeing and safety. However, the local authority had received a large number of safeguarding concerns over the previous 12 month period. These related to the care and treatment at the service.

Staff had access to PPE (personal protective equipment) such as gloves and aprons worked in a way that promoted good infection control, but equipment was not kept in a sterile or clean environment.

A computerised monitoring system was in place to monitor missed calls. Previously late calls had been safeguarding concern, but this had improved.

We made recommendations about how the provider assess risks to people in their home environment.

Training had been highlighted as a concern by the local authority, but this was improving and a the service now monitored this.

People at risk of neglect, malnutrition and dehydration did not have robust person centred care plans for staff to follow. This was a breach in regulation 14 of the Health and social care act.

Staff adhered to principles of the Mental capacity act, seeking consent and not limiting freedom, but assessments were not robust. We made recommendation's for the provider to review these processes to keep abreast of current legislation and guidance.

Supervisions were not robust and we made additional recommendations for this to be improved.

People told us that staff were caring but felt undervalued by the service and this resulted in staff leaving. This disrupted good continuity of care.

Care plans were not person centred and did not give staff the information that would support them to provide person centred care. This was a breach in regulation 9 of the Health and Social Care Act 2008; Person centred care.

Written complaints were responded too, but verbal complaints were not always followed up. When investigations took place, the registered manager did not explore all available facts to reach a decision. This is a breach of regulation 16, of the Health and Social Care Act, 2008; Complaints.

Staff felt undervalued due to the pay and conditions. S

The inspection took place on 28 July 2015. Bloomsbury Homecare is a domiciliary care agency providing care and support to older people in their own homes. At the time of our inspection there were 40 people using the service.

The service did not have a registered manager 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 2008 and associated Regulations about how the service is run. The registered manager had recently left and there was a new operations manager in post who was not yet registered with CQC.

People were safe because staff understood their responsibilities in managing risk and identifying abuse. People received safe care that met their assessed needs.

There were enough staff who had been recruited safely and who had the skills and knowledge to provide care and support in ways that people preferred.

The provider had systems in place to support people to take their prescribed medicines safely.

Staff had the skills to recognise when people needed support with their health needs and supported people to access health care professionals.

People were treated with kindness and respect by staff who knew them well.

People were supported to maintain relationships with friends and family so that they were not socially isolated.

There was an open culture and the provider encouraged and supported staff to provide care that was centred on the individual.

The provider had systems in place to check the quality of the service and take the views and concerns of people and their relatives into account to make improvements to the service.

As part of this inspection we spoke with six people receiving support from Bloomsbury Home Care and three relatives/carers. We also spoke with four staff, the manager and the provider. We looked at people’s support records. We looked at staff records, training and supervision. We also looked at the provider’s arrangements to safeguard people from abuse and to monitor the quality of the services provided.

During our inspection we gathered evidence to help us answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well-led?

Below is a summary of what we found. The detailed evidence supporting our summary can be read in our full report.

Is the service safe?

People who used the service all told us that they felt safe when Bloomsbury Home Care staff visited their home. People told us that they felt their rights and dignity were respected and they felt in control of decisions about their care and support. One person told us: “I feel safe when they come. You’re always introduced to new staff. That reduces my stress.” Another person told us: “Previous agencies were really awful. I wasn’t getting my medicines. Now they check that I have enough medicines and it works really well.”

There were systems in place to protect people from poor practices or abuse. In general safeguarding procedures were robust and staff understood their role in safeguarding the people they supported.

Staff were not consistently following up on health concerns and reporting them to health professionals when appropriate. This could potentially put people at risk. The provider was aware of this issue and was taking steps to address this with staff. Some people did not have risk assessments that covered their medical condition. People might potentially be put at risk of harm if staff did not have guidance on minimising risks for the individual person.

Recruitment records were disorganised, it was therefore difficult to establish if practices were consistent across the service. This could potentially lead to inappropriate staff being employed. The manager had used disciplinary action when needed. Some staff needed additional training to help them meet people’s needs.

We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to risk management, training and recruitment.

Is the service effective?

People told us that the service met their needs. However, there was considerable variation in the standards and content of support records. Some were of a good standard and related to the person’s individual needs. However, others were mainly concentrated on staff tasks. There was very little information in these records about people’s abilities, preferences and how they liked their support provided. This lack of information would make it difficult for new or temporary staff to provide support that met their needs and wishes. It also could lead to a lack of consistency and effectiveness of the support provided.

Some people’s support files showed evidence of regular reviews while others had no evidence of any reviews. This meant that some people were not being offered regular opportunities to discuss their care and support needs.

We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to involving people in planning their care.

Is the service caring?

People and their relatives were very complimentary about the staff and said that they respected people's privacy and dignity. One person told us: “The staff are very caring and supportive. The client comes first. They stay on if there’s anything out of the ordinary.” A second person said: “They always ask if there’s anything else they could do before they leave.” A third person said : “They are genuinely caring. They don’t make me feel they’re invading my home.”

Is the service responsive?

People told us that the service was responsive to their needs and that staff would change their usual visit time if they had an appointment. They said that the management team would provide another support worker if they were not happy with them for any reason. Some concerns had been raised about individual members of staff. The records demonstrated that the manager had investigated and resolved the concerns to the satisfaction of the person concerned.

One person told us: “They’ve never let me down. They come at the time I need. They do what I want them to do.” Another person said: “They give me space and respond to changes in my needs and moods.” People particularly appreciated that staff promoted their independence wherever possible. This enabled them to remain in their own homes and in some instances to reduce the care they needed.

Is the service well-led?

There was evidence from talking to staff and looking at records that there was variation in standards across the agency. It was not possible to establish whether staff were receiving regular supervision and support. The management team did not have fully effective quality assurance systems to monitor and improve standards within the service.

A third of the team leaders had no qualifications. Team leaders were responsible for the assessments of people’s needs and staff recruitment, supervision and training within their teams. The manager, with the support of the provider, managed fifteen team leaders in seven counties. It was difficult for him to provide the level of support and supervision needed by some team leaders.

We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to quality assurance and support for staff.

As part of this inspection we checked on the standard, care and welfare, that was not met at our last inspection in November 2013. This related to demonstrating that staff were monitoring people’s medical condition and developing more personalised support records. At this inspection we found that the provider had considerably improved the support documentation and was now meeting this standard. Training was being given a higher priority and the systems for monitoring the quality of service provided were continuing to be developed.

We spoke with two people receiving support from the service and three relatives of people using the service. The people we spoke with were both very complimentary about the care and support they received. One told us: “The staff are marvellous, I couldn’t wish for better. It’s like having a daughter giving my care.” Another person said: “I can’t praise them enough.” A relative described how staff had behaved “very professionally in an emergency” and “do things above and beyond” what they needed to do. Another relative was also extremely complimentary about the standard of support and care provided. A third relative considered that the quality of staff varied. They said that a few staff needed more training but felt that the overall standards had improved since they started using the agency.

As part of our inspection we spoke with four people who were receiving a service from Bloomsbury Home Care. They all told us that they were very happy with the standards of care and support they received. Two people told us that Bloomsbury Home Care was the best agency they had ever used. One of them said, “I’ve had horrendous experiences at previous agencies but I’m totally happy with Bloomsbury. They’ve made a huge difference to my life.” People were all very complimentary about the staff describing them as “caring and compassionate”, “courteous” and “professional”.

The care records, however, did not always provide evidence of the good standards of care that people described. The manager told us that the care documentation was being revised and additional staff training would be given to improve their recording. There were systems for monitoring standards in the agency but some of the audits checked whether records had been completed rather than the quality of the information contained in them. The manager told us that they would make further developments to improve these the audits.

People with whom we spoke told us that they were happy with the service they received from the care workers at Bloomsbury Homecare. People with whom we spoke told us, "The carers turn up on time, do the extra mile and extra time when my X really wants their hair washed. Very good service, can't fault them." Another person with whom we spoke said, "We have the same carer in the week and someone different at weekends and we are glad we don't have all different people coming in to us."

A number of people who responded to our survey told us that they had no complaints about the service, were treated with respect and were helped to keep their independence. The care workers asked people what they needed doing and they were always kind, caring and professional.