Bosworth Homecare 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 and younger adults in Swadlincote and surrounding areas. Not everyone using this service receives 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 our inspection 79 people were receiving a service.

The service had a registered manager in place 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.

At our last inspection in March 2017, we rated the service as requires improvement. This was because where people did not have the capacity to make some decisions and assessments were not carried out to ensure decisions had been made in people’s best interest. Quality monitoring systems were in place but these were not always effective and had not identified that people may not have received their support visits at the agreed time. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the service provided to at least good.

At this inspection, we saw further improvements were still required. This was because there was insufficient staff to provide them with safe, effective dignified care from staff who knew them. Medicines were not always managed safely and safeguarding concerns were not suitably reported to protect people from potential future harm. People did not always receive their care at the right time and for the right length of time. Information was not always available in an accessible format. The quality monitoring systems were not always effective and had not ensured that improvements were made. This is the third consecutive time the service has been rated ‘Requires Improvement’.

Providers should be aiming to achieve and sustain a rating of ‘Good’ or ‘Outstanding’. Good care is the minimum that people receiving services should expect and deserve to receive and we found systems in place to ensure improvements were made and sustained were not effective.

Risks to people’s health and wellbeing were assessed and this was reviewed to ensure people continued to be assisted in a safe manner. There were safe recruitment procedures in place to ensure new staff were suitable to work with people and staff understood how to reduce the risk of infection.

Staff were supported and trained to ensure that they had the skills to support people effectively. When people required assistance to eat and drink, the provider ensured that this was planned to meet their preferences and assessed need. People were able to make decisions about how they wanted to receive support to ensure their health needs were met.

The support people received was reviewed to ensure it continued to meet people’s wishes. People felt able to raise concerns or suggestions in relation to the quality of care.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the Registration Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report.

We inspected this service on 28 February, 1 and 3 March 2017. This was an announced inspection and we telephoned the provider two days’ prior to our inspection, in order to arrange home visits with people.

At our last inspection in February 2016, we identified concerns with how some decisions had been made where people no longer had capacity and how complaints had been investigated. The quality assurance systems had not identified where medicines may not have been given and information about how the provider could make improvements was not fed back to people. On this inspection we found improvements had been made but further improvement was required.

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 older adults. At the time of the inspection 91 people were receiving a service.

There was a registered manager in 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.

Where people did not have the capacity to make some decisions, suitable systems were not in place to ensure assessments were carried out and decisions had been made in people’s best interest.

Quality monitoring systems were in place but these had not identified our concerns with how capacity was assessed; that concerns were not recorded and had not been effective for ensuring people received their support visits at the agreed time.

Potential risks were identified and management plans were in place to guide staff on the best way to reduce these risks. Staff understood their role in protecting people from harm and poor care. Where people needed support to take their medicines, systems were in place to ensure they received them when needed.

There were recruitment procedures in place to ensure staff were suitable to work within a caring environment. Staff had access to training to improve their knowledge of care and enhance their skills. Staff sought people’s consent before providing care and supported people when they needed help with their decision making.

People received kind and compassionate care. Staff supported people to maintain their dignity, independence and privacy. Staff gained information about what was important to people so that they could provide care which met their preferences.

People received care that was individualised to their personal preferences and needs. People were supported to express their views about the service within quality monitoring calls and through a survey. People were provided with information about how the provider had responded.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the Registration Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report.

We inspected this service on 24 and 25 February 2016. This was an announced inspection and we telephoned the provider two days’ prior to our inspection, in order to arrange home visits with people. This was the first inspection of this service.

The service provides care and domiciliary support for older people and people with a learning disability who live in their own home in and around Swadlincote.

There was a registered manager in 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’s consent was sought before staff provided care and support. However, some people did not have capacity to make certain decisions. It was not clear how some decisions had been made and whether other people had the necessary authorisations to make decisions on behalf of others.

The provider had systems in place to assess and monitor the quality of care although they had not identified where medicines may not have been given and action to make improvements had not been taken. People were encouraged to give their feedback about the service but information about how the service could make improvements and was operating was not fed back to people.

Staff listened to people’s views and they knew how to make a complaint or raise concerns. Not all complaints had been fully investigated and details of the investigation and outcome had not been given to all people.

Staff knew how to recognise the signs of abuse and knew what actions to take if they felt people were at risk. People’s risks were assessed and support plans included measures to reduce or prevent potential harm.

Positive and caring relationships had been developed between staff and people who used the service. People were involved in the planning and reviewing of their care and were treated with dignity and respect by staff who understood the importance of this.

People were treated with care and kindness and staff were friendly and respectful. People benefitted from having support from staff who had a good understanding of their individual needs. People were positive about the way staff treated them.

People received an agreed level of staff support at a time they wanted it and were happy with how the staff supported them. People had a regular team of staff who had the skills to meet their needs. People knew who was providing their support in advance and the provider was flexible and responsive to changes. People received their medicine and were supported to apply any creams or ointments they needed to keep well. People received the assistance they required to have enough to eat and drink.

People benefitted from receiving a service from staff who worked in an open and friendly culture and were happy in their work. Checks were carried out prior to staff starting work to ensure their suitability to work with people.

Staff knew how to keep people safe and understood their responsibilities to protect people from the risk of abuse. Risks to people’s health and safety were managed and plans were in place to enable staff to support people safely. There were sufficient numbers of staff to ensure visits were made when they should be and to meet people’s care needs.

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

We contacted five people using the service, spoke with them or with their relatives so that we could collect their views about the service provided by the agency. We also looked at the comments made by people whose views had been gathered by the agency.

Comments included, “I find staff to be respectful”. “No grumbles they always get on with the job and do what I want them to do.” “They tidy up afterwards and are always on time”.

Comments about care included, “staff seem to write loads of notes and follow instructions.” “I find they will listen to me and follow my wishes also”. “I have a rota of regular staff who visit me”.

Comments about staff included, “I am very pleased with my care worker they are always pleasant and seem to know what I need without my having to ask”.

Comments on quality included, “if I had any concerns I would speak to the office and it would be dealt with. I find the time care workers arrive at the visit can vary slightly but it is alright by me”. “The quality of the service is just what I want as staff are always willing to help me”. “I find the office staff helpful when you ring them”. “I feel that I am fully involved in the care of my relative. If changes are needed staff will listen and make those changes to help me”.

A relative who we spoke with told us, “I have been involved in the care and welfare of my relative and we find the staff who visit are respectful of our needs and wishes”.

Another relative said, “we have been able to choose the gender of the staff visiting our home and to provide personal care.” This helps to maintain privacy and dignity and shows that people are involved in decisions about their care.

We were also told, “staff are careful to maintain my relatives privacy and will close the shower and room doors when providing intimate care. My relative is encouraged to do the things that they can for themselves when possible”.

We saw an email from a relative who thanked staff for the support they provided to their relative and for their very caring, professional and responsible communication when talking with them over the telephone with regards to their relative’s condition. They explained that their relative was reassured and this allowed them to feel they could manage and resolve the situation more easily as a result despite their distance.

We received information of concern about missed or late calls. We shared this information with Derbyshire County Council. We combined a visit together to check how people’s needs were actually being met by the agency.

We spoke with four people, their representatives and with two staff. People told us care workers would always ask for their consent before carrying out an activity. They all told us “the care itself is usually very good”. One person explained “you are given a choice especially when you first start having care. The service tries to deliver care at the times you have agreed with them. Sadly, this changes. I have found my times have been altered without me being told. It makes the staff look as if they are inconsiderate”.

People told us they were provided with assessments for their care and had been fully involved in this. One person told us “it took over and hour to go through my needs. The staff went through it in great detail”.

One person told us “care workers are sometimes late so I have to chase them up but I should not have to do this. They have been known to arrive over half an hour late. I have also experienced missed calls. Someone from the office should be making the calls to people to let them know when this happens”.

Two people told us they had a care plan, which they had seen and were in agreement with. People told us staff used their equipment with them safely when required.