The inspection took place on 15, 16 and 25 April 2018 and was announced. The service was last inspected on 8 January 2016 and there were no breaches of the regulations found at that time.

The inspection was prompted in part by a notification of an incident following which a person using the service was put at risk. This incident may be subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated there were potential risks to other people using the service. These related to the management of safeguarding risks. As part of this inspection we examined those potential risks.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community . Not everyone using Dhek Bhal receives regulated activity. The service offers support to people in the South Asian Community and provides a respite service for carers of South Asian elders through a sitting service. This service offers a break to family members who are the main carers. CQC only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. Where they provide personal care, we also take into account any wider social care provided.

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 2008 and associated Regulations about how the service is run.

People were kept safe and risks minimised. There were safe and consistent numbers of suitably qualified staff to meet the needs of people. The service was able to provide people with their agreed individual packages of care.

People using the service were protected because staff understood their responsibility to safeguard vulnerable adults. The staff team had received training in this subject. There were safe systems in place to support people with their medicines. Medicine systems were reviewed and checked regularly to monitor for any errors or shortfalls.

People had positive comments and feedback about the care staff. People had clearly built up warm close relationships with the staff who visited them. People said staff were kind and respectful and understood how to provide the care and support they required.

People and their relatives were encouraged to make their views known. People were involved in making decisions about their care. People knew how to make a complaint and were encouraged to share their views and opinions about the service they received.

There were quality monitoring systems in place to fully check the quality of the service provided. The experiences of people who used the service were used as a key part of how quality was checked and monitored.

There was a positive management culture within the service. The registered manager was very committed in their role. They had a clear vision for how they wished to develop the service through good practice and continuous improvement.

This inspection was carried out on 8 January 2016. We gave the registered manager 48 hours’ notice of our intention to undertake an inspection. This was because the organisation provides a domiciliary care service to people in their own homes and we needed to be sure that someone would be available at the office.

The agency was providing services to 31 people in the community. This ranges from sitting service (this is a service where a person just needs company or the main carer needs respite) to personal care and day care services. Most of them are people from the South Asian Community who have different faiths and languages. Many people who use the service do not speak English as their first language. The main languages spoken by the people who use the service are Bengali, Urdu, Punjabi and Arabic.

When we last inspected the service in April 2014 we found the service met all of the requirements of the regulations we assessed them against. During this inspection we found they continued to be meeting the requirements of the regulations.

There was a registered manager in 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 were satisfied with care and support provided by the service. People told us they felt safe because staff were there when they needed them. They said staff advised them about personal safety and ensured that they lived in a secure and safe place. Relatives felt confident that staff responded to people's needs promptly and ensured they lived in a safe place.

Staff were knowledgeable about safeguarding vulnerable people from abuse. They had attended a range of training programmes including the Mental Capacity Act 2005 (MCA). The MCA is a law designed to protect and empower people who may lack the mental capacity to make their own decisions about their care. The service had a staff recruitment system which ensured that all new staff were properly checked before they started work. This meant people were supported by staff who had been checked regarding their knowledge, skill, experience and suitability of delivering quality care.

Each person had a care plan which was personalised and based on their assessed needs. The care plans were regularly reviewed and updated with the involvement of most people and their representatives.

Staff had good knowledge of the needs of each person and what they needed to do to meet people’s needs. There were suitable arrangements in place to ensure that staff rotas were covered and people were visited as recorded in their care plans.

People and their relatives told us staff were kind, friendly and caring. They said staff arrived on time and completed tasks before leaving. People told us staff undertook tasks such as making drinks cooking meals and housework. People told us made sure their privacy and dignity were maintained. This was confirmed by staff who described the importance of treating people with respect and dignity. We noted that people were encouraged to be as independent as possible by, for example, doing as much as they could do with their personal care. Staff said these were all based on the risk assessment of each person.

People and their relatives told us they knew how to make a complaint if they were not happy about any aspect of the service. They said they would speak to staff or the managers if they had a concern. The service had a complaints' procedure with information about how people could make a complaint. Staff knew how to guide people to make complaints. This ensured that people's concerns were managed appropriately by the service.

There was a clear management structure in place and staff knew their roles and responsibilities. The registered manager carried out regular audits and checks of the quality of the service and ensured that improvements were made as required.

The registered manager was very familiar with the needs of the people using the service and staff felt supported by the management team. There were systems in place to enable people to give feedback on the service and auditing systems monitored the quality of the service.

We visited this agency's premises and a person who used the service in their home. During our visit we spoke with the registered manager and three members of staff in the office. We also spoke with two people who used the service. One member of staff was spoken with at the home of the person that we visited..

People who used the service told us they were happy with the care and support provided by the agency. They told us that they had been involved in assessments to decide if the service could meet their needs. One person told us, "They are very flexible, caring and responsive. They have always sent me somebody I know and that means a lot to me because I find it stressful to have somebody I don’t know ". A relative told us, " They regularly keep me informed and they are doing a really good job.

Staff also told us they attended relevant training courses to enable them to do their work. They told us they received regular supervision meeting and annual appraisal. They were able to speak to the manager regularly.

The provider and staff were aware of their responsibilities regarding protecting vulnerable people from abuse. Staff told us they knew how to raise concerns and would not hesitate to do so if they were concerned.

The provider had quality assurance systems in place to check that the quality

of the service being delivered was meeting people's needs.

Appropriate checks were carried out before care staff started to work with people who used the service.

As part of our inspection we were supported by an expert-by-experience. This was to make sure people who used services understood and spoke with us in the language they were familiar and felt comfortable with. We asked people who used the service about their experiences of the service by Dehk Bahl. We spoke with seven relatives and twelve people who used the service via the telephone after our site visit.

People told us they were "very happy" with the service provided. They told us staff were punctual and reliable when making their visits and care was delivered by a consistent set of carers. Oner person said staff listened to them and prompt action was taken by the office to remedy concerns once any issues were made known.

One relative told us that staff were “very professional they make my relative smile” and communication with them and the office was good. A second relative told us staff involved people in making decisions about their support to ensure that individual preferences could be met. A third relative told us staff demonstrated "care and consideration" for people who used services and that personal choices and wishes were respected about how support was delivered

We found records were maintained of the support and care that was delivered and needed.

People confirmed reviews of their care plans were carried out. They were aware of the complaints procedure and how to use it, if it was required

Dhek Bhal is a registered charity which provides a personal care service in Bristol and South Gloucestershire. At the time of the inspection they provided support to 22 people most of whom are people from the South Asian Community who have different faiths and languages. Many people who use the service do not speak English as their first language. The main languages spoken by the people who use the service are Bengali, Urdu, Punjabi and Arabic.

People we spoke with provided positive feedback regarding their experience of the service. They felt that their cultural values and beliefs were understood and respected. This made them feel comfortable when discussing their needs with the care staff.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service and has the legal responsibility for meeting the requirements of the law like the provider. The staff felt well-supported by the registered manager as they placed an emphasis on being open and approachable Staff we spoke with told us they would approach the registered manager if they had any concerns and felt confident these would be addressed.

Before people started using the service they were visited in their own home by a senior member of staff who carried out an assessment of their needs. The assessment process involved people through talking about their needs and preferences and the planning of their service. People's mental capacity had been assessed as part of the pre-assessment support planning.

We were told by the registered manager that all people currently have the mental capacity to make their own decisions. Staff we spoke with demonstrated an understanding of the Mental Capacity Act 2005 and how to apply the principles of the Act. The Act protects the rights of people who are not able to make decisions about their care or treatment.

The service worked with key organisations, including the local authority and safeguarding teams, to support care provision and service development. We have received appropriate notifications of any issues affecting the service when necessary, such as concerns of abuse towards a person who used the service by a person known to the individual. By reporting the matter to the local authority safeguarding team appropriate action was taken to safeguard the person involved.

The management team carried out quality monitoring to assess the quality of care provided and plan on-going improvements. These included audits of practice and satisfaction surveys for people who used the service and their representatives. Changes had been made in response to audit findings and feedback from people.