DOMICILIARY CARE AGENCY Bellcare Domiciliary Care Services Ltd Office 25, Mossbay House 40 Peart Road Derwent Howe Workington Cumbria CA14 3YT Lead Inspector Mrs Margaret Drury Unannounced Inspection 18 th January 2008 10:30 Bellcare Domiciliary Care Services Ltd DS0000046305.V351696.R01.S.doc Version 5.2 Page 1
The Commission for Social Care Inspection aims to: Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Inspection Report Author CSCI Audience General Public Further copies from 0870 240 7535 (telephone order line) Copyright This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Internet address www.csci.org.uk Bellcare Domiciliary Care Services Ltd DS0000046305.V351696.R01.S.doc Version 5.2 Page 2
This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this agency are those for Domiciliary Care. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Bellcare Domiciliary Care Services Ltd DS0000046305.V351696.R01.S.doc Version 5.2 Page 3
SERVICE INFORMATION Name of service Bellcare Domiciliary Care Services Ltd Address Office 25, Mossbay House 40 Peart Road Derwent Howe Workington Cumbria CA14 3YT Telephone number 01900 872030 Fax number Email address georgina@bellcare.co.uk Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration Bellcare Domiciliary Care Services Ltd Georgina Sara Stott Domiciliary Care Agencies Bellcare Domiciliary Care Services Ltd DS0000046305.V351696.R01.S.doc Version 5.2 Page 4
SERVICE INFORMATION Conditions of registration: Date of last inspection 24th July 2006 Brief Description of the Service: Bellcare Domiciliary Care Agency is situated in a new office block on an industrial estate on the outskirts of Workington. The agency has recently changed hands and is now owned by Carol and Ian Wilson, with Mrs Wilson as the person responsible for overseeing the business. A new manager has been appointed, who has recently been registered with The Commission for Social Care Inspection. The agency is operated from an office that forms part of a modern serviced office block with car parking facilities nearby. There are currently two offices in use with an option for further accommodation when this becomes necessary. The agency is responsible for providing one to one domiciliary care to older people with: physical disability, sensory loss, dementia, mental health needs and terminal illness. Care is no longer given to children and younger adults. Bellcare operates throughout Cumbria and, currently, provides services to approximately 220 people. Bellcare Domiciliary Care Services Ltd DS0000046305.V351696.R01.S.doc Version 5.2 Page 5
SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 3 star. This means the people who use this service experience excellent quality outcomes This unannounced visit that forms part of the key inspection took place over two days. The first day was spent with the owner/responsible individual and the manager looking at documentation and discussing the operation of the agency. We were also able to speak to support workers during this part of the inspection. On the second day we visited service users in their own homes to ascertain their opinion of the agency, speak to staff and meet with the owner and manager to give feedback about the inspection. Prior to the visit information was gathered from various sources Returned questionnaire survey forms The Annual Quality Assessment Audit completed by the manager The Service history What the service does well: The manager conducts in depth assessments of service users prior to the service starting. This ensures the agency is able to provide the level of care required to meet the assessed needs. This information then forms the basis for the individual plan of care. There is a full recruitment and selection process that ensures no support worker starts their work before all the necessary legal checks are completed. Staff training is given a high priority with a full staff training programme in place and there are now over 50% of the staff trained to National Vocational Qualification (NVQ) levels 2, 3 and 4. Two staff have become trainers in the Learning Disability Awards Framework (LDAF) training programme whilst others have been trained to train staff in adult protection issues. The agency benefits from positive ownership and management and there is a commitment to providing a high level of care and service and to progressively maintain the positive service already provided. Staff working at the agency were complementary about the support they received from the owner and manger. Comments received during interviews included, My supervisor is so helpful and always at the end of the phone and It is a real pleasure to come to work. Bellcare Domiciliary Care Services Ltd DS0000046305.V351696.R01.S.doc Version 5.2 Page 6
The agency has a full complement of policies and procedures that are reviewed annually and arrangements are in hand for staff to be involved in further reviews. All staff are given an in-depth care workers guide, which sets out their roles and responsibilities. A quality assurance system is in place and a copy of the latest report was made available for us during the visit. When speaking to those who use the service some commented, I only have to pick up the phone for help and someone is there, and the girls are lovely, and are now my friends. The ethos of the agency is to promote independence and to ensure those using the service maintain control of their own lives. What has improved since the last inspection? This is only the second inspection since the current owner took over the agency and improvements had already begun when we last visited. However, further improvements have been made to the rota system to ensure staff are able to read and understand it more easily. The management structure has been reviewed and this has improved the lines of communication. All staff can now access the service on line, as the computer programme used is web based. The staff training programme has been extended in order for senior staff to become trainers and one supervisor has completed her NVQ level 4 and has also become an assessor, thus ensuring that the qualification can be completed by the staff in house. The number of people receiving services has increased to 220 and the hours of care provided now exceeds 2000. What they could do better: Thee were no requirements or recommendations made as a result of this visit and we are confident that this agency will continue to provide the high level of care and support already given to those using this service. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Bellcare Domiciliary Care Services Ltd DS0000046305.V351696.R01.S.doc Version 5.2 Page 7
DETAILS OF INSPECTOR FINDINGS CONTENTS User Focused Services (Standards 1 6) Personal Care (Standards 7-10) Protection (Standards 11-16) Managers and Staff (Standards 17-21) Organisation and Running of the business (Standards 22-27) Scoring of Outcomes Statutory Requirements Identified During the Inspection Bellcare Domiciliary Care Services Ltd DS0000046305.V351696.R01.S.doc Version 5.2 Page 8
User Focused Services The intended outcomes for Standards 1 6 are: 1. Current and potential service users and their relatives have access to comprehensive information, so that they can make informed decisions on whether the agency is able to meet their specific care needs. 2. The care needs requirements of service users and their personal or family carers when appropriate, are individually assessed before they are offered a personal domiciliary care service. 3. Service users, their relatives and representatives know that the agency providing their care service has the skills and competence required to meet their care needs. 4. Each service user has a written individual service contract or equivalent for the provision of care, with the agency, except employment agencies solely introducing workers. 5. Service users and their relatives or representatives know that their personal information is handled appropriately and that their personal confidences are respected. In the case of standards 5.2 and 5.3, these do not apply to employment agencies solely introducing workers. 6. Service users receive a flexible, consistent and reliable personal care service. In the case of standards 6.3 and 6.4 these do not apply to employment agencies solely introducing workers. The Commission considers Standard 2 the key standard to be inspected. JUDGEMENT we looked at outcomes for the following standard(s): Standards 1, 2, 3 & 6 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. All those wishing to use this agency are fully assessed prior to the service starting, thus ensuring all assessed needs can be fully met. EVIDENCE: There is comprehensive and detailed information available to prospective service users and their families. This consists of a Statement of Purpose, mission statement, copy contract and service users guide, which outlines the Bellcare Domiciliary Care Services Ltd DS0000046305.V351696.R01.S.doc Version 5.2 Page 9
rights of the individual. This documentation can be made available in differing formats to suit different needs, All those wishing to use this service are fully assessed prior to the service starting. This assessment takes into account personal care needs, mental health needs, medication, moving and handling and risk assessment. Part of the risk assessment also includes the way staff enter and leave the premises to ensure safety at all times. Where possible and with the service user s permission family members are invited to be present during the assessment. This gives opportunity for them to discuss with the manager what services the agency can offer. From discussions with the staff and service users it was obvious that service users were very much involved in their care provision and that the senior staff consult with them on a regular basis. Equality and diversity are taken into account when assessing and staff are aware of the diverse needs of the service users who feel that their individual needs have been recognised and addressed. Bellcare Domiciliary Care Services Ltd DS0000046305.V351696.R01.S.doc Version 5.2 Page 10
Personal Care The intended outcomes for Standard 7 10 are: 7. The care needs, wishes, preferences and personal goals for each individual service user are recorded in their personal service user plan, except for employment agencies solely introducing workers. 8. Service users feel that they are treated with respect and valued as a person, and their right to privacy is upheld. 9. Service users are assisted to make their own decisions and control their own lives and are supported in maintaining their independence. 10. The agency s policy and procedures on medication and health related activities protect service users and assists them to maintain responsibility for their own medication and to remain in their own home, even if they are unable to administer their medication themselves. In the case of standards 10.8 and 10.9, these do not apply to employment agencies solely introducing workers. The Commission considers Standards 8 and 10 the key standards to be inspected. JUDGEMENT we looked at outcomes for the following standard(s): Standards 7, 8 & 10 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The support and personal care which people using this service receive is based on their individual needs. Privacy and dignity are maintained at all times. EVIDENCE: Every one who uses this service has an individual plan of care that has been developed from the initial needs assessment. The plan covers such areas as, personal care, communication, bathing, if required, mobility, continence, dietary, social interests and personal preferences. Also included is a full risk assessment regarding moving and handling and an assessment of the service user s property. The care plans are relevant, understandable and reflect the needs of the service user. They are used as a working tool in the provision of care. Bellcare Domiciliary Care Services Ltd DS0000046305.V351696.R01.S.doc Version 5.2 Page 11
An initial review after 6 weeks takes place and thereafter every six months. More frequently if necessary, particularly if the service is resumed after a stay in hospital. Service users are involved in the care planning process and those care plans we examined had all been signed by the by the individual. A copy is kept in the home, providing permission is given. Reviews take place in the service user s home and are completed by a senior carer who also updates the office copy. We were able to visit some of those who use this service in their own homes and found them to be very pleased with the service provided by Bellcare. They were all very complementary about the kindness of the staff and the open lines of communication with the office. I only have to pick up the phone to receive help was one comment we received. There is a medication policy in place that is reviewed annually. The manager conducts medication training in house. A training video is used and a workbook has been prepared for completion. This also contains the policy and procedure, details of the appropriate legislation and other information regarding the prompting of service users to take their medication. Bellcare Domiciliary Care Services Ltd DS0000046305.V351696.R01.S.doc Version 5.2 Page 12
Protection The intended outcomes for Standards 11-16 are: 11. The health, safety and welfare of service users and care and support staff is promoted and protected, except for employment agencies solely introducing workers. 12. The risk of accidents and harm happening to Service Users and staff in the provision of the personal care, is minimised, except for employment agencies solely introducing workers. 13. The money and property of service users is protected at all times whilst providing the care service, except for employment agencies solely introducing workers. 14. Service users are protected from abuse, neglect and self-harm, except for employment agencies solely introducing workers. 15. Service users are protected and are safe in their home, except for employment agencies solely introducing workers. 16. The health, rights and best interests of service users are safeguarded by maintaining a record of key events and activities undertaken in the home in relation to the provision of personal care, except for employment agencies solely introducing workers. The Commission considers Standards 11, 12 and 14 the key standards to be inspected at least once. JUDGEMENT we looked at outcomes for the following standard(s): Standard 11, 12, & 14 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People who use this service know they are secure and feel confident that their welfare and safety needs are always promoted. EVIDENCE: Bellcare has in place policies and procedures and risk assessments showing that the safety of those using the service is a priority. There is a Health and Safety manual in place written for the agency by a professional organisation. A condensed copy forms part of the care workers guide ensuring that all who Bellcare Domiciliary Care Services Ltd DS0000046305.V351696.R01.S.doc Version 5.2 Page 13
work at Bellcare are aware of health and safety issues. There is a comprehensive risk assessment procedure and all assessments were up to date, which ensures the safety and security of those using the service. Part of the initial assessment includes the resident s property to make sure both service user and carers are safe at all times. Staff are now provided with mobile phones to make it easier to report anything of importance to the staff in the office or the on call supervisor at night. Details of calls are kept to ensure the lines of communication are kept open. A daily record of events and activities is kept and copies forwarded to the office each week. These are checked by the manager as a further means of maintaining good communication and quality of the care provided. The manager and one of the senior carers have recently become trainers in adult protection and are preparing new training courses for all staff. These are due to start in February. Many of the staff have already received training in this subject but more detailed courses are being prepared for existing and newly appointed staff. All these measures ensure all risks are minimised and show that protection of service users has a high priority. Bellcare Domiciliary Care Services Ltd DS0000046305.V351696.R01.S.doc Version 5.2 Page 14
Managers and Staff The intended outcomes for Standards 17-21 are: 17. The well-being, health and security of services users is protected by the agency s policies and procedures on recruitment and selection of staff. 18. Service users benefit from clarity of staff roles and responsibilities, except for employment agencies solely introducing workers. 19. Service users know that staff are appropriately trained to meet their personal care needs, except for employment agencies solely introducing workers. 20. The personal care of service users is provided by qualified and competent staff, except for employment agencies solely introducing workers. 21. Service users know and benefit from having staff who are supervised and whose performance is appraised regularly, except for employment agencies solely introducing workers. The Commission considers Standards 17, 19 and 21 the key standards to be inspected. JUDGEMENT we looked at outcomes for the following standard(s): Standards 17, 18, 19, 20 & 21 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. This service is led by an experienced owner and manager who, by promoting clear vision and values, provide a very high standard of care and support. EVIDENCE: The registered owner works closely with the manager to ensure a high standard of service is provided to those who use this agency. There is a full set of policies and procedures in place, which are updated annually to ensure they meet current legislation. Future reviews will include input from staff as part of staff supervision. This will cover each of the policies in turn in order that all staff will become familiar with and understand them. Bellcare Domiciliary Care Services Ltd DS0000046305.V351696.R01.S.doc Version 5.2 Page 15
There is a full recruitment and selection process and no new member of staff starts work until all the legal checks have been completed and written references received. All staff have full job descriptions and are given a care worker guide that outlines roles and responsibilities as well as in depth information about their duty of care to those using this service. Staff training is given a very high priority with over half the care staff already qualified to National Vocational Qualification (NVQ) level 2 or above. One of the supervisors has completed level 4 and is now also a qualified NVQ assessor with another supervisor working towards the award. This will ensure that all NVQ training can be completed in house. Two of the supervisors have become trainers for the Learning Disability Award Framework (LDAF) and are currently providing staff training in this discipline. There are also trainers for adult protection as the manager and one of the supervisors have attended a course organised by Cumbria County Council. There are regular updates on all mandatory training and equality and diversity training is currently being organised for all staff. Other recent training courses completed include, learning disabilities health needs, Mental Capacity Act, performance management, abuse and dementia and infection control. Staff who spoke to us during the visit were all complementary about the help and support they received from the senior staff in the agency and all agreed it was a super place to work and it is a pleasure to come to work. Staff supervision is on going with records kept on the staff files. Annual appraisals are also completed for every member of staff. Bellcare Domiciliary Care Services Ltd DS0000046305.V351696.R01.S.doc Version 5.2 Page 16
Organisation and Running of the Business The intended outcomes for Standards 22 27 are: 22. Service users receive a consistent, well managed and planned service. 23. The continuity of the service provided to service users is safeguarded by the accounting and financial procedures of the agency. 24. The rights and best interests of service users are safeguarded by the agency keeping accurate and up-to-date records. 25. The service user s rights, health, and best interests are safeguarded by robust policies and procedures which are consistently implemented and constantly monitored by the agency. 26. Service users and their relatives or representatives are confident that their complaints will be listened to, taken seriously and acted upon. 27. The service is run in the best interests of its service users. The Commission considers Standards 22 and 26 the key standards to be inspected at least once. JUDGEMENT we looked at outcomes for the following standard(s): Standards 22, 23, 24, 25, 26 & 27 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The registered owner and registered manager make the best possible use of available resources to deliver a high quality service. EVIDENCE: Bellcare is run from a modern, serviced office block situated not far from the centre of Workington. The agency currently has the use of two offices with an option of hiring extra space for group meetings or staff training. Access is suitable for people who may have a physical disability and there is ample car parking available at the front and rear of the building. There is suitable working space for the office staff and all the equipment required to run a business. Bellcare Domiciliary Care Services Ltd DS0000046305.V351696.R01.S.doc Version 5.2 Page 17
The agency has recently introduced a new rota system that is available to all staff via the web-based computer programme. This ensures all staff know where they should be and at what time. It also ensures a consistent and wellmanaged system for the service users. Daily records of events and visits are kept in the service users homes. These are completed after each visit and forwarded to the office at the end of each week. The registered manager checks them to ensure all duties have been completed on the right day and time. Comments received from service users during the home visits included, the girls are great and always on time, and the office let me know if there is going to be a delay. The registered owner is very much hands on when it comes to the running of the business. There is an annual business plan produced and a copy of that for 2007/08 was made available for us during the office visit, together with a copy of the latest financial accounts. She works closely with her financial advisers to ensure the service remains finically sound with sufficient resources for expansion. Health and safety policies and procedures are in place with a health and safety manual provided by an external professional company. All risk assessments are in place and reviewed on a regular basis. The agency has a complaints procedure that is made available to all who use the service. There have been none to record and none have been received by The Commission for Social Care Inspection. When we spoke to service users they all knew how to complain and to whom, although they all said they never had any reason to. The registered manager has introduced an excellent quality audit system whereby annual surveys are sent to staff, people who use the service, relatives and stakeholders. From the replies received she draws up an annual quality assurance statement/report that is available for anyone to read. A copy of the 2007 report was given to us during the visit. Areas covered included, details of all the returned survey forms, philosophy of care, service user s charter, staff training evaluation and objectives for the following year. The best quality care and support possible are high on this service s agenda and the owner and registered manager are working hard to ensure this achievement is continued. Bellcare Domiciliary Care Services Ltd DS0000046305.V351696.R01.S.doc Version 5.2 Page 18
SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Domiciliary Care have been met and uses the following scale. 4 Standard Exceeded (Commendable) 3 Standard Met (No Shortfalls) 2 Standard Almost Met (Minor Shortfalls) 1 Standard Not Met (Major Shortfalls) X in the standard met box denotes standard not assessed on this occasion N/A in the standard met box denotes standard not applicable User Focused Services Managers and Staff Standard No Score Standard No Score 1 3 17 4 2 4 18 3 3 3 19 4 4 X 20 4 5 X 21 4 6 4 Personal Care Organisation And Running Of The Business Standard No Score Standard No Score 7 4 22 4 8 4 23 4 9 X 24 3 10 4 25 4 Protection Standard No Score 11 4 12 4 13 X 14 4 15 X 16 X 26 4 27 4 Bellcare Domiciliary Care Services Ltd DS0000046305.V351696.R01.S.doc Version 5.2 Page 19
Are there any outstanding requirements from the last inspection? N/A STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Domiciliary Care Regulations 2002 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Bellcare Domiciliary Care Services Ltd DS0000046305.V351696.R01.S.doc Version 5.2 Page 20
Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Bellcare Domiciliary Care Services Ltd DS0000046305.V351696.R01.S.doc Version 5.2 Page 21