GGW Care Limited

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

At the time of the inspection we were told the service supported 20 service users in Bromley and 5 in Surrey with personal care.

People’s experience of using this service and what we found

There was an absence of effective leadership and while some concerns identified in the warning notice we had served on the provider following the October 2022 inspection had been acted on other areas of concern we identified had not been resolved. We identified further areas of concern.

There remained an ineffective quality monitoring system. It was difficult to gather clear and consistent information and some records were not readily available, other records about people’s care were not accurate or contradictory. The registered manager did not have a clear grasp of the day to day running of the service.

Safeguarding issues were not always identified or managed effectively. Risks were not always assessed or safely managed. Medicines were not always safely managed. Staff recutiment processes were not sufficiently safe to ensure people were protected from unsuitable staff.

Assessments of people’s needs were carried out but they did not always accurately reflect their needs or the care provided. Care plans and assessment records we viewed contained contradictory information about the people staff supported. Staff did not always have guidance on how to provide person centred care. Care plans did not always guide staff on people’s individual preferences, likes and dislikes.

Care plan records did not show how people’ s needs under the Equality Act, such as their culture, religion or sexuality had been discussed or considered. Care plans did not guide staff on how to meet these needs.

People told us they felt safe and well looked after by staff. They said their calls were mostly on time and they were supported by staff who understood their health needs. Staff followed safe infection control practices.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. However, we found some improvements needed to the way mental capacity assessments and best interests’ meetings were recorded to evidence that each decision was considered separately.

The provider had acted on our recommendation in relation to training and a new training provider had been sourced. Staff told us they received the right training for their roles.

People told us they were supported by staff who knew them well and who were kind and caring and supported them to be as independent as possible.

People and their relatives told us they knew how to raise a complaint and were confident these would be addressed and acted on.

People told us their views about the service were sought through surveys and regular phone calls. They had a strong relationship with their care coordinator or supervisor and contact with the service was mainly carried out this way rather than through the office.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service under the previous provider, at their previous address was requires improvement (published 3 February 2023). This service has been rated requires improvement for the last four previous inspections. The provider had completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

At our last inspection we recommended that the provider review their staffing levels and staff training arrangements. At this inspection we found the provider was using two new training providers. Staff told us they received appropriate training for their work.

Why we inspected

This inspection was prompted by a review of the information we held about this service and to follow up on action we told the provider to take at the last inspection.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for GGW Care Limited on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to assessing risks, medicines management, safeguarding people from harm, safe recruitment processes, showing dignity and respect and providing person centred care, at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety in respect of some breaches identified. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, 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.

BeeAktive Care is a domiciliary care service. The office is located in the London borough of Bromley. The service operates in the London borough of Bromley and in the county of Surrey for people whose care is commissioned by either authority or private packages of care.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

At the time of the inspection, the service supported 10 service users in Surrey and 25 service users in the London Borough of Bromley.

People’s experience of using this service and what we found

This was a targeted inspection of Safe and Well led carried out due to concerning information we had received about people’s care and the safe running of the service.

Based on our inspection of these areas we found people were not always protected from the risk of abuse or neglect and raised a vulnerable adult safeguarding alert with both the two local authority safeguarding teams who commission the service.

Some risks were still not always identified and adequate risk management plans were not always in place to reduce risk.

People gave us mixed feedback about the punctuality and reliability of their calls. We have made a recommendation in relation to staff rostering and scheduling.

While some improvements had been implemented by the provider since the last inspection. However, the system of monitoring the quality and safety of the service remained ineffective at identifying and acting on risks in relation to, people's support calls and the care received. Some care plans did not include sufficient information about risks to people or the support they needed.

We had continued concerns about the culture of the service and found the registered manager did not always act in an open and transparent way.

There had been improvements to the management of medicines and people told us they received their medicines when they should.

People were positive about the care they received from their regular care workers and they felt safe with their care. Half the people we received feedback from were happy with the way the service was run.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 6 December 2022) and there were breaches of regulation. At this inspection we found the provider remained in breach of regulations.

The service remains rated requires improvement. This service has been rated requires improvement for the previous four consecutive inspections.

Why we inspected

The inspection was prompted in part due to concerns received about people’s care and the safe running of the service. A decision was made for us to inspect and examine those risks.

We undertook this targeted inspection to check on these concerns and to understand whether the Warning Notice we had previously served in relation to Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains Requires Improvement.

We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for BeeAktive Care on our website at www.cqc.org.uk.

Enforcement and Recommendations

Due to the short period of time between the inspection and the date to comply with our notice, and the unavailability of some records, we were not able to follow up on the areas in the Warning Notice and check the notice had been complied with. We will do this at the next inspection.

At this inspection we have identified continued breaches in relation to the assessment of risk and the governance of the service. We identified a new breach in relation to safeguarding adults from abuse or neglect.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

At the time of the inspection, we were told the service supported 20 service users in Surrey and 12 in the London Borough of Bromley.

People’s experience of using this service and what we found

There was an absence of effective oversight and governance systems for call monitoring, medicines, risks, staff training and recruitment. Audits completed were not effective at identifying concerns.

Medicines were not always safely managed and some risks to people were not assessed or planned for. There were discrepancies in staff training records.

We have made two recommendations. One that the provider reviews their staffing levels. A second recommendation for the provider to review their staff training provision and seek appropriate advice on providing staff training in health and social care from a recognised body.

There was a chaotic atmosphere at the inspection and records we asked for were hard to find. Some information we asked about for example in relation to people’s needs changed.

People and their relatives were mostly positive about the service they received. They told us they felt safe, and that staff were kind and caring. Staff understood what might constitute abuse and how to report it. There were infection control measures in place.

Assessments of people’s needs were completed before people started to use the service. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Staff told us they received training and supervision. People’s nutritional needs were identified and met. People’s health needs were included in their care plans. Staff communicated with health professionals where this was appropriate. They told us they felt well supported by the management team.

The service carried out spot checks on staff and sought feedback about the service through surveys and telephone monitoring.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 14 January 2021). The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found the provider remained in breach of regulations.

Why we inspected

We carried out an announced comprehensive inspection of this service in November 2020. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, staff practice in relation to the Mental Capacity Act and the quality monitoring of the service.

We undertook this focused inspection to check they had followed their action plan and to confirm they met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service remains Requires Improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for BeeAktive Care on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to the assessment and management of risk and the governance and quality management of the service.

We served a Warning Notice on the provider and registered manager requiring them to comply with this regulation by 30 January 2022.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety.

We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

BeeAktive Care is a domiciliary care service in the London Borough of Bromley providing personal care and support to people living in their own homes. The service supports people under a discharge from hospital scheme. Some people using the service have longer term assessed packages of care and support.

At the time of the inspection the registered manger told us there were 60 people in total using the service under both schemes. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

People’s experience of using this service and what we found

Medicines were not always safely managed. The provider did not always comply with the Mental Capacity Act code of practice. People were not always supported to have maximum choice and control of their lives and staff did not consistently support them in the least restrictive way possible and in their best interests.

There were systems to monitor the quality and safety of the service but these were not always effectively used to identify possible risks or identify learning and improvements to the service.

There had been improvements made since the last inspection, the provider had introduced a new electronic care planning system which allowed them to monitor the calls and support provided. People told us staff were not usually late. However, we had mixed feedback about staff staying the full length of their call.

People were protected from the risk of abuse because staff knew the action to take if they suspected abuse had occurred.

People said they felt safe using the service and safe recruitment practices were followed. Risks to people were identified and assessed and guidance provided to staff. Staff had received training on infection control and people told us they wore PPE and observed good infection control practice.

People’s needs were assessed before they started using the service and had a personalised plan for their care which reflected their individual needs and preferences. Staff were supported in their roles through training and regular supervision. People were supported to maintain a balanced diet and were supported to access to a range of healthcare services when required.

People told us they had the same small staff team who knew them well and they liked. Staff treated people with care, consideration dignity and respect. People were involved in making decisions about the support they received. People knew how to complain and told us issues they had raised had been addressed by the management team.

Staff spoke positively about the support they received from the provider and registered manager. They told us they worked well as a team and were well supported by the registered manager. People were complimentary about the service and told us they were consulted and involved in giving feedback through surveys or telephone calls.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement. (Report published November 2019).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection some improvements had been made and the provider was no longer in breach of two regulations. However, in other areas not enough improvement had been made and the provider was still in breach of regulations.

The last rating for this service was requires improvement (published 24 October 2018). The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

This inspection was carried out to follow up on a number of safeguarding alerts and complaints and to follow up action we told the provider to take at the last inspection.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for BeeAktive Care Limited on our website at www.cqc.org.uk.

Follow up

We will meet with the provider following this report being published to request an action plan and discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

BeeAktive Care is a domiciliary care service in the London Borough of Bromley providing personal care and support to people living in their own homes. The service supports people under a discharge from hospital scheme. Some people using the service have longer term assessed packages of care and support. At the time of the inspection the registered manger told us there were 40 people in total using the service under both schemes.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

People’s experience of using this service and what we found

Overall the feedback we received from people and relatives was complimentary. However, we found concerns about aspects of the management and governance of the service. Although there had been some improvements made to staff recruitment processes following the issues we identified at the last inspection; legal requirements were still not consistently met. The monitoring of the quality and safety of the service was not always effective. Care plans did not always provide an accurate record of care and support. Records related to the management of the service were not always robustly maintained.

Other areas needed improvement and there were other breaches of regulation. Staff did not have sufficient skills and knowledge to meet the needs of the people they supported. Records did not verify that all staff new to health and social care received training to a recognised standard. Although these issues were acted on following the inspection.

Some risks to people were identified and assessed other risks were not, or, did not include enough detail on how to reduce the risks for people or staff. Medicines were mostly administered safely but medicines risk assessments did not always assess or identify all possible risks and the system for recording and administering topical creams was not robust. Action was taken to address some of these issues following the inspection. Staff did not have full understanding of their roles under the Mental Capacity Act 2005 and code of conduct.

People’s communication needs were assessed but it was not evident that they had been consulted about a more suitable format for them to be given information about the service.

People and their relatives told us they felt very safe and well cared for. They usually had the same group of care workers who were mostly reliable and stayed the full length of the call. Staff had safeguarding training and understood their roles in relation to safeguarding. There were systems to administer oral medicines as prescribed. Staff understood how to reduce the risk of infection.

People’s needs were assessed before they started to use the service. People’s nutritional needs were identified and met. We saw some complimentary feedback on the way the service worked with health professionals and relatives to ensure people’s health needs were met. However, we identified that some improvements were needed to ensure staff had a full understanding of people’s health needs.

We received some very positive feedback about the way staff treated people with dignity and respected their privacy. Staff sought people’s consent when offering them support. People and their relatives said staff treated them with care and kindness and they were encouraged to be as independent as possible. People’s needs in respect of their protected characteristics were assessed and supported. Staff understood people’s cultural and religious needs and how to support them to meet these needs where required.

There were some systems to monitor the quality and safety of the service through checks on medicines records, daily notes and spot checks on staff. Staff received regular supervision to support them in their roles. Staff told us there was a very supportive working culture at the service and the management team were approachable and available. Our observations confirmed this was the case.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was ‘Requires improvement’. (Report published October 2018) and there was one breach of regulation. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found some improvements had been made but the provider remained in breach of the same regulation and we found four other breaches of regulations.

Enforcement

We have found evidence that the provider needs to make improvements. Please see the safe, effective, responsive and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. The agency provides a service to adults with physical disabilities and older people, including people living with dementia. The agency also had a contract to provide people with additional support on discharge from hospital. Not everyone using BeeAktive Care Limited 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 20 people were provided with personal care by the agency.

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.

The provider completed recruitment checks on staff but these needed to be more robust to help ensure that the right people were employed to provide care for people. This meant there was a lack of management oversight with staff recruitment as the provider had not identified the shortfalls we found at this inspection. The registered manager sent us an action plan after the inspection which showed they had taken appropriate steps to improve this.

There were enough staff and people felt safe with the staff who supported them. Staff knew how to recognise and report any concerns they had about people’s care and welfare and how to protect them from abuse. Risks were identified and managed effectively to protect people from avoidable harm.

People were fully involved in making decisions about their own care and received a comprehensive assessment before they started using the service. Assessments considered whether people had any needs in relation to their disability, sexuality, religion or culture and these were incorporated into care plans if 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.

The support provided was person-centred and flexible, taking into account peoples’ preferences and individual circumstances. People’s care needs were regularly reviewed and their care plans updated to reflect any changed needs.

People were supported by regular staff who were appropriately trained and supervised. Management observed how staff cared for people in their home to ensure their practice was safe and people received the support they needed.

People told us they were always treated with dignity and respect. The service had received many written compliments that praised the staff and management team for the quality of the care provided for people.

Staff supported people to maintain and develop their independence and follow their interests and hobbies.

People were supported with their dietary and health needs. Staff took prompt action when people became unwell or were at risk from poor nutrition. They consulted other healthcare professionals to ensure that people received the additional support they needed. Medicines were managed safely and people had their medicines at the times they needed them.

The service was well managed. The registered manager was supported in their role by a deputy and administration staff. Staff felt well supported, recognised for their work and involved in the running of the service.

Quality assurance systems were in place and the provider had plans to refine roles and responsibilities in relation to monitoring the quality and safety of the service. The agency had effective links with external organisations and health professionals.