Background to this inspection
Updated
26 March 2022
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
This was a targeted inspection to check whether the provider had met the requirements of the Warning Notice in relation to Regulation 12 – Safe Care and Treatment and Regulation 17 – Good Governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
Inspection team
The inspection team was made up of one inspector.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
We gave the service 24 hours’ notice of the inspection. This was because it is a small service and we needed to be sure that the provider or registered manager would be in the office to support the inspection.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. The provider did not complete the required Provider Information Return (PIR). This is information providers are required to send us annually with key information about the service, what it does well and improvements they plan to make. We used all this information to plan our inspection.
During the inspection
During the inspection we spoke with one person and two relatives about their experience of using the service. We also spoke with five staff members, which included; the registered manager, the managing director, the admin assistant and care workers. We reviewed care and medicine records for two people, and information relating to provider oversight.
After the inspection
After the inspection we continued to review information relating to staff training, staff deployment, complaints and communication within the service.
Updated
26 March 2022
About the service
Blossoming Hearts is a domiciliary care agency. It provides personal care to people aged 18 and over living in their own homes and flats.
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. The service was providing support to 20 people with personal care needs at the time of our inspection.
People’s experience of using this service and what we found
We found a lack of oversight of systems and processes, particularly with regard to updating care plans and risk assessments. Risk assessments and care plans were not updated, and some staff were not aware of how to mitigate risks, which placed people at risk of harm. We did not find there was direct impact to people because of this, but the provider fully accepted the potential risks and had already started to work on improving these.
Staff had good insight as to people's likes and dislikes and respected their wishes, despite the lack of information about people’s preferences and choices. People and relatives supported this with both written and verbal reports about the level of care they received.
The system to monitor staff training was not effective. Staff had not had annual refresher training where it was required. Staff were unaware of the training they had completed although they did know what to do and who to go to for assistance, including safeguarding. However, further action was needed in relation to the moving and handling training, particularly with using equipment in confined spaces.
Staffing was not adequate as systems did not allow time for travelling from person to person. People and their relatives commented carers did not always stay their allotted time or were late arriving because of this. Transport for staff was raised as part of the problem.
There had been some difficulties covering shifts at short notice, partly due to staff being unfamiliar with a different system and partly due to difficulties with wifi and telephone signals in rural areas. Short notice sickness also caused a problem. The management team recognised this could be improved with better communication going forwards, and a review of rotas as well as additional recruitment.
The registered manager and director had learnt from a previous report and had put robust and safe methods in place for recruitment. All information was correct and appropriate to ensure safe recruitment was in place. When there had been a lack of understanding about regulations this was immediately addressed.
PPE supplies were good and there were positive comments about the appropriate use of PPE by Staff from people and relatives. People felt confident with their care delivery.
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; There were policies and systems in the service to support this practice.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at the last inspection and update
The last rating for this service was Requires Improvement published 7 August 2019 with two breaches of regulations. The provider failed to complete an action plan after the last inspection to show what they would do and by when to improve.
At this inspection enough improvement had not been made and the provider was still in breach of regulations. The service remains rated Requires Improvement. This service has been rated requires improvement for the last two consecutive inspections.
Why we inspected
The inspection was prompted in part due to concerns received about infection control and safe staffing practices. A decision was made for us to inspect and examine those risks.
We looked at infection prevention and control measures under the Safe key question. We look at this in all inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.
The overall rating for the service has not changed from Requires Improvement. This is based on the findings at this 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 Blossoming Hearts on our website at www.cqc.org.uk.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
We have found evidence that the provider needs to make improvements. We have identified breaches in relation to Regulation 12 (Safe Care and Treatment), and Regulation 17 (Governance)
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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.