Best Solutions Health Care Ltd

Updated 16 February 2023

The inspection

We initially carried out this performance review and assessment under Section 46 of the Health and Social Care Act 2008 (the Act). We checked whether the provider was meeting the legal requirements of the regulations associated with the Act and looked at the quality of the service to provide a rating.

Unlike our standard approach to assessing performance, we did not intend to visit the office of the location. This is a new approach we have introduced to reviewing and assessing performance of some care at home providers. Instead of visiting the office location we use technology such as electronic file sharing and video or phone calls to engage with people using the service and staff.

Due to the registered manager not sending the required documents we attempted to carry out a site visit. However, entry to the registered location was not possible as the registered manager told us they had moved the office location. We sent an email to the registered manager after the inspection to inform them of their duty to apply to us to change the office location, which they later did. They also confirmed that they had sent all of information they had electronically.

We therefore 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.

Inspection team

The remote inspection was carried out by 1 inspector. The on-site inspection visit was carried out by 3 inspectors.

Service and service type

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations. At the time of our inspection there was a registered manager in post.

Notice of inspection

We gave the service 24 hours’ notice of the inspection. This was because 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 sought feedback from the local authority who work with the service. The provider was asked to complete a Provider Information Return (PIR) prior to this 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

We used technology such as telephone calls to enable us to engage with people using the service and staff, and electronic file sharing to enable us to review documentation. We visited the locations office to review documentation but were unable to gain entry as the registered manager, who is also the nominated individual, told us they had moved the registered office. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

Inspection activity started on 14 November 2022 and ended on 18 November 2022. We spoke with 5 staff, including the registered manager, 1 person who used the service and 2 relatives. We reviewed the care records of 2 people and 3 staff files. We reviewed a variety of records relating to the management of the service, including policies and procedures.

Updated 16 February 2023

About the service

Best Solutions Health Care Ltd is a domiciliary care agency and provides personal care and support to people who require assistance in their own home. At the time of our inspection there were 3 people being supported by the service.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

At the time of the inspection, the location did not care or support anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.

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

Systems in place did not safeguard people from the risk of abuse. Risks to people were not adequately assessed to keep them safe. medicines were not safely managed. Medication administration charts were not audited, and action was not taken to address errors promptly. Policies and procedures were in place to guide staff around infection prevention. Staff did not always wear appropriate PPE to reduce the risk of the spread of infection. Incidents and accidents were not monitored to ensure action was taken to keep people safe.

People's needs and choices were not recorded to give staff appropriate guidance to care for them. Staff did not always receive sufficient training to help them carry out their roles. Multiple training topics were covered in one day, meaning staff were not provided with enough time to develop their learning.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Complaints were not appropriately addressed. Records did not reflect complaints the service had received or what action had been taken as a result.

The registered manager did not have an adequate understanding of their role or the regulatory requirements. There was a lack of service oversight and the registered manager did not ensure that there were effective governance systems in place, with no audits and quality control. Policies and procedures did not provide staff with clear guidance and had not been reviewed to ensure they were up to date.

People told us that staff were kind and caring towards them, but staff did not promote their privacy and dignity. Staff told us they were supported but there were no records to show they had received an induction, supervision or that their practice had been checked. Staff told us they felt the registered manager was approachable and they felt supported in their roles.

Staff were recruited safely, and people told us staff were kind and caring. Staff were recruited safely. Where people required support with eating and drinking, people told us staff supported well in this area.

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

Rating at last inspection

This service was registered with us on 07 December 2020 and this is the first inspection.

Why we inspected

This inspection was prompted by a review of the information we held about this service. We carried out an inspection to give the provider a rating.

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 monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment, staffing, person centred care, good governance, safeguarding people from abuse, and consent at this inspection.

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

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.

This inspection started as an ‘inspection using remote technology’. This means we used technology such as electronic file sharing to gather information, and phone calls to engage with people using the service as part of this performance review and assessment. However, the registered manager did not provide all of the documents requested during the inspection; therefore, we also visited the location’s office to gather this information, but we were told the office had moved location.