About the service:

Beaumont Healthcare Limited is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to younger adults, people living with dementia, people with a learning disability, people with mental health needs, a physical disability and sensory impairments. The service is provided from an office based in Eaton Socon.

Not everyone using Beaumont Healthcare 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 staff were providing care to 267 people.

Peoples experience of using this service:

People were safeguarded from the risk of harm by a sufficient number of safely recruited staff who were given skills to safely manage any identified risk. Trained and competent staff administered and managed people's medicines safely. Risk to people were managed well and lessons were learned when things did not go quite so well. Infection control systems promoted good hygiene standards.

Skilled staff were supported, supervised and mentored to effectively meet people’s needs. Staff encouraged and promoted people’s eating and drinking. Staff enabled people to access healthcare support by working well with others involved in people’s care. 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.

People were cared for by staff with compassion, kindness and dignity. Staff knew people well and they promoted people’s privacy and independence. Systems were in place to ensure people made decisions about who and how their care was provided.

People’s care was person centred and based on what mattered to them. The provider responded to people’s concerns in line with their policies to the person’s satisfaction. Systems were in place to meet people’s end of life care needs and help ensure a dignified and pain free death. One relative told us that the difference staff made to their family member was they had “Given them a new lease of life.”

The registered managers led by example and they fostered an open and honest staff team culture where staff felt valued and supported. Quality assurance, governance and audits helped identify and drive improvements. People had a say in how the service was run and developed. The service and its management team worked with other organisations such as health professionals and safeguarding teams to the benefit of people.

Rating at last inspection: Good (report published 19 August 2016).

Why we inspected: This was a planned inspection based on the previous rating.

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

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

Beaumont Healthcare is registered to provide personal care to people who live in their own homes. At the time of this inspection a service was provided by 115 care staff to 380 people living in the Cambridgeshire and Mid Bedfordshire areas.

This announced inspection took place on 20 and 21 July 2016.

The service had a registered manager in place. 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’s policy on administration and recording of medicines had been followed, which meant that people received their prescribed medicines. Audits had identified issues with medicines’ management and action had been taken.

People had their needs assessed and reviewed so that staff knew how to support them to maintain their independence. People’s care plans and risk assessments contained person- focussed information. The information in the risk assessments was not up to date for three people.

There was a sufficient number of staff available to ensure people’s needs were met safely. The risk of harm for people was reduced because staff knew how to recognise and report abuse. Staff were aware of the procedures for reporting concerns, systems were followed and concerns were investigated.

Staff were only employed after the provider had carried out comprehensive and satisfactory pre-employment checks. Staff were well supported by the registered manager and senior staff through supervisions and staff meetings.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and report on what we find. We found that staff were trained in the principles of the Mental Capacity Act 2005 (MCA) and could describe how people were supported to make decisions.

People received care and support from staff who were kind, caring and respectful to them. Staff treated people with dignity and respected their privacy.

People knew how to make a complaint. The provider investigated any complaints and as a result made changes to improve the service.

The registered manager was supported by a staff team that included a number of other managers and care workers. The service had an effective quality assurance system in place. People and relatives were encouraged to provide feedback on the service and their views were listened to and acted on.

People we spoke with told us that they were happy with the carers who provided care to them or to their relative. One person said, "The carers have been fantastic" and another told us, "The staff are first class." People said that, mostly, staff arrived on time and that they always stayed for the appropriate length of time.

The staff we spoke with were positive about working for the agency and said that they received appropriate training and support which enabled them to carry out their role effectively. The agency has their own training department and managers carried out regular monitoring of staff's competencies.

There were clear care plans in place which provided guidance to staff about how to meet people's assessed needs. Risks were identified with plans in place of the action needed to manage the risk.

The agency had recently greatly increased the number of people they provided a service to in a short space of time. The managers had worked hard to ensure that every person had been visited and an assessment had been carried out. There had been initial difficulties in ensuring consistency in the provision of staff but people told us that this had improved recently.

People told us that they were treated with respect by the care staff who were supporting them. People informed us that they had made choices about their care arrangements and had been included in the planning of their care. Other comments that people made included, "My care could not be better. They (care staff) have been excellent", and "I get a lot of help and all the care staff have been very good, but I would like the same staff all the time".

Beaumont Healthcare Limited is an agency providing care to people in their own homes. At the time of the inspection they were providing a service to 411 people.

This announced inspection took place on the 30 November, 1 December and 22 December 2015.

At the time of the inspection there was a registered manager in place. 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.

Risks had not always been managed to keep people as safe as possible. Risk assessments had not always been completed. This meant that staff did not have the information they required to ensure that people received safe care.

Care plans did not contain all of the relevant information that staff required so that they knew how to meet people’s current needs. We could not be confident that people always received the care and support that they needed.

The Care Quality Commission (CQC) is required by law to monitor the Mental Capacity Act (MCA) 2005, Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The provider was not acting in accordance with the requirements of the MCA including the DoLS. The provider could not demonstrate how they supported people to make decisions about their care and where

they were unable to do so, there were no records showing that decisions were being taken in their best interests. This also meant that people were potentially being deprived of their liberty without the protection of the law.

Staff were aware of the procedure to follow if they thought someone had been harmed in any way.

There were procedures in place which were being followed by staff to ensure that people received their medication as prescribed. Regular audits of the medication administration records highlighted any concerns and the appropriate action had been taken to deal with them.

There were enough staff available to meet people’s needs. The recruitment process was followed to ensure that people were only employed after satisfactory checks had been carried out.

Staff were kind and compassionate when working with people. They knew people well and were aware of their history, preferences, likes and dislikes. People’s privacy and dignity were upheld.

Staff monitored people’s health and welfare needs and acted on issues identified. People were provided with a choice of food and drink. Any issues with eating and drinking were reported back to the office so the relevant healthcare professional could be contacted when needed.

There was a complaints procedure in place and people felt confident to raise any concerns either with the staff or the registered manager.

The registered manager obtained the views from people that used their service, their relatives and staff about the quality of the service being provided.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.You can see what action we told the provider to take at the back of the full version of the report.

Please note that the summary section will be used to populate the CQC website. Providers will be asked to share this section with the people who use their service and the staff that work there.