This announced inspection was carried out 28 July 2017 and was completed on 11 August 2017 when we had spoken by people, relatives and staff by telephone. The service provides care and support to people in their own homes. At the time of the inspection, 41 people were being supported by the service, some of whom may be living with chronic health conditions, physical disabilities and dementia.

Although the provider had made improvements to their systems to keep accurate and up to date records of people's medicines when we inspected them in August 2016, we found they needed a longer period for this to be fully embedded and followed by staff. During this inspection, we found no concerns with the quality of people's records.

There was no registered manager in post. A new manager who had recently been employed by the service had not yet registered with the Care quality Commission. 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.

People were safe because the provider had effective systems to keep them safe, and staff had been trained on how to safeguard people. There were individual risk assessments that gave guidance to staff on how risks to people could be minimised. People’s medicines were managed safely and administered in a timely manner by trained staff. The provider had effective recruitment processes in place and there was sufficient numbers of staff to support people safely.

Staff received effective training, support and supervision that enabled them to provide appropriate care to people who used the service. Staff understood their roles and responsibilities in ensuring that people consented to their care and support, and that this was provided in accordance with the requirements of the Mental Capacity Act 2005 (MCA). Where required, people were supported to have enough to eat and drink.

Staff were kind and caring towards people they supported. They treated people with respect and supported them to maintain their independence as much as possible. People were happy with how their care was provided and they valued staff’s support. People had developed friendly relationships with staff who supported them regularly.

People’s needs had been assessed and they had care plans that took account of their individual needs, preferences and choices. Care plans had been reviewed annually or when people’s needs changed. Staff were responsive to people’s needs and where required, they sought appropriate support from healthcare professionals. The provider had a system to manage people’s complaints and concerns.

The manager provided stable leadership and supported staff to carry out their roles effectively. The provider had systems to assess and monitor the quality of the service. They encouraged feedback from people, relatives, staff and external professionals to enable them to continually improve the service.

During our inspection in July 2016, we found that management of medicines was inconsistent and staff did not always follow the provider's policy in the recording of medication. Medication administration records (MAR) were not always fully completed.

This was a breach of regulation 12 (1) (2) (a)(b)(g) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We found that the quality control and auditing systems were not always used and did not always drive improvement.

This was a breach of regulation 17 (2) (a) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

This report only covers our findings in relation to the outstanding breaches of regulation. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Better Health Care Limited on our website at www.cqc.org.uk.

This inspection was announced and took place on 18 August 2016.

During this inspection, we found that improvements had been made to the systems in place within the service, to ensure that MAR sheets were filled out and audited correctly. All staff had been re-trained in medication administration.

While improvements had been made we have not revised the rating for the key questions; to improve the rating to 'Good' would require a longer term track record of consistent good practice. We will review our rating for safe and well led at the next comprehensive inspection.

Better Health Care is a domiciliary care agency providing personal care and support to people in their own homes, within the Bedford area. At the time of our inspection the service was providing care and support to approximately 32 people.

This inspection took place on 19 July 2016 and was announced. Prior to this inspection we had received concerns in relation to the care people were receiving and the management and administration of medications within the service. We therefore needed to ensure that people's care was being delivered in line with the fundamental standards.

The service did not have a registered manager. They had a manager in post that was going through the registration process. 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.

Staff had an understanding of abuse and the safeguarding procedures that should be followed to report abuse and people had risk assessments in place to enable them to be as independent as possible. The staff we spoke with were able to demonstrate what they would do should they have any concern that abuse was taking place.

Staffing levels were adequate to meet people’s current needs. The staff recruitment procedures ensured that appropriate pre-employment checks were carried out to ensure only suitable staff worked at the service. Staff induction training and on-going training was provided to ensure they had the skills, knowledge and support they needed to perform their roles.

Management of medicines was inconsistent and staff did not always follow the provider’s policy in the recording of medication. Medication administration records were not always fully completed and there were no adequate systems to audit these records to highlight any errors or omissions.

Staff were well supported by the manager and senior team, and had regular one to one supervisions, and spot checks. The staff we spoke with were confident that the support they received enabled them to do their jobs effectively.

People's consent was gained before any care was provided and the requirements of the Mental Capacity Act 2005 were met. Everyone we spoke with told us that staff members always gained their consent before carrying out any care tasks.

People were able to choose the food and drink they wanted and staff supported them with this. If required, staff supported people to access health appointments. We saw that people had information about their likes and dislikes with food and drinks, and dietary requirements recorded within their files.

Staff treated people with kindness, dignity and respect and spent time getting to know them and their specific needs and wishes. People were involved in their own care planning and were able to contribute to the way in which they were supported.

The service had a complaints procedure in place, but it was not being used according to the provider’s own policy. We found that complaints had been made verbally, but no evidence was found that these complaints were recorded and acted upon appropriately.

Quality monitoring systems were in place but were not always used and not always effective. We found that some people’s records were not being audited for quality, and when audits were being conducted, there was no evidence that actions were taken to address mistakes and drive future improvement.