Better Healthcare Services (Luton) is a domiciliary care agency that provides personal care to people in their own homes.

At the last inspection, the service was rated Good.

At this inspection we found the service remained Good.

The service has 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 service took safeguarding concerns seriously and followed the local authority policy and guidance when dealing with safeguarding people from harm.

Where appropriate the service had attended and contributed to safeguarding discussions and meetings.

There was a robust recruitment procedure to help ensure the staff recruited were suitable to work with the people using the service.

Staffing levels were sufficient to provide the level of care required.

Risk assessments were in place and were regularly reviewed and updated.

Staff were trained to administer medicines safely. Regular checks were undertaken to help ensure on-going competency in this area.

There was a robust induction programme, which included mandatory training, shadowing and buddying with an experienced worker. Staff demonstrated a good understanding of their roles and responsibilities.

Supervisions were undertaken and Professional Development Reviews (PDR) were held annually to ensure learning was reviewed and training needs were met.

Care files were clear and comprehensive and contained relevant health and personal information. The service was flexible and responsive to changing needs, desires and circumstances.

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.

Confidentiality was respected and independence was promoted. Communication with relatives was on-going throughout the duration of their relative’s involvement in the service.

Comments were encouraged formally and informally and there was a complaints policy in place. Literature given out to families gave the information and opportunity for people to raise concerns or make suggestions.

Feedback was regularly sought from families and users of the service. The service listened and took action to address any concerns and suggestions put forward by people who used the service and their families.

Team meetings were regularly undertaken, giving staff the opportunity to discuss any issues and to share good practice examples. The meetings were used as a forum to share current best practice guidance and keep staff up to date with new methods and innovation.

A number of audits were undertaken, results analysed and lessons learned from these to drive continual improvement in service delivery.

Further information is in the detailed findings below.

We undertook an announced inspection of Better Healthcare Services (Luton) on 21 April 2015. We told the provider two days before our visit that we would be carrying out the inspection. Better Healthcare Services (Luton) is a care agency that provides personal care to people in their own homes. At the time of our inspection approximately 75 people were receiving a support or personal care from the service.

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 had a robust recruitment process in place. There were appropriate numbers of staff employed and allocated to meet people’s needs and provide a flexible service. People were supported by staff who had been trained to support them safely.

Staff received regular training and supervision and were knowledgeable about their roles and responsibilities.

Staff had the skills, knowledge and experience required to support people well and were able to provide a personalised service to the people they supported and built good working relationships.

People and their relatives were able to speak to the provider if they had any concerns and staff were kind and caring towards the people that they supported.

People were involved in making decisions about their care and support, and support plans were in place which provided details on how to support them.

Risk assessments were in place for all people receiving support and were reviewed regularly.

People were supported to eat and drink well and to access healthcare professionals when required.

The manager was accessible and approachable. Staff, people who used the service and relatives felt able to speak with the manager and provide feedback on the service. The provider carried out regular spot checks on the service being provided and staff performance.

Medication was administered by staff who had received training and were competent in the safe administration of medication.

Peoples’ diversity, values and human rights were respected. The people we spoke with told us they or their relatives had their privacy and dignity respected and were encouraged to be independent. They said they felt consulted about their care and that their choices and preferences in relation to their care were respected. They said they were given useful and relevant information by the service.

Peoples’ needs were assessed and care and treatment was planned and delivered in line with their individual care plan. The people we spoke with said they or their relatives had received an assessment of their needs when they started using the service and this had been updated to reflect any changes to their health or circumstances. They told us that staff displayed a good understanding of their needs and how to meet them.

The people we spoke with told us they or their relatives felt safe being cared for by staff from Better Healthcare Services. They said the staff were friendly and professional and appeared qualified and experienced to carry out their roles. They said they felt the standard of care provided was very good.

People who use the service, their representatives and staff were asked for their views about their care and treatment and they were acted on. The people we spoke with told us they were able to raise concerns with care managers and any concerns they had were dealt with satisfactorily. They said they were able to provide feedback on their care and treatment either directly to care managers visiting their homes or by completing questionnaires provided by the service.

One person summarised the general feeling of the people we spoke with by saying: “I have no issues at all with this service. Their communication is very good”. A relative of a person using the service we spoke with said: “Health wise the service has been excellent for my [relative] and care workers are very good at putting everything in place”.

Prior to our inspection, we received concerns that people who used the service were not being provided with safe and appropriate care. There had also been concerns about the inconsistency in care staff, staff being late for most of the planned visits, leading to people with complex health needs being left in bed for long periods of time without medication, food and fluids.

One inspector from the Care Quality Commission (CQC) conducted this inspection. We gathered evidence against the standards we inspected to help answer our five key questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found. The summary is based on what we found at the inspection by looking at records and what people told us about their experiences of the service. We spoke with eight people using the service, relatives of two people, six care staff, the manager, the services' client services director and the operations director. At the time of our inspection Better Healthcare Services (Luton) provided care and support to 77 people who used the service.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People who used the service told us they felt safe. We found people's needs had been assessed, and care plans and risk assessments were in place to ensure that they were provided with appropriate and safe care. However, these did not always accurately reflect people's changing needs.

However, we found the provider had made recent improvements to ensure that people were supported by a consistent group of staff to ensure continuity of care.

Is the service effective?

Detailed care plans were in place to provide guidance to staff on how to deliver appropriate and effective care. However, the service did not always identify changes to people's health needs to ensure that appropriate referrals were made to other health and social care professionals. This did not ensure prompt and effective care and treatment for people who used the service. The high turnover of staff may have also had an impact on the effectiveness of the service.

Is the service caring?

People we spoke with told us that the staff were caring and met their care needs. However, they did not always arrive on time and this meant that care was not always provided at the agreed times.

Is the service responsive?

We found the service was not responsive because they did not always act promptly to respond to people's changing needs. Two of the people supported by the service's health had deteriorated, but we did not see evidence that prompt action had been taken to refer them to other health or social care professionals.

Is the service well-led?

The service had no registered manager in place and therefore had lacked consistent leadership until a new manager was appointed recently. We found that this lack of consistent leadership meant that there was no consistent guidance and support for the staff to enable them to provide safe and appropriate care.