About the service:

• The service’s office is based in the Slough central business district. Care is provided in the surrounding areas.

• The service provides personal care to adults with complex needs, some of whom have dementia.

• This is the only location that the provider operates.

• At the time of our inspection, six people used the service and there were 14 staff.

People’s experience of using this service:

• The provider had made some improvements to the service since our last inspection.

• Staff received better training, induction, supervision and support so they could effectively perform their roles.

• The service had assessed people’s care risks in a more detailed way and had better plans in place to mitigate the risks.

• There were safer recruitment practices in place to ensure that only fit and proper staff were employed to provide care or support the service.

• Relatives told us the staff were kind, friendly and dedicated. They said staff knew people’s needs well.

• Governance of the service requires improvement. Insufficient checks and audits are carried out to determine the quality of the care. The provider had failed to act on some areas already identified for improvement.

• The provider sought professional assistance to achieve compliance with the regulations. The provider had delayed seeking this support and as such, has neither implemented nor sustained all the necessary changes to ensure a good service.

• A competent staff member who can satisfactorily lead the service and ensure safe care with good governance must register as the manager with us. This is a condition of the provider’s registration.

• The service met the characteristics for a rating of “good” in all the key questions we inspected, except for well-led. The rating for well-led remained at “requires improvement”. The overall rating for the service remained at “requires improvement” because of a continued breach of a regulation.

• More information is in our full report.

Rating at last inspection:

• At our last inspection, the service was rated “requires improvement”. Our last report was published on 8 September 2018.

Why we inspected:

• All services rated “requires improvement” are re-inspected within one year of our prior inspection.

• This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Follow-up:

• The service will be required to submit an action plan to us setting out how they will achieve a rating of at least "good".

• We will assess the current application for the manager to register with us and make a decision.

• We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned for future dates.

Better Life Care is a domiciliary care service that provides personal care to children; younger adults and older adults who live in their own homes in the areas of Slough, Windsor and Maidenhead and Aylesbury. The service was providing personal care to 28 adults. There were no children using the service at the time of our visit.

The service has a registered manager. 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 and associated Regulations about how the service is run.

This is the first inspection under Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We found people were not always satisfactorily protected from identified risks. This was because risk managements plans were not always put in place when risks to people were identified. The service failed to ensure there were safe recruitment practices in place and medicine competency assessments were not undertaken to ensure staff followed best practice. We have made a recommendation for the service to seek current guidance and best practice on conducting medicine competency assessments.

People and relatives felt the service protected them from abuse. Staff were aware of their responsibilities to ensure people were kept safe from harm.

People and relatives felt staff were skilled to carry out care. Comments received included, “Yes, most of them (staff) do. If someone is being trained they are observed to make sure they’re doing the right thing.”

We found there was no formal programme of induction for new staff. We recommended the service seek current guidance on how to devise a staff induction programme. Staff received appropriate training but there was no system in place to gauge their understanding of the training received. Staff were not supervised in line with the service’s supervision policy.

People were supported to have maximum choice and control of their lives and staff did support them in the least restrictive way possible; the policies and systems in the service did support this practice.

People and relatives spoke positively about the caring approach of staff. Comments included, “They (staff) are very caring. They do it from the heart.”

Staff knew the people they were cared for and supported, including their preferences and personal histories. People and their relatives were involved in making decisions about their care. Staff ensured people’s dignity was protected whilst carry out personal care. People were enabled to communicate their needs in a range of ways and staff responded to them appropriately.

Care records and risk assessments were not regularly reviewed and reviews of care were not regularly undertaken. We recommended the service seeks current guidance and best practice on how to schedule reviews of care and ensure people's care plans and identified risks are regularly reviewed and updated. People were supported to have care plans that reflected how they would like to receive their care and support. Staff knew and understood how to respond to each person’s diverse cultural, gender and spiritual needs. People and their relatives knew how to make a complaint and staff knew how to respond when complaints were received.

People and relatives felt the service was well-managed. There were no effective systems in place to assess; monitor and improve the quality of the service being provided. The registered manager did not update their training to ensure they worked in line with current legislation and best practice. There were no systems to appropriately analyse or identify themes or demonstrate improvements in the provision of care.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 as a result of this inspection. You can see what action we told the pr