Date of assessment: 14 March 2025 to 21 March 2025. The service is a domiciliary care agency providing personal care to older and younger adults, who may also be living with physical and sensory disabilities, dementia, mental health or learning disability and/or autism. This assessment was carried out to follow up on previous enforcement action taken. We assessed the service against ‘Right support, right care, right culture’ guidance to make judgements about whether the provider guaranteed people with a learning disability and autistic people respect, equality, dignity, choices, independence and good access to local communities that most people take for granted. The provider had a good learning culture and people could raise concerns. People were protected from the risk of abuse. Risks to people were assessed, managed and understood. People were supported to be involved in the referral process and their preferences were clearly documented. Staff followed best infection prevention and control (IPC) practice when supporting people. There were enough suitably trained staff, and care calls were monitored to ensure people received the support they needed. Leaders led by example and an inclusive and positive culture was promoted. Systems and processes to oversee risk and drive improvement were in place and effective. The provider had positive working relationships with relevant stakeholders. The provider was previously in breach of the legal regulation in relation to good governance. Improvements were found at this assessment and the provider was no longer in breach of this regulation.
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Bhandal Care improved from its previous Inadequate rating and exited Special Measures, but remains in breach of Regulation 17 due to ineffective governance systems, failure to submit all statutory notifications to CQC, and insufficient contingency planning. Care planning for behaviours that challenge and embedding a consistent learning culture are the principal outstanding concerns.
Concerns (5)
criticalGovernance: “Systems and processes to ensure quality performance, risks and regulatory requirements had not always been effective.”
criticalIncident learning: “Whilst some statutory notifications had been submitted to CQC, we found other notifiable incidents had not been reported since our last inspection.”
moderateCare planning: “Care plans and risk assessments did not always contain guidance for staff to follow when people expressed distress or agitation.”
moderateRecord keeping: “A large number of the files we requested to see on the day of our inspection were unavailable. These were sent to us later in the week for us to review.”
moderateLeadership: “The provider did not as yet have a fully supported management structure. The provider's systems did not always effectively monitor the quality of care provided.”
Strengths
· People felt safe and staff completed safeguarding training; the provider made referrals to the local authority when needed.
· Medicines were managed safely with MAR charts in use and staff competence checked.
· Staff were described as caring and kind; people and relatives provided highly positive feedback.
· Complaints handling was improved with processes introduced to review and resolve concerns.
· The provider worked in partnership with district nurses, GPs and local pharmacies to deliver effective care.
Quality-Statement breakdown (23)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Staffing and recruitmentGood
safe: Preventing and controlling infectionGood
safe: Using medicines safelyGood
safe: Learning lessons when things go wrongGood
effective: Staff support, training, skills and experienceGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Staff working with other agencies to provide consistent, effective, timely careGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
caring: Ensuring people are well treated and supported; respecting equality and diversityGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
caring: Respecting and promoting people's privacy, dignity and independenceGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: Planning personalised careGood
responsive: Meeting people's communication needsGood
responsive: Supporting people to develop and maintain relationships and to avoid social isolationGood
responsive: End of life care and supportNot rated
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Engaging and involving people using the service, the public and staffGood
well-led: How the provider understands and acts on the duty of candourGood
Bhandal Care, a Derby domiciliary care agency, was rated Inadequate overall at its first inspection in December 2022, with breaches of regulations 12, 16, 17, 18 and 19 relating to unsafe recruitment, insufficient staffing, ineffective complaints management, poor governance, and gaps in care planning and medicines records. The service was placed in special measures, with warning notices issued for failures in complaints handling and good governance.
Concerns (13)
criticalStaffing levels: “Care rotas did not demonstrate there were enough staff to meet people's needs at their scheduled times. Records showed staff were scheduled to provide care to more than one person at the same time.”
criticalSafeguarding: “They had not recognised a significant pressure sore would require reporting to the local authority safeguarding team. There was a risk people may be exposed to potential risk and harm.”
criticalStaff training: “One staff member told us they had not received any training in learning disability care or catheter care despite the training matrix recording they had recently received training in this.”
criticalStaff competency: “Records showed all areas had been completed in one day, including completion of all 15 minimum standards of the Care Certificate.”
criticalGovernance: “Systems to assess, monitor, improve service quality and care delivery and identify and reduce risks were not operated effectively. Records were not always accurate, complete or contemporaneous.”
criticalComplaints handling: “There was no complaint's log in place. This meant there were no response times, investigation details or outcomes recorded in a complaint's log for us to review.”
criticalRecord keeping: “People's individual care plans, care records as well as staff records, and spot checks contained other people's names. Records were not always accurate or complete.”
criticalMedication management: “Some MAR charts had not always been completed in line with the provider's good practice policies for medicines management. Information on allergies, the dosage of some medicines and when medicines had been stopped had not been recorded.”
criticalCare planning: “One person required catheter care and there were no details of this in their care plan. Another person's care plan did not provide guidance for care staff on what to do should they not be able to obtain a blood sugar reading.”
moderateMissed or late visits: “Almost all relatives commented on the lateness of care calls. One relative told us they felt staff were often rushed and continence pads were not always checked.”
moderateInfection control: “The registered manager was aware not all staff wore aprons when providing personal care. People told us staff did not always wear facemasks as required in line with government guidance.”
moderateIncident learning: “The registered manager told us this was not recorded in a way that allowed it to be reviewed for trends, themes and lessons learnt.”
moderateLeadership: “The provider had no effective systems in place to manage the service in the absence of the registered manager.”
Strengths
· Staff worked with other agencies involved in people's care, for example contacting district nurses for people.
· People's equality and diversity needs were respected, with assessment processes checking for equality characteristics to prevent discrimination.
· New care staff shadowed experienced staff when they first started, which staff found helpful for moving and handling and medicines administration.
· People were supported to have maximum choice and control of their lives, with staff supporting them in the least restrictive way possible.
· People's communication needs were considered in assessments and the service attempted to match non-English-speaking people with staff who could communicate in their first language.
Quality-Statement breakdown (22)
safe: Staffing and recruitmentInadequate
safe: Preventing and controlling infectionRequires improvement
safe: Assessing risk, safety monitoring and managementInadequate
safe: Using medicines safelyRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseInadequate
safe: Learning lessons when things go wrongRequires improvement
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the law
Requires improvement
effective: Ensuring consent to care and treatment in line with law and guidanceGood
effective: Staff working with other agencies and supporting people to live healthier livesGood
caring: Ensuring people are well treated and supported; respecting equality and diversityRequires improvement
caring: Respecting and promoting people's privacy, dignity and independenceGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
responsive: Improving care quality in response to complaints or concernsInadequate
responsive: Planning personalised care to ensure people have choice and controlRequires improvement
responsive: Meeting people's communication needsGood
responsive: Supporting people to develop and maintain relationships to avoid social isolationGood
responsive: End of life care and supportNot rated
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsInadequate
well-led: Continuous learning and improving careInadequate
well-led: How the provider understands and acts on the duty of candourRequires improvement
well-led: Engaging and involving people using the service, the public and staffRequires improvement