Bespoke Care Services East Dorset Ltd is a domiciliary care service providing a regulated activity of personal care. The service was providing care and support to people in their own homes. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. Our assessment started on 28 May 2024 and we conducted the site visit on 4 June 2024 which concluded the assessment. At the time of our inspection there were 51 people receiving personal care from the service. Since our last inspection significant improvement had been made at the service, these had been embedded and sustained and further improvements were created to ensure governance systems operated robustly within the service. The provider and registered manager had created a service improvement plan and were working towards further development and strengthening of the systems.
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Bespoke Care Services East Dorset Ltd was rated Requires Improvement overall on its first inspection, with breaches of regulations 13, 17, 18 and 19 identified relating to failures in safeguarding reporting, unsafe recruitment, CQC notification obligations and ineffective governance systems. Care delivery was generally strong, with Good ratings across effective, caring and responsive domains, and the registered manager took prompt remedial action following the inspection.
Concerns (4)
criticalSafeguarding: “Safeguarding incidents had not always been identified and reported appropriately to the local authority. This was a breach of regulation 13 of the Health and Social Care Act 2008.”
criticalStaffing levels: “Staff were not always recruited safely. Recruitment procedures had not been followed and the required safety checks had not been completed on one member of staff.”
criticalGovernance: “Governance systems had not identified the shortfalls we found during the inspection. This was a breach of Regulation 17 of the Health and Social Care Act 2008.”
criticalIncident learning: “The registered manager had not notified CQC of a significant event where people had been placed at risk of potential abuse. This was a breach of Regulation 18 of the CQC (Registration) Regulations 2009.”
Strengths
· People and relatives expressed high satisfaction with care, describing staff as efficient, kind, respectful and well trained.
· Care plans were person-centred, detailed, regularly reviewed and updated in consultation with people and their families.
· Medicines were managed and administered safely, with staff trained and competency-checked regularly.
· Staff received appropriate induction, regular supervision, appraisals and a wide programme of training including the Care Certificate.
· Consistent small teams of staff provided care, with people knowing who was coming and rarely experiencing missed visits.
Quality-Statement breakdown (19)
safe: Systems and processes to safeguard people from the risk of abuseRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Assessing risk, safety monitoring and management; learning lessons when things go wrongGood
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Staff support: induction, training, skills and experienceGood
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: Respecting and promoting people's privacy, dignity and independenceGood
responsive: Planning personalised care to ensure people have choice and controlGood
responsive: Meeting people's communication needsGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportNot rated
well-led: Managers and staff being clear about their roles, understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: Engaging and involving people using the service, the public and staffGood
This targeted inspection of Bespoke Care Services East Dorset Ltd checked compliance with a Warning Notice regarding Regulation 19 (fit and proper persons employed), finding sufficient improvements had been made and the provider was no longer in breach. The overall service rating remains 'Requires improvement' from the previous inspection as targeted inspections do not reassess the full key question.
Concerns (1)
criticalStaffing levels: “the provider had failed to ensure safe recruitment practices were followed. Appropriate recruitment checks were not always completed to ensure that only suitable staff were employed.”
Strengths
· Recruitment practices were safe with all required pre-employment checks completed including DBS, employment references, and health screening.
· Consistent, small team of experienced staff who knew people well and how they preferred their care to be given.
· Provider invested in an electronic rota and planning system providing effective scheduling and organisation of care visits.
· Rotas showed suitable travelling time between visits and staff received rotas in advance.
· Provider was no longer in breach of Regulation 19 following improvements since last inspection.