We carried out this assessment from 6 September to 3 October 2024. We visited the registered office on 13, 20 and 24 September 2024. This assessment was carried out following concerns shared with us about people's safety. Right At Home Bedford is a domiciliary care agency that provides the regulated activity of personal care to people in their own homes. We looked at all quality statements from the safe, caring, and well-led key questions. We found areas of concern and good practice. The scores for the effective and responsive key questions are based on the key question ratings from previous inspections. Our overall rating of this service has changed from outstanding to requires improvement. We found 3 breaches of legal regulations in relation to safe care of people, safeguarding, and governance arrangements. There were concerns regarding reporting safeguarding concerns, incident reporting, managing medicines, and care planning. People's needs were not always well assessed and planned for. However, the provider had appropriate safeguarding policies and procedures, and staff knew who they could report concerns to externally. Staff told us leaders were approachable and supportive.
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Right at Home Bedford received an Outstanding overall rating on its first inspection, with Outstanding ratings for Caring and Well-led, driven by an exceptionally person-centred culture, highly motivated staff, and distinctive leadership that embedded continuous improvement and genuine compassion throughout the service. No regulatory breaches or failure themes were identified.
Strengths
· Exceptional person-centred culture with staff going above and beyond, including arranging a live football match visit and Christmas activities for isolated people.
· Careful staff-to-client matching based on personality, interests, language and cultural background, including Punjabi-speaking carers.
· Robust safeguarding systems with staff confident in reporting concerns and clear escalation pathways to local authority safeguarding teams.
· Strong medicines management with regular audits, competency spot checks and clear PRN protocols.
· Distinctive and visible leadership with registered manager and managing director attending care calls and maintaining close knowledge of every person.
Quality-Statement breakdown (24)
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Assessing risk, safety monitoring and managementGood
safe: Staffing and recruitmentGood
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
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 care; supporting people to live healthier livesGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
caring: Ensuring people are well treated and supported; respecting equality and diversityOutstanding
caring: Supporting people to express their views and be involved in making decisions about their careOutstanding
caring: Respecting and promoting people's privacy, dignity and independenceOutstanding
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesGood
responsive: Meeting people's communication needsGood
responsive: Supporting people to develop and maintain relationships to avoid social isolation; support to follow interestsGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportGood
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringOutstanding
well-led: How the provider understands and acts on the duty of candour; managers and staff being clear about their rolesOutstanding
well-led: Engaging and involving people using the service, the public and staff, fully considering their equality characteristicsOutstanding
well-led: Continuous learning and improving careOutstanding
well-led: Working in partnership with othersOutstanding