Date of assessment 23 June to 24 June 2025. Bell Green, also known as Asher Excellent Ltd, is a domiciliary care agency registered to provide personal care to people in their own homes. The service provides support to older and younger people, some of whom have dementia and / or physical disabilities. At the time of our inspection the service was supporting 1 person. The last rating for this service was inadequate (report published 30 June 2023). We identified 3 breaches of the regulations, and 2 warning notices were served due to the provider’s failure to meet these legal regulations. We undertook this inspection to check improvements had been made and to confirm they now met legal requirements. This service has been in Special Measures since 27 June 2023. The purpose of special measures is to ensure that services providing inadequate care make significant improvements. Special measures provide a framework within which we use our enforcement powers in response to inadequate care and provide a timeframe within which providers must improve the quality of the care they provide. At this inspection we found sufficient improvement had been made and the service was no longer in special measures. Improvements meant the provider was no longer in breach of the regulation relating to safe care and treatment and safe staffing, but we found a continued breach of the regulation related to good governance. The provider had not consistently implemented systems and processes to record their checks on the safety and quality of the service. The provider’s informal unrecorded checks did not meet the requirements of the regulations and meant they may not identify areas where improvements were needed. Overall, improvements had been made to the safety of the service. For example, staff were recruited in a safe way and people were supported with their medicines when needed. Some further improvements were needed in risk management and the safe handling of medicines to ensure staff always had important information to refer to when needed. Staff demonstrated an effective, caring and responsive approach when delivering care and support.
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Bell Green (Asher Excellent Ltd), a domiciliary care agency supporting one person at the time of inspection, was rated Inadequate overall at its first inspection, with breaches of Regulations 12, 17 and 19 resulting in Warning Notices and special measures. Critical failures spanned unsafe risk management, absent medicine administration records, incomplete pre-employment checks, no staff identity badges, and ineffective governance by a provider also holding full-time employment elsewhere.
Concerns (12)
criticalMedication management: “there was no medicine administration record (MAR) in place for staff to follow the prescriber's directions or to record administration as required.”
criticalCare planning: “Care plans and general risk assessments failed to provide staff members with the information needed to ensure people received safe care which met their needs.”
criticalStaff training: “Staff had not received all the training they needed. Whilst the care certificate is a part of training...it does not provide all the knowledge, skills and experience staff need.”
criticalSafeguarding: “People were not always protected from risks of abuse because care staff were not issued with an identity badge before undertaking care calls alone to people.”
criticalGovernance: “The provider did not have effective quality assurance systems and processes in place.”
moderateStaffing levels: “There was no effective care call monitoring system in place...One person told us about frequent lateness they experienced, telling us, 'Staff are often late'.”
moderateRecord keeping: “no record of the initial assessment was recorded or included in the plan of care.”
moderateStaff competency: “A staff member referred to 'calling 911' when they should have referred to 999 for a UK emergency number.”
moderateInfection control: “The provider had no information available for staff to refer to about infection control and prevention when working in people's own homes.”
moderateLeadership: “The provider had another full-time job elsewhere...This meant support available to staff was limited.”
minorIncident learning: “There was a system in place to record any accidents or incidents but there was no analysis process in place for when needed.”
minorPerson-centred care: “People's plans of care did not give staff information about their hobbies and interests.”
Strengths
· People gave positive feedback about the caring approach of staff; one person said 'I like the staff because they are calm and reassuring to me.'
· Staff respected and promoted people's privacy and independence during personal care.
· People were supported with nutritional and hydration needs; one person said 'Staff take their time in supporting me with meals, I enjoy cooking with them.'
· The provider engaged with people for feedback and visited them personally; one person said 'The manager comes and visits me and asks me about how things are, they really go the extra mile for me.'
· Staff felt supported by the provider and had access to PPE stocks.
Quality-Statement breakdown (19)
safe: Assessing risk, safety monitoring and managementInadequate
safe: Using medicines safelyInadequate
safe: Staffing and recruitmentInadequate
safe: Systems and processes to safeguard people from the risk of abuseInadequate
safe: Preventing and controlling infectionRequires improvement
safe: Learning lessons when things go wrongRequires improvement
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Staff work with other agencies to provide consistent, effective, timely careRequires improvement
effective: Ensuring consent to care and treatment in line with law and guidanceGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
caring: Ensuring people are well treated and supported; respecting equality and diversityRequires improvement
caring: Respecting and promoting people's privacy, dignity and independenceGood
responsive: Planning personalised care to ensure people have choice and controlRequires improvement
responsive: Meeting people's communication needsRequires improvement
responsive: Improving care quality in response to complaints or concernsGood
well-led: Managers being clear about their roles, and understanding quality performance, risks and regulatory requirementsInadequate
well-led: How the provider understands and acts on the duty of candourRequires improvement
well-led: Continuous learning and improving care; Working in partnership with othersRequires improvement
well-led: Engaging and involving people using the service, the public and staffGood