Business Services Bromley received an overall rating of Requires Improvement for the second consecutive time, with continuing regulatory breaches under Regulations 12 and 17 for unsafe risk assessment and medicines management and ineffective governance systems, alongside a new breach of Regulation 18 for an inadequate staff training programme. Strengths were noted in the caring and responsive domains, with staff treating people with dignity, involving them in care planning, and maintaining consistent, timely visits.
Concerns (10)
criticalCare planning: “A third person had fluctuating mobility and required staff to use a hoist...their moving and handling risk assessment did not contain any guidance for staff detailing the steps staff should follow to safely hoist them.”
criticalMedication management: “We found six gaps on one person's MAR from August 2018 and five gaps on another, which meant we were unable to establish whether the two people had received their medicines as prescribed.”
criticalMedication management: “One person's MAR contained inaccurate information regarding the maximum safe dose of an 'as required' pain relieving medicine.”
criticalStaff training: “The registered manager was unable to explain how staff were able to effectively complete training in such a wide number of areas on a single day.”
criticalStaff training: “Records also showed that the same staff member was working on 12 May 2018 so they could not have attended training on that date.”
criticalGovernance: “The provider's systems for monitoring the quality and safety of the service were ineffective in consistently identifying issues or driving improvements.”
moderateGovernance: “In total we found areas of concern in five people's care plans which had not been identified by the provider during their auditing process.”
moderateLeadership: “They were not aware of all of the different events which they were required to notify CQC about...they were unaware of the frequency at which a hoist should be serviced.”
moderateCare planning: “The assessment did not consider nutrition or hydration, or people's skin integrity to help demonstrate that assessments had been conducted holistically.”
moderateCare planning: “People's care plans did not identify when they received support from other healthcare services, or whether support from healthcare professionals had been considered.”
Strengths
· Staff were kind, caring and treated people with dignity and respect, with people and relatives speaking positively about their interactions.
· The provider followed safe recruitment practices including DBS checks, identity verification, employment history and references.
· Sufficient staff were deployed to meet people's needs, with travel time included in rotas and no missed visits reported.
· Staff were aware of safeguarding procedures and knew how to report abuse allegations to the manager and CQC.
· Staff were supported through regular supervision (at least quarterly) and an annual appraisal.
Quality-Statement breakdown (25)
safe: Risk assessment and care planning for identified risksRequires improvement
safe: Medicines managementRequires improvement
safe: Staffing levels and deploymentGood
safe: Safe recruitment practicesGood
safe: Safeguarding awarenessGood
safe: Infection controlGood
safe: Incident and accident reporting and reviewGood
effective: Induction and training programmeRequires improvement
Business Services Bromley, a small domiciliary care agency supporting five people, improved from Requires Improvement to Good across all key questions, having resolved three previous regulatory breaches in safe care and treatment, staffing, and good governance. The service demonstrated consistent safe practice, personalised care planning, strong staff support structures, and effective quality assurance systems.
Strengths
· Risks to people had been assessed with clear staff guidance in care plans, representing improvement from previous breach of regulation 12.
· Medicines safely managed with up-to-date MARs, competency-assessed staff, and PRN guidance in place, resolving previous regulation 12 breach.
· Sufficient staffing with no missed visits reported; safe recruitment practices including DBS checks and references.
· Staff received safeguarding training and were aware of internal and external reporting routes including whistleblowing.
· Staff received induction, Care Certificate, ongoing training, regular supervision and annual appraisals, resolving previous regulation 18 breach.
Quality-Statement breakdown (23)
safe: Assessing risk, safety monitoring and managementGood
safe: Using medicines safelyGood
safe: Staffing and recruitmentGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
effective: Staff support: induction, training, skills and experienceGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood