BGS Healthcare Ltd is a domiciliary care agency providing the regulated activity personal care. At the time of our assessment there were 90 people using the service. We undertook an announced on-site assessment on the 23 and 28 February 2024. 2 inspectors and expert by experience completed this assessment. People felt safe and staff were aware of their responsibilities to identify and report potential abuse. Staff received safeguarding training and were confident any concerns raised would be properly dealt with. Staff understood mental capacity and were able to apply their knowledge in practice. Staff worked with people to assess any risks they faced. There were detailed risk management plans, which gave staff clear guidance on what to do to support people safely. There were systems to minimise the risk of infection and clear focus had been given to improve the safe management of people’s medicines. There were enough staff to meet people’s needs, and people were supported by a consistent staff team. People were complimentary about the staff and positive relationships had been developed. Staff had been recruited safely with all pre-employment checks completed prior to them starting. People had a comprehensive care plan, which they helped devise and review. Their rights to choice, independence, dignity and respect were promoted. Staff were well supported by leaders, which enabled good person-centred care to be delivered. Leaders were involved in the service daily and had oversight of service provision. There were a range of governance systems and office staff were assigned different responsibilities. However, shortfalls in the quality of people’s daily records, had not been identified. Leaders told us training sessions would be arranged to address this. There were regular competency checks and spot checks of staff’s performance to ensure a good standard of care was being provided.
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This targeted inspection of BGS Healthcare Ltd found sufficient improvements had been made to meet the requirements of a Warning Notice relating to Regulation 17 (good governance), specifically around medicines management. The overall rating of Requires Improvement from the previous comprehensive inspection remains unchanged as this targeted inspection did not assess all areas of the key questions.
Strengths
· Medicines managed safely using an electronic system enabling timely oversight and trend analysis
· Second-check system implemented for medicine transcription to reduce errors
· Staff trained and observed administering medicines, with reflective learning following errors
· Collaborative working with GPs and healthcare professionals to support people's medicine needs
· Clear policies covering transdermal patches, topical medicines, safe storage and cultural considerations
safe:Insufficient evidence to ratewell-led:Insufficient evidence to rate
This targeted inspection of BGS Healthcare Ltd focused solely on medicines management following a warning notice for breach of Regulation 12; the provider had met the notice requirements but ongoing inconsistencies in MAR recording investigation meant further improvement was still needed. The overall rating remains Requires Improvement as not all key question areas were assessed.
Concerns (2)
moderateMedication management: “Codes signifying that people did not have their medication were not investigated. This meant that some inconsistency in medicines recording were not always identified.”
moderateGovernance: “We saw audits in place to monitor medicines management were not always robust.”
Strengths
· Provider met the warning notice requirements and was no longer in breach of Regulation 12 (safe care and treatment)
· Staff received additional face-to-face training in medicines management and were knowledgeable about safe administration and storage
· A new digital system was implemented to monitor medicines administration and alert management to missed medicines in real time
· A new system for disposing refused or disused medicines was implemented
· Monthly medicines audits were introduced to maintain oversight of medicine administration
BGS Healthcare Ltd received an overall rating of Requires Improvement for the third consecutive time, with three regulatory breaches found relating to unsafe medicines management (Warning Notice issued under Regulation 12), failure to notify CQC of a safeguarding incident (Regulation 18), and ineffective governance systems (Regulation 17). Caring, effective, and responsive domains were rated Good, with staff described as compassionate and person-centred care plans in place.
Concerns (8)
criticalMedication management: “Staff were dispensing medicines for people to take later and signing the MARs with a 'P'...no risk assessment in place to support this practice.”
criticalMedication management: “There were gaps in people's MARs...some gaps had no explanation. This meant that people may not have had their medicines on some days.”
criticalGovernance: “Audits had not identified some gaps and inappropriate practices in relation to medicines administration.”
criticalSafeguarding: “The provider had not submitted one statutory notification in relation to safeguarding concerns...breach of Regulation 18 (2)(e).”
moderateRecord keeping: “Management of complaints had not been sufficiently recorded, this meant that we were unable to assess whether these had been handled appropriately.”
moderateIncident learning: “There was no clear overview and analysis of accidents and incidents used to identify possible trends or patterns.”
moderateStaff competency: “Other staff told us they didn't understand the principles of the Act and couldn't remember if they had received training in this area.”
minorComplaints handling: “We saw no formal record of response to complaints the service received...responses were done verbally either via phone call or face to face.”
Strengths
· People told us staff were caring and treated them with respect, with multiple positive testimonials from service users.
· Care plans were personalised; staff knew people well and people told us they were happy with the care they received.
· Staff received regular training and had regular one-to-one support from their line manager.
· People were involved in writing their care plans and told us they felt they had choice and control in their day-to-day care.
· The service worked in partnership with other healthcare professionals including physios, GPs and occupational therapists.
Quality-Statement breakdown (21)
safe: Using medicines safelyRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Learning lessons when things go wrongRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Assessing risk, safety monitoring and managementGood
safe: Preventing and controlling infectionGood
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the law
BGS Healthcare Ltd received an overall rating of Requires Improvement at its April 2018 inspection, with a regulatory breach of Regulation 12 identified due to unsafe and poorly recorded medicines management, alongside weaknesses in risk assessment detail, Mental Capacity Act compliance, and person-centred care planning. The service demonstrated genuine strengths in its caring approach, staff dedication, safeguarding awareness, and responsiveness to people's health needs, and had remediated the previous Regulation 17 breach from March 2017.
Concerns (9)
criticalMedication management: “Medicines were not always managed safely. Processes in place did not clearly identify the level of support that people received with their medicines.”
criticalMedication management: “We saw gaps on people's MAR's which made it hard to ascertain if the person had received their medicines or staff had forgotten to sign.”
criticalMedication management: “One person's MAR was being signed by staff but it had no recorded medicines on it, instead it just stated the month 'November'”
moderateConsent / capacity: “At times the service had accepted decisions made by relative's who did not have the appropriate legal authority to make that decision or consent on a person's behalf.”
moderateCare planning: “We found there was a lack of person centred detail in some of the plans. The majority of people's care plans were written on one page and some were very brief.”
moderateRecord keeping: “Some risk assessments were incorrectly completed and this had not been identified during reviews.”
moderateGovernance: “Completed audits had not identified all of the concerns we found at this inspection. One audit review stated that care plans needed to be more detailed. However, this audit had no date.”
minorPerson-centred care: “The information did not identify the individual as a person in their own right with specific wishes and preferences.”
minorMissed or late visits: “People consistently raised that the times of visits were varied and this caused frustration. 'They don't come at a set time unfortunately, but they do always come'”
Strengths
· People felt safe and staff demonstrated awareness of safeguarding responsibilities and escalation procedures.
· Sufficient staffing levels maintained; staff reported not feeling rushed during care visits.
· People and relatives spoke positively about caring, respectful staff who upheld dignity and promoted independence.
· Staff dedication praised, including attending visits on foot during severe snow conditions.
· Good working relationships with health and social care professionals, who praised responsiveness and approachability.
This targeted inspection of BGS Healthcare Ltd identified a continued breach of Regulation 17 (good governance) due to persistent failures in medicines management, including inaccurate records, absent competency checks, and no evidence of learning from medicines errors. The overall rating remains Requires Improvement from the previous comprehensive inspection; a warning notice was served.
Concerns (6)
criticalMedication management: “People's medicines administration records were not always clearly updated with changes. This had contributed to two medicines errors.”
criticalGovernance: “There was no evidence of analysis of medicines errors and a review of what had happened and why. There was no evidence of reflective practice for the staff.”
criticalRecord keeping: “Systems were not in place to check the accuracy of transcribing medicines information onto the providers electronic system. This had led to a medicines error.”
moderateMedication management: “People who had been prescribed medicine to be given using a patch did not have a record for staff to know where on the body the patch had been applied.”
moderateStaff competency: “Staff had not all been shown how to apply topical creams or eye drops. There had also been no competency checks for this type of medicines administration.”
moderateIncident learning: “There was no evidence of analysis of medicines errors and a review of what had happened and why. There was no evidence of reflective practice for the staff.”
Strengths
· People and relatives expressed satisfaction with medicines support; staff described as competent and helpful.
· Body maps in place to guide staff on where to apply topical creams.
· Medicines administration records included allergy information and level of support required.
· Regular medicines audits completed with some issues identified and improvement actions recorded.
· Staff felt able to seek advice from the office if unsure about medicines administration.
Quality-Statement breakdown (2)
safe: Using medicines safelyInsufficient evidence to rate
safe: Learning lessons when things go wrongInsufficient evidence to rate
BGS Healthcare Ltd requires improvement overall, with breaches of Regulation 17 due to failure to notify CQC of safeguarding alerts and the absence of a robust system for monitoring missed or late visits. Staff training records were inconsistent and unverifiable, and supervision documentation was incomplete, though people and relatives consistently praised the compassionate, reliable and person-centred care delivered by staff.
Concerns (7)
criticalGovernance: “We had not been notified of the three safeguarding alerts made to the local authority by the registered manager... breach of Regulation 17(2)(a),(b),(d) of the Health and Social Care Act 2008”
criticalMissed or late visits: “There was no robust system for missed or late calls, relied on staff or the person informing the office.”
criticalSafeguarding: “We had not been notified as required of safeguarding alerts made to the local authority.”
moderateStaff training: “We saw two systems for recording training, one paper and one computer based. The two systems didn't correlate; this resulted in us being unable to confirm that all staff had undertaken the training necessary.”
moderateStaff competency: “We were told that the district nurse had provided the training to staff on how to manage the catheters, however there were no records to confirm this.”
moderateSupervision / appraisal: “Despite this, supervision records were not always in place for all the meetings which had taken place.”
minorRecord keeping: “One care plan stated 'currently being hoisted. The registered manager told X is unable to move, but they are able stand for a wash and should have been updated.'”
Strengths
· People and relatives were very complimentary about the standard of care and support received, describing staff as compassionate, kind and reliable.
· Safe recruitment checks had been completed including criminal records, references and proof of ID.
· Staffing levels were sufficient and adjusted according to people's needs; continuity of care was maintained by assigning two or three regular staff to each person.
· Consent and Mental Capacity Act processes were in place; mental capacity assessments were undertaken where required.
· Care plans detailed people's preferences, likes and dislikes, and regular reviews were conducted and agreed with people and their representatives.
Quality-Statement breakdown (14)
safe: Recruitment checksGood
safe: Safeguarding awareness and proceduresGood
safe: Medicines managementGood
safe: Staffing levelsGood
effective: Staff training records and monitoringRequires improvement
effective: Staff supervision and appraisal recordsRequires improvement
effective: Consent and Mental Capacity ActGood
caring: Relationships, dignity and respectGood
Good
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
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: Planning personalised care to meet people's needs, preferences, interests and give them choice and controlGood
responsive: Improving care quality in response to complaints or concernsRequires improvement
responsive: End of life care and supportGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Planning and promoting person-centred, high-quality care and support with opennessGood
well-led: Engaging and involving people using the service, the public and staffGood
well-led: Working in partnership with othersGood
effective: Health needs monitoring
Good
caring: Dignity and respectGood
caring: Involvement in care choicesGood
caring: Relationship building with peopleGood
responsive: Person-centred care planningRequires improvement
responsive: Complaints handlingGood
responsive: Communication and information needsGood
well-led: Quality assurance and auditRequires improvement