Biliv Care Limited

We assessed the service against ‘Right support, right care, right culture’ guidance to make judgements about whether the provider guaranteed people with a learning disability and autistic people respect, equality, dignity, choices, independence and good access to local communities that most people take for granted.

The inspection was prompted by stakeholder information shared with us. This was the first inspection for this provider and we have assessed the service against all the quality statements in the key questions of safe, effective, caring, responsive and well-led.

The provider was developing a learning culture to make improvements when things had gone wrong. However, this was not always effective. The provider investigated incidents thoroughly but outcomes, conclusions and mitigations put in place to reduce to risk of reoccurrence needed to be clearer. People and their relatives felt they could raise concerns. Staff understood and managed risks. However, some risks had not been identified and information put in place to support staff knowledge of some specific medical and health conditions. The provider’s oversight of staff learning did not always ensure training was completed in a timely way. The provider had not always assessed the effectiveness of the training to ensure staff were confident and competent to apply their learning in practice.

The provider’s governance processes had not always been effective in identifying where improvements were needed, how these improvements would be implemented and embedded into the service delivery.

People were protected from the risk of abuse because staff knew what to look for and how to report concerns. There were enough staff available to support people. Staff received supervision and support to maintain quality care. Staff managed medicines well and involved people in planning any changes. There were no concerns identified with infection control practices.

People were involved in assessments of their needs. Care plans considered people’s communication, personal and health needs. Care was based on latest evidence and good practice. Where people required support with their nutritional and hydration needs, they had enough to eat and drink to stay healthy. The provider and the staff worked with all agencies involved in people’s care for the best outcomes and supported smooth transitions for people moving between their home and hospital. Staff understood the importance of supporting people’s independence and gaining people’s consent and involved people in decisions about their care. Staff were knowledgeable about the process to follow if a decision was needed to be taken in people’s best interests where they did not have capacity.

People received person centred care including those related to their protected equality characteristics. People’s care was reviewed to ensure this remained effective. Staff understood people’s rights and how these should be met. Staff were encouraged to raise concerns, and they felt listened to.

People were treated with kindness and compassion. Staff protected people’s privacy and dignity and treated them as individuals supporting their individual preferences. People felt involved in their care and told us staff responded to their needs in a timely way. The provider supported staff wellbeing.

People were involved in decisions about their care. Information provided to people living with a learning disability or sensory impairment could be made clearer and presented in a more suitable format, such as easy read. People knew how to give feedback and were confident the provider took any concerns seriously and would act on it in a timely manner. The service was easy to access and worked to eliminate discrimination. People received fair and equal care and treatment. The provider supported staff to reduce health and care inequalities through training and feedback.

The provider and staff had a shared vision and culture based on listening, learning and trust. The registered manager and nominated individual were visible and supportive, helping staff develop in their roles and would lead by example. Staff felt supported to give feedback and told us they were treated equally, free from bullying or harassment. Staff understood their roles and responsibilities. There was a culture of continuous improvement. The provider took a positive approach to our assessment and considered it an opportunity to learn and make improvements.

The provider was in breach of the legal regulations in relation to assessing some risks to the health and safety of people and processes to monitor and improve the quality of the service.

In instances where CQC have decided to take civil or criminal enforcement action against a provider, we will publish this information on our website after any representations and/ or appeals have been concluded.