Archived: Bramley House Extended Care

There were 14 people using the service at the time of this inspection. We spoke with six people by telephone to ask their views about the service they received from the agency.

At our last inspection we found that people who used the service were not always involved in developing their care plans and that care plans did not contain enough information to ensure that staff knew how to provide care appropriately.

Some people told us they did not always receive their visits on time and that they were often not contacted if their care worker was running late.

We found that the provider had distributed satisfaction surveys to seek people's views but had not analysed the results or told people what action they had taken in response to feedback.

Information about the service had not been made available in different formats to make it accessible to people. There were no plans in place to deal with emergencies and there were some gaps in staff recruitment records.

At this inspection we found that the provider had taken action to address these issues.

People told us that the manager had visited them to seek their views about their care plans and the service they received. They said that they had been happy with the manager's response if they had raised concerns or requested changes to their care. We checked a sample of care plans and found that that they contained detailed information for staff about people's needs and the way in which they preferred their care to be provided.

All but one of the people we spoke with told us that their care workers always arrived on time. They said that the agency supplied a replacement care worker if their regular care worker could not attend and let them know if a replacement care worker would be attending.

Information had been made available to people in different formats and contingency plans had been developed to ensure that people would continue to receive care in the event of an emergency. We found that there were effective recruitment and selection processes in place and that the provider had obtained all necessary documentation in relation to staff.

We also found new concerns with regards to recruitment and consent to care and treatment and have set new compliance actions.

As we had given the provider more than adequate time to become compliant and there was little to no movement since the last inspection and as we have also identified two new areas of non compliance, we will require the remaining and new compliance actions to be met in a scale of weeks this time and we will check and take further action if they are not completed within timescales set.

At the time of this inspection Bramley House Extended care was providing an active service to 17 people.

We spoke to 4 people who use the service and one persons' relative who advocated for them.

People we spoke with all made very positive comments about the staff and care they provided and said the staff were caring and treated them well. People also said that they were usually supported by staff familiar to them.

All but one of the newer people receiving a service we spoke to told us they had received quality questioners but none had not yet seen any feedback from the agency as to what quality issues had arisen from the questioners and what the organization was going to do about them to improve quality.

Two people said that they usually received their visits at the right time.

Three people told us they did not always received their visits at the right time and that they usual were not contacted to be informed that they would be coming late. One person told us they should at least have the courtesy to tell you, another told us they can come so late it is my meal time and they have to interrupt it for care, and another person told us there was a day last week when no one came at all.

None of the people we spoke with knew about the agencies out of hours emergency contact system although one had the number of their home career. One person said they would look in the folder but this may not have had the up to date interim measures in place.

We found that before people received any care or treatment they were not asked for their consent and where people did not have capacity the provider did not act in accordance within legal requirements.

We saw there were no written contingency plans to continue appropriate and safe care in all reasonable foreseeable emergencies. This meant that if an emergency situation did occur there would be no procedures known to staff to mitigate the risks that may arise. The previous compliance action regarding this remains unmet.

We noted that people who used the service were not cared for and supported by staff who had appropriate checks undertaken before they began work, to ensure they were suitable to work with the people the service supports.

We found that here were not always enough qualified, skilled and experienced staff to meet people's needs. Although there had been some improvements with recruitment of care workers, there were still shortfalls in staffing that created the same shortfall identified in the last report of insufficient levels of management and administration duties being carried out.

We saw that staff received sufficient supervision to ensure that people who used the service would be cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

We noted that the provider did not have an effective system to regularly assess and monitor the quality of service that people receive and did not have adequate monitoring systems to ensure the effective and safe management of the service.

We found that people were not protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not maintained.

People told us that their care and support needs with them and they were provided with a copy of their care plan. We found that not all people's care plan reviews were up to date.

People we spoke with all made very positive comments about the care and support they received. People told us "I am more then happy with the service", "I am very happy with the care" and "excellent staff".

People said that they always received their visits at the right time and the right numbers of staff were always available to support them. People also said that they were always supported by staff familiar to them.

Staff received training and development and they told us that they liked working at the agency. Although we found that found that staff were not receiving regular formal supervision to monitor their practice.