Browncross Healthcare Limited (Domiciliary Services)

People’s experience of using this service:

People and their relatives were positive about the caring nature of their regular care workers.

People told us staff were sensitive when providing personal care which helped them to feel comfortable and ensured their dignity was respected.

People and their relatives felt the service was personalised and the provider listened to them if they had any concerns. With reablement and urgent discharge care, the provider tried to be as flexible as possible to meet their needs.

People were given regular opportunities to give feedback about the service and felt the provider was approachable. Issues were discussed across the organisation as a learning opportunity and the provider had been proactive in addressing areas that needed improvement.

People were cared for by staff who felt valued and supported in their role. Care workers spoke positively about the support they received and how they were encouraged to improve the quality of care.

The provider worked closely with a range of health and social care professionals to ensure people received effective care and support. Staff had demonstrations from occupational therapists to help with safe moving and handling procedures.

Rating at last inspection: At the last inspection the service was rated Good. (Report published 5 May 2017).

Why we inspected: This was a planned comprehensive inspection based on the outcome of the previous inspection. We had been in regular contact with the provider to monitor the size of the service.

Follow up: We will continue to monitor information and intelligence we receive about the service until we return to visit as per our re-inspection guidelines. We may inspect sooner if any concerning information is received.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

At our previous inspection on 23 and 25 August 2016 a breach of legal requirements was found. After the inspection, the provider wrote to us to say what they would do to meet the legal requirements in relation to notifications.

We undertook this focussed inspection to check that they had followed their plan and to confirm that they now met the legal requirements in relation to the breach found. This report only covers our findings in relation to this requirement. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Browncross Healthcare Limited’ on our website at www.cqc.org.uk’

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Browncross Healthcare Limited is a domiciliary care agency which provides personal care and support to people in their own homes. At the time of our visit the service was providing personal care and support to 55 people in the London Boroughs of Bexley, Camden and Barking and Dagenham.

At our previous inspection we found that the provider did not always notify the CQC of notifiable incidents.

At this inspection, we found that improvements had been made.

The provider was aware of the type of incidents that they were required to notify the Care Quality Commission (CQC) of and had reviewed their notifications protocol. Records of the notifications were kept with additional information added as investigations were carried out.

After the comprehensive inspection, the provider told us what they would do to meet legal requirements in relation to managing risks to people’s safety and welfare, consent, governance, and person centred care. We carried out this inspection to check that they had followed their plan and to confirm that they now met legal requirements. During this inspection we found that improvements had been made.

Browncross Healthcare Limited is a domiciliary care agency which provides personal care and support to people in their own homes. At the time of our visit the service was providing personal care and support to 49 people in the London Boroughs of Bexley, Camden and Barking and Dagenham. All of the people using the service were funded by their local authority.

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The provider had updated their medicines policy in January 2016 which took into account the concerns raised at the last inspection and was reviewed again in May 2016. Staff had completed training in medicines which was refreshed annually.

People’s risks were managed and care plans contained appropriate risk assessments which were updated regularly when people’s needs changed. The provider had a robust recruitment process and staff had the necessary checks to ensure they were suitable to work with people using the service. People had regular care workers to ensure they received consistent levels of care.

People and their relatives told us they felt safe using the service and care workers understood how to protect people from abuse. Staff were confident that any concerns would be investigated and dealt with. All staff had received training in safeguarding adults from abuse and had a good understanding of how to identify and report any concerns.

Care workers received an induction training programme to support them in meeting people’s needs effectively and were always introduced to people before starting work with them. They shadowed more experienced staff before they started to deliver personal care independently and received regular supervision from management. They told us they felt supported and were happy with the supervision they received and the content of the training available.

Staff understood the principles of the Mental Capacity Act 2005 (MCA). Care workers respected people’s decisions and gained people’s consent before they provided personal care.

Care workers were aware of people’s dietary needs and food preferences. Care workers told us they notified the office if they had any concerns about people’s health and we saw evidence of this in people’s daily logs and minutes of meetings. We also saw people were supported to maintain their health and well-being through access to health and social care professionals, such as GPs, district nurses and social services.

People and their relatives told us care workers were kind and caring and knew how to provide the care and support they required. Care workers understood the importance of getting to know the people they supported to develop positive caring relationships.

People told us that staff respected their privacy and dignity and promoted their independence. There was evidence that language and cultural requirements were considered when allocating care workers to people using the service.

People were involved in planning how they were cared for. An initial assessment was completed from which care plans and risk assessments were developed. Care was personalised to meet people’s individual needs and was reviewed if there were any significant changes, with health and social care professionals being updated on people’s current condition.

People and their relatives knew how to make a complaint and were able to share their views and opinions about the service they received. There were regular monitoring systems in place to allow people and their relatives the opportunity to feedback about the care and treatment they received. The provider allocated a member of staff to deal with each complaint that was received.

The provider was aware of the concerns that had been highlighted at the previous inspection and the management team had worked hard to make a number of improvements to the quality of service, which had been highlighted by people and their relatives. They were open and honest during the inspection when information was not available and acknowledged when there had been an oversight.

Staff felt well supported by the management team and were confident they could raise any concerns or issues, knowing they would be listened to and acted on.

There were processes in place to monitor the quality of the service provided and understand the experiences of people who used the service. This was achieved through regular communication with people, care workers, supervision and an enhanced monitoring programme that had been developed since the previous inspection. However the registered manager failed to notify the CQC about a safeguarding concern that had been raised which is a legal requirement of the provider’s registration.

We identified one breach of the Regulations in relation to notifications and you can see what action we told the provider to take at the end of the full version of this report.

The detailed evidence supporting our summary can be read in our full report.

Is the service safe?

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. If the service identified that someone was at risk, for example of having a fall, then they put strategies in place to minimise those risks.

People were cared for, or supported by, suitably qualified, skilled and experienced staff. The service carried out in-house training which covered key skills that care staff may need to carry out their job. New members of staff were carefully checked in terms of their suitability for the role. For example, the service followed-up on references, required photographic identification, and carried out Disclosure and Barring Service (DBS) checks.

Is the service effective?

We found that people's needs had been assessed and suitable care plans were in place. These were regularly reviewed. The service was also able to accommodate requests in relation to providing care that was in line with people's religious persuasion, or cultural and linguistic background.

People's health, safety and welfare was protected when more than one provider was involved in their care and treatment, or when they moved between different services. This was because the provider worked in co-operation with others.

Is the service caring?

People's privacy, dignity and independence were respected. People's views and experiences were taken into account in the way the service was provided and delivered in relation to their care. People told us that the care staff were polite and respectful. For example, one of the people using the service told us "the care staff are courteous and helpful. I enjoy their company."

Care staff knew what was required and were following each person's care plan. The people using the service were generally satisfied with the care they received. One person said "They are really nice and very helpful. If there are ever any problems, then they can usually find a solution."

Is the service responsive?

We examined how the service responded to complaints as well as what actions they took. We looked at responses to any adverse incidents involving people who used the service. We saw that the service responded to these issues by carrying out investigations and then took actions to resolve any problems.

Is the service well led?

The provider had effective systems to regularly assess and monitor the quality of service that people received. For example, people using the service were regularly visited by care co-ordinators in order to elicit their views about the quality of the care. The service had also carried out a survey with the people using the service about the quality of the care they had received. The provider had taken actions where they identified any poor performance. Members of staff were invited to attend meetings where they could raise any concerns and the quality of care being provided was discussed.

People told us they were consulted about how their care was provided. We saw that people's care needs were assessed and recorded in their care plans. Risk assessments had been carried out and information was updated as required.

Staff training and procedures were in place to make sure any medication needs could be safely met, although none of the people using the service at the time of this inspection needed any support from their care workers to take medication.

Following our last inspection we asked the provider to improve the recording of staff training, supervision and appraisals. We found during this visit that staff training, supervision and appraisals were well recorded.

There were systems in place to monitor the quality of the service. Regular spot checks were carried out and customer satisfaction surveys were used to gather the views and experiences of people using the service.

One person told us they are 'happy with the care, once we get a care worker who becomes a regular and knows what our [relative] needs, then the care goes well'. Another relative told us "lovely carer, provides respite care for my [relative], an absolute gem, rings me up if she is going to be held up, can really trust her.'

Relatives of people using the service told us that they felt consulted about their family members' needs but no one said that they had been asked to comment on the quality of the service.