Archived: Brookleigh Caring Services

Brookleigh Caring Services is a domiciliary care agency registered to provide personal care to people in their own home. At the time of our visit there were 309 people receiving personal care calls.

The service had a registered manager in place. 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.

The service was previously inspected on 19 January 2016 and was not meeting one of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This related to safe care and treatment. We took action by requiring the registered provider to send us action plans telling us how they would improve this. When we returned for this inspection we found the issues identified had not been addressed.

The systems and processes in place to protect people from the risk of harm were still not sufficiently robust. We saw that some risks had been identified without any information on how staff could mitigate these risks. Other risks were apparent from information in people’s care records but no risk assessment was in place.

We considered that the service was failing to protect people using the service against the risks associated with the unsafe use and management of medicines.

Clear and accurate records were not being kept of medicines administered by care workers. Gaps in the medicines administration records meant we could not be sure people were always given their prescribed medicines. Details of the strengths and dosages of some medicines were not recorded correctly. Care plans and risk assessments did not support the safe handling of people’s medicines.

Complaints were not always being handled in line with the registered provider’s complaints policy.

Records were not always comprehensive or up to date. Contact information we were given was not current. Some people’s care plans lacked the level of detail required to be person centred. Person centred planning is a way of helping someone to plan their life and support, focusing on what’s important to the person.

A number of people we spoke with told us it was difficult to contact the office and calls were not always returned. People did not always receive rotas informing them which staff would be providing their care.

Although there were systems in place to monitor and improve the quality of the service provided these were not being used effectively to make improvements. The results of a satisfaction survey was analysed but no action plan was produced and people’s comments were not taken into consideration. Audits of care plans and medicines had not picked up the issues we identified.

Staff were able to tell us about different types of abuse and were aware of the action they should take if they suspected abuse was taking place. Staff were aware of whistle blowing procedures and all said they felt confident to report any concerns.

Appropriate environmental checks had been done on people’s homes to ensure health and safety of staff and the people they cared for.

Staff had received appropriate training and had the skills and knowledge to provide support to the people they cared for. New staff had a comprehensive induction and shadowed a more experienced colleague until they were sufficiently confident and capable to work alone.

People who used the service were happy with the care provided by staff. Staff were knowledgeable about the people they provided care to; they promoted independence and respected people’s privacy and dignity.

People were supported to maintain good health and to access health professionals when needed.

We found that safe recruitment and selection procedures were in place and appropriate checks had been undertaken prior to staff starting work.

Staff had been receiving regular supervision and annual appraisals to monitor their performance.

Staff had received training on the Mental Capacity Act (2005) and demonstrated an understanding of the requirements of the Act.

We saw that people were given support to ensure their nutritional needs were met.

Staff meetings were held regularly and staff who were unable to attend had access to the meeting minutes. The registered manager was described as approachable and staff told us they felt supported by management.

We identified a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the registered provider to take at the back of the full version of the report. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

We last inspected the service on 20 June 2014 and found that the service was not in breach of any of the regulations inspected at that time.

Brookleigh Caring Services is a domiciliary care agency registered to provide personal care to people in their own home. At the time of our visit 309 people were using the service for the provision of personal care.

The service had a registered manager in place. 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.

We saw that some individual risk assessments were in place and that they covered the key risks specific to the person. These included areas such as risk of falls and moving and handling, but they did not always contain sufficient detail. Some risks had been identified but no corresponding risk assessment was in place.

We looked at care plans and found that they lacked sufficient detail to be suitably person centred. We have made a recommendation about care planning.

Although staff were observed administering medication safely, records were not always correct. We have made a recommendation about the management of records for medicines.

People told us they felt there were sufficient staff and although call times were not always strictly adhered to, when staff were running late people were contacted to advise them of the delay. The service had no recorded missed calls.

Staff received appropriate training and had the skills and knowledge to provide support to the people they cared for. New staff underwent a comprehensive induction and shadowed a more experienced colleague until they were judged competent to carry out calls alone.

There were systems and processes in place to protect people from the risk of harm. Staff were able to tell us about different types of abuse and were aware of the action they should take if they suspected abuse was taking place. Staff were aware of whistle blowing procedures and said they felt confident to report any concerns without fear of recrimination.

Appropriate environmental checks had been done on people’s homes to ensure the health and safety of staff and the people they cared for.

Staff were knowledgeable about the people they provided care to and were respectful of people’s privacy and dignity. People who used the service said that staff were caring and kind. People told us that staff encouraged them to be independent and they were happy that staff took time to chat with them.

People were supported to maintain good health and to access health professionals when needed.

We found that safe recruitment and selection procedures were in place and appropriate checks had been undertaken prior to staff starting work. However we found there to be some documents missing from recruitment files, for example health monitoring forms and some gaps in employment were not fully explored. These omissions were not widespread and did not impact on the overall safety of the recruitment process.

Staff received regular supervision and annual appraisals to monitor their performance.

Staff received training on the Mental Capacity Act (2005) and demonstrated an understanding of the requirements of the Act.

We saw that, where appropriate, people were provided with a choice of food and drinks to help ensure their nutritional needs were met.

There was a complaints procedure in place and people we spoke with were aware of how to make a complaint if necessary. We saw evidence that complaints had been investigated appropriately but that outcomes had not been recorded.

Staff meetings were held regularly and were seen as a robust method of communication.

There were systems in place to monitor and improve the quality of the service provided and the registered manager and other senior staff audited paperwork and conducted spot checks on staff practice regularly.

We found the provider was breaching one of the Health and Social Care Act 2009 (Regulated Activities) Regulations 2014. This related to the safe assessment and mitigation of risk. You can see what action we told the provider to take at the back of the full version of this report.

As part of this inspection we spoke directly with 25 people who used the service. We also sent out a total of 61 questionnaires to people who used the service. We received a response rate of 60%, this was broken down to include 35% completed by people who used the service and a further 25% that were completed by relatives or representatives of people who used the service.

We also spoke with the registered provider, acting manager, receptionist, care co-ordinator and care staff. We reviewed records relating to the management of the regulated activity, which included nine people's care records and a range of documentation used in assessing and monitoring the quality of service provision.

Is the service safe?

People who used the service told us that they felt safe when staff were at their homes and when they were receiving care and support from them.

Where appropriate risk assessments had been completed in respect of the health and safety of people who used the service and staff delivering care.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which does not apply to people living within their own homes.

Is the service effective?

The majority of people who used the service told us that they were happy with the care they received and felt their needs had been met. Some people did express concerns about how the provider communicated with them. People gave examples of calls being changed at the last minute and the provider not notifying them of those changes.

We saw that where people lacked capacity to make decisions about their personal care needs staff acted in accordance with legal requirements. Where people did have capacity we found that their consent and wishes were obtained and that staff acted in accordance with those.

Is the service caring?

Care records we looked at were very focused on the person central to them. They included a lot of detail about the person they concerned, their likes and dislikes and an overview of what they wanted their care to look like.

Responses to our questionnaires included comments about specific staff members and the professional relationships that people had built up with those staff. Responses informed us that people felt that they were treat with respect and kindness by staff when they were having their personal care needs met.

Is the service responsive?

We saw that people's care needs had been assessed when they were referred to the service. We saw that care planning and delivery was focused around these needs. As and when these needs changed we saw evidence that planning and delivery was considered. For example, we saw that when people's needs changed interim care plans were put into place to manage these changing care needs. Care records also contained an overview of other healthcare professionals that had been, or continued to be, involved in their care.

The provider had an effective complaints process in place, which was accessible to people who used the service, their relatives or representatives. We found that where complaints arose the provider worked alongside other stakeholders to ensure thorough investigation.

Some people who used the service told us that communication between the office and themselves as clients was an issue. They told us that throughout the year they had experienced problems with being notified to changes to the planned calls.

Is the service well-led?

We saw that the provider had effective assurance processes in place to monitor the quality of the service that was provided. There were mechanisms in place to ensure that the feedback and experience of the people who used the service were gathered. From feedback provided to us we did not see that appropriate methods of communication were used to obtain this feedback and that the mechanisms used did not stretch to cover all service users.

The provider had implemented various systems and processes on the back of concerns raised about the service. This included the introduction of a medicines management team, to help support with medication issues, and a new system to monitor and log call visits.

The provider also worked in collaboration with the local commissioning authority to identify and investigate any significant events that occurred.

What people told us:

The majority of the people we spoke with told us that they were happy with the service they received. They said, 'I'm very happy with the care and support which I receive. I do like the staff.' Another said, 'I've got the best carers going.' 'My carer is top notch, she is very much home from home.' Another person said, 'When they come out, they are very friendly. They always ask what I want. They are doing a good job.'

One relative we spoke with said, 'I feel content knowing my mam is safe and well looked after."

We did receive some negative comments from people who used the service, one person we spoke with said, 'Brookleigh don't return my calls. When I ring up with a problem, I feel that they don't take me seriously.'

People told us, 'On the whole I find the carers are very good and for which I am very grateful, they brighten up my day and really do care'. Another person told us, 'I have no quibble with my usual care workers but the office should be more proactive, when they have nobody to cover the weekend calls. They don't do anything about it till 10 minutes before the carers are due, this often happens."

We found that overall 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. Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare and people were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

People were cared for, or supported by, suitably qualified, skilled and experienced staff and there were enough qualified, skilled and experienced staff employed to meet people's needs.

The provider had an effective system to regularly assess and monitor the quality of service that people receive.

We found that people who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. There was an effective complaints system available. Comments and complaints people made were responded to appropriately.

One person who used the service told us, "The care staff are great, second to none they are superb."

Another person told us, "I have had a number of carers and they have all been great."