Background to this inspection
Updated
23 August 2022
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
Inspection team
Two inspectors completed a site visit. An Expert by Experience made telephone calls to relatives off site to seek their feedback. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.
Registered Manager
This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
At the time of our inspection there was a registered manager in post.
Notice of inspection
We gave a short period notice of the inspection because we needed to be sure that the provider or registered manager would be in the office to support the inspection.
We visited the location’s office on 29 June 2022.
What we did before the inspection
We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
We reviewed information we had received about the service from a variety of sources including notifications received from the registered manager (events which happened in the service that the provider is required to tell us about). We sought feedback from the local authority and Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. We used all of this information to plan our inspection.
During the inspection
We spoke with five people and five relatives of people who use the service. We spoke with 16 staff members, including the registered manager, customer service manager and care workers. We reviewed a range of records, including parts of eight people’s care records and medication records. We looked at four staff files in relation to recruitment. A variety of records relating to the management of the service were also reviewed.
Updated
23 August 2022
About the service
Break Barriers Nottingham Ltd is a domiciliary care agency which supports people in their own homes living in the Nottinghamshire area. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. At the time of inspection 57 people received support with personal care.
People’s experience of using this service and what we found
There was an increased risk of staff not managing people’s medicines consistently and safely because medicines records were not always accurate.
Whilst staff worked well with other health and social care professionals once they were involved, the referrals to the external agencies were not always made in a timely manner.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. However, some mental capacity assessments required further work to ensure they were completed thoroughly and as per the best practise guidance.
The quality assurance systems were not always effective in monitoring the quality of the service. A range of checks were completed; however, they had not identified the shortfalls we found during the inspection. Learning from errors and improving care was delayed at times because the providers response to addressing shortfalls was at times reactive rather than proactive.
People had care plans which reflected their individual needs. When risks to people’s health and wellbeing were identified, appropriate mitigating action plans were put in place. Staff knew people’s needs and people told us they knew and were comfortable with the staff delivering care and support.
There were enough staff to meet the needs of the people using the service. People received their care visits on time.
People were safe from the risk of abuse. Staff understood what concerns should be reported and knew how to report them.
Staff had received appropriate training to carry out their role safely.
People received support from kind and caring staff. Staff were respectful and promoted people’s independence. People and their relatives were involved in decisions about their care, which was regularly reviewed.
People felt the staff supported them with their personal goals and remaining as independent as possible. People’s communication needs were recorded in their care plans and staff were aware of how to best communicate with people in their preferred way.
People, their relatives and staff spoke highly about the management. They had confidence in the leadership and felt they could report any issues or concerns.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was outstanding (published 8 September 2017).
Why we inspected
This inspection was prompted by a review of the information we held about this service.
The overall rating for the service has changed from outstating to requires improvement based on the findings of this inspection.
Follow up
We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.