Archived: Breckland Care at Home

At our last inspection in December 2016, we found that the quality and safety of the care provided to people required improvement. We identified that the provider had been in breach of two regulations of the Health and Social Care Act 2008 (Regulated Activities) 2014. This was because risks to people’s safety had not always been assessed appropriately and there were a lack of robust governance systems in place to monitor the quality of care people received. After that inspection, the provider sent us an action plan telling us what they were going to do to improve the quality of care people received.

Since our last inspection the provider of the company has changed and at this inspection, we found that sufficient improvements had been made and that the service was no longer in breach of any regulations. The overall rating for this service has now changed from Requires Improvement to Good.

This service is a domiciliary care agency. It provides personal care to people living in their own homes. At the time of the inspection it was providing care to approximately 50 people.

There was a registered manager at the service. 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.

People’s individual care needs and preferences had been assessed. However, the information contained within people’s care records was not sufficient to guide staff on how to meet these needs. Therefore improvements are required within this area to reduce the risk of people receiving inappropriate care.

We have also made a recommendation regarding the manager and provider familiarising themselves with the Accessible Information Standard. This standard was put in place in 2012 to ensure that people had access to appropriate information to meet their individual communication needs.

The people we spoke with told us they received the care they required and that this met their needs and preferences. The provider had ensured there were enough staff to do this.

Staff had received sufficient training and support to make sure they could provide people with safe and effective care. People received their medicines when they needed them.

Staff used good infection control techniques to reduce the risk of spreading infection and risks to people’s safety had been assessed and managed well. People’s consent was sought before staff completed a task and where required, were supported to eat and drink enough and with their healthcare needs.

The staff were kind, caring and compassionate and people were empowered to have control of the care they received. People were treated with dignity and respect. People’s concerns and complaints were listened to and investigated but a record of these was not always made which may help the provider identify any patterns in relation to care delivery.

There was an open culture where people, relatives and staff could raise concerns without fear. The provider had a clear vision to ensure the delivery of care met people’s individual needs and we found this to be the case.

Systems were in place to monitor the quality of care people received. Where shortfalls were found, actions had been taken and lessons learnt where appropriate. People and staff were encouraged to give their views regarding the running of the service to drive improvement.

People were happy that the service was run well but the staff had mixed views about this with some saying they felt very valued and supported but others saying this was not the case. The provider said they were actively working on fully engaging staff within the business.

The service had a registered manager in post. 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 scheme is run.

People were not always assisted to be as safe as possible because risk assessments had not been completed for all risks. Staff did not have the necessary information they needed to reduce people’s risks.

There were no systems in place to monitor and audit the quality of the service provided. There was a system in place to record complaints but outcomes of complaints had not been used to improve the service.

People had their needs assessed and reviewed so that staff knew how to support them to maintain their independence. People’s care plans contained person centred information. The information was up to date and correct.

Staff understood the principles of the Mental Capacity Act 2005 (MCA) and could describe how people were supported to make decisions. However, no training had been provided by the service and this limited staff’s ability to keep aware of current information and regulations regarding people’s care.

Staff had completed all training required by the provider. However, there was no effective system to ensure that staff received further training to update their skills.

The risk of harm for people was reduced because staff knew how to recognise and report abuse.

The provider’s recruitment process was followed and this meant that people using the service received care from suitable staff. There was a sufficient number of staff to meet the needs of people receiving a service.

People’s privacy and dignity was respected by staff and staff treated them with kindness. There was a complaints procedure in place.

Staff meetings, supervision and individual staff appraisals were not completed regularly. Staff were supported by supervisors, a care co-ordinator and the registered manager during the day. An out of hours on call system was in place to support staff, when required, in the evening.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

As part of this inspection we spoke with six people who used the service, two relatives, the management team and five members of care staff. We also reviewed records relating to the management of the service which included five care plans, staff records and quality assurance monitoring records.

The summary describes what people using the service, relatives and staff told us and the information we found in records we looked at.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People who used this agency told us they felt safe. We were told 'The staff are very trustworthy. I have no concerns about the team of staff who visit me.' Another person said, 'I feel completely safe and at ease.'

Safeguarding procedures were in place and understood by a trained staff team.

Recruitment procedures assured safety checks were completed before staff were deemed suitable to work with vulnerable people. This ensured people were supported by appropriate staff.

People were supported by staff who could meet their needs in a timely and safe manner. For example, medication administration to be given at appropriate times as stated on the medication administration charts.

Is the service effective?

People's needs were assessed prior to the agreement to start the service to ensure that Breckland Care at Home could meet the required care and support.

Care plans were completed and tailored to meet individual needs. Although, we found that not all care plans were reviewed and up to date. We spoke to the manager about this and they confirmed to us that they were aware of the shortfall and that action was taking place to improve this.

Concerns that had been highlighted as part of the providers on-going quality monitoring had been addressed and the service had improved.

Is the service caring?

All the people we spoke with told us the staff were caring. We heard words such as 'caring' 'kind' 'faultless' 'respectful' and 'skilled'. One person said, 'We could not be happier. The care staff are all kind and caring. They show a real interest in us (couple) and treat our home like their own.'

Staff we spoke with gave us examples of the caring support they gave to people using the agency. It was clear they were caring in their approach to meet the individual needs of the people receiving support from this agency.

Is the service responsive?

People told us that if they had any concerns they could call the office and they would be listened to and their concerns would be acted upon.

We found that staff were trained and supported well.

Changes and emergencies within the service provision were responded to well. Staff were contracted and available to meet the demand of sudden changes.

Is the service well led?

Systems were in place to address any shortfalls in staff performance. Supervisions or spot checks highlighting poor performance by a staff member would be addressed.

Audits were carried out to ensure staff were trained, supervised and appraised in a timely manner.

Care plans were checked but at the time of this inspection were not all up to date. However, the manager had already identified the shortfall and action had begun to improve the system.

Concerns were acted upon and addressed at the time the concerns were raised. The Care Quality Commission had not received any complaints about the service provided by this agency.