Burn Brae Care Limited

Burn Brae Care Limited is a domiciliary care service providing personal care to 160 people, with a range of needs, at the time of the inspection.

Burn Brae Care Limited also provides a responder to service to people living in extra care housing. 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.

People’s experience of using this service and what we found

People and their family members told us they felt safe being supported by the care staff, who were kind, caring and compassionate. Staff had been trained in safeguarding vulnerable adults and children and knew how to report concerns and minimise risk.

Improvements had been made to the way medicines were managed since the last inspection. Safe recruitment practises were followed. People said they were supported by regular staff who arrived on time, knew them well and stayed for the required time frame.

People’s needs and preferences for care and support were assessed on a regular basis and changes made to care plans as needed. People thought the staff were competent and professional. Staff said they were well trained and well supported by the management team who were always on hand if needed.

Staff worked in partnership with other care professionals such as speech and language therapy, physiotherapists and district nurses to make sure people received the care and support they needed. People said they were supported to attend medical appointments if needed.

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. Staff supported people in the way they requested and were respectful of people’s dignity, encouraging people to maintain their independence.

No one had any concerns or complaints about the service and said they thought everything was well managed. Various systems and processes were used to make sure people’s care was of a good quality. People were encouraged to share feedback on the service and the staff by way of regular visits from management and coordinators and also through an annual survey.

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 good (report published 18 August 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

This inspection took place between 30 May 2017 and 30 June 2017. On the 30 and 31 May 2017 we visited the provider’s office base and also people within their own homes who were in receipt of care. Between 31 May and 30 June 2017 we gathered feedback from people, their relatives and staff. This inspection was announced. We gave the provider 48 hours' notice because it is a domiciliary care service and we needed to make sure that someone would be available in the provider’s office to assist us.

A registered manager was in post at the time of our inspection who had been registered with the Commission to manage the carrying on of the regulated activity since October 2010. The registered manager was also the provider and nominated individual of 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 were complimentary about the service and the staff who supported them. Staff said that morale was good amongst the wider staff team and they felt supported by the registered manager/provider, who was responsive in their role.

Matters of a safeguarding nature were dealt with appropriately by the service and referred to the relevant local authority safeguarding adults team for investigation and action as necessary. Staff were aware of their own personal responsibility to report matters of a safeguarding nature and to protect the vulnerable people to whom they provided care.

Medicines were safely managed, although records related to the administration of medicines were sometimes not completed accurately by staff to reflect whether people received their medicines as prescribed. We discussed this with the provider to ensure they continued to audit these records and take action where shortfalls were identified in staff practice.

Recruitment processes were robust and appropriate vetting checks were carried out to ensure that new staff employed were suitable to work with vulnerable adults.

Accidents and incidents that occurred during the delivery of care were recorded and monitored. People were supported to remain safe in their own homes and anything of concern that was identified during a care visit by a staff member was reported to office staff for them to take appropriate action. For example, where any health and safety issues were identified within people’s homes, office staff arranged for support to be provided by professionals such as plumbers and electricians.

Risks that people were exposed to in their daily lives had been accessed if this was linked to the care package provided by the service, although some records related to these risks could be improved. We discussed this with the provider who took our feedback on board and said they would continue to improve records within the service.

Staffing levels were determined by people’s needs and the care packages in place. Nobody that we spoke with fed back any concerns about staffing levels. Some staff said that at times they were late for care calls as travel time was not included in their rotas, although overall this was not a regular occurrence.

People told us they were happy with the standards of care and support they received. They described how they enjoyed good working relationships with care staff and they were treated with dignity and respect. Staff gave examples of how they protected and promoted people’s privacy and dignity during the delivery of care, including, for example, closing people’s bedroom curtains when assisting them to get dressed, so they were not exposed. People also received person centred care in line with their individual needs and preferences.

Staff displayed genuine caring attitudes towards the people they supported, when assisting us with our enquiries. Staff said they were appropriately trained and supported within their roles and that all training had been refreshed since our last visit. They said they received supervision regularly in the form of one to one meetings or observations of their practice and that on an annual basis they were appraised by the provider about their performance in their role in the preceding year.

Complaints were dealt with appropriately and records retained about complaints included information about how the complaint had been handled and the outcome.

Feedback from people about the service they received was gathered annually and the results analysed. The provider had not yet developed formal feedback mechanisms to gather the opinions and experiences of staff, relatives and healthcare professionals, although we saw that any feedback given by healthcare professionals throughout the year on an ad hoc basis was retained and noted on people’s care records held within the office.

The provider was committed to delivering a good service that was person centred. Since our last inspection they had made improvements to the management of medicines within the service and also introduced new quality assurance and governance systems. However, the provider needs to ensure that these improvements are sustained and there is continued development, particularly in respect of records, about which we have made a recommendation.

Burn Brae Care Limited is a domiciliary care service based in Prudhoe Northumberland that provides care and support to people within their own homes. The care and support provided ranged from 24 hour care packages to short visits, which for example, supported people to access the community, and provided companionship. Services offered ranged from daytime personal care, overnight care, 'sitting services', enabling services and domestic support. At the time of our inspection the service supported approximately 225 people and employed 76 staff. They provided a service in the Tynedale areas including Prudhoe, Stocksfield, Ovingham, Riding Mill, Slaley and Blanchland. People with end of life care needs, dementia, older persons and learning disabilities were supported by the service.

There was a registered manager in post who was also the nominated individual/registered provider of 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 spoke highly of staff whom they said supported them safely and in line with their needs. Systems were in place to protect people from abuse and there were channels available through which staff could raise concerns. Records showed that safeguarding matters had been handled appropriately and referred on to either people's social workers or the relevant local authority safeguarding team for investigation. The provider worked collaboratively with these organisations.

People's needs and risks that they were exposed to in their daily lives were assessed, documented and regularly reviewed. Staff supported people to manage health and safety risks within their own homes. Recruitment processes were thorough and included checks to ensure that staff employed were of good character and appropriately skilled. Staffing levels were determined by people's needs and the number of people using the service.

We identified concerns with the management of medicines which we relayed to the provider. These concerns related to the recording of the administration of medicines and practices that staff had adopted which had not been assessed as safe. This included leaving medicines prepared on the side for people to take themselves. Care planning and risk assessments related to people's medication needs were not robust.

Staff told us they felt supported by the provider and received a lot of training but we concluded they were not supported to retain their skills and keep up to date with current best practice guidance as training was not refreshed on a rolling programme. We have made a recommendation about this which you can find in the body of the full report. Supervisions and appraisals were carried out regularly, as were staff meetings.

CQC monitors the application of the Mental Capacity Act (2005) and deprivation of liberty safeguards. The nominated individual/manager understood their legal responsibility under this act and they assessed people's capacity when their care commenced and on an on-going basis, if necessary. The nominated individual told us that any decisions that may need to be made in people's best interests in the future, would be referred to their care managers and families.

People reported that staff were very caring and supported them in a manner which promoted and protected their privacy, dignity and independence. People said they enjoyed kind and positive relationships with staff and we observed this when we visited people within their own homes.

Care records were person centred and evidenced the provider was responsive to people's needs. People were supported to access the services of external healthcare professionals if they needed support to do so.

People knew how to complain and records showed that complaints were handled appropriately and records were kept of each complaint received. People's views and those of their relatives were gathered through care reviews and questionnaires.

We received positive feedback from both people and staff about the service. Staff told us they found the provider approachable. Auditing and quality monitoring of the service delivered was limited and some systems that were in place were not effective or robust.

We identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were Regulation 12, Safe care and treatment and Regulation 17, Good governance. The provider had also not met their obligations under the Care Quality Commission (Registration) Regulations 2009 as they had not submitted all of the statutory regulations that they were supposed to. We are dealing with this matter outside of the inspection process.

We viewed care records for three people. We found that care needs were assessed, planned and delivered in a way which met people's individual needs. We found that people had knowledge of, and had consented to, their care plans. People told us, "They know me well but always ask before they help me" and "Reliable, smiling and consistent staff."

We found there were appropriate arrangements in place to assist people with their medication in a safe and suitable manner.

We found that staff were trained and supported in their roles. People told us, "Skilled, happy and reliable, whatever the time or weather."

People's personal records were accurate, fit for purpose and held securely. Other records were kept in an appropriate form.

We viewed care records for three people. We found that care needs were assessed, planned and delivered in a way which met people's individual needs. We found that people had knowledge of, and had consented to, their care plans. People told us, "The support I receive is marvellous" and "I cannot fault the care and support." Relatives commented, "The standard of care is excellent" and "Prompt, reliable and caring approach."

We found there were appropriate arrangements in place to assist people with their medication in a safe and suitable manner.

We found that staff were trained and supported in their roles. People told us, "Lovely staff, very skilled and pleasant." Relatives commented, "Staff are wonderful, efficient and caring" and "Staff were an absolute lifeline."

People confirmed they were given the opportunity to comment on the service, change routine or raise complaints.