Bramble Home Care Limited

Bramble Home Care Limited is a domiciliary care service that provides personal care and support to people living in their own homes. The service supported 49 people who received personal care at the time of the inspection.

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 the inspection, the location did not care or support for anyone with a learning disability or an autistic person who received personal care. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.

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

We found improvements were needed to ensure people's risks were assessed and mitigated in areas such as diabetes, health appliances care and moving and handling tasks. Records relating to the assessment and management of people's risks required improvement to ensure staff had access to complete and up-to-date information to keep people healthy and safe.

We found that improvements were needed to the provider's quality monitoring systems and processes, including the monitoring of care call delivery and care records.

We did not find that these shortfalls had impacted on people's care. The provider had identified areas that required improvement through their own quality monitoring and had developed an improvement plan. However, further time was needed for the registered manager to embed and complete their improvement plan before we could judge it to be effective in bringing about the required improvements.

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.

The majority of people and relatives we spoke with told us they felt safe and cared for by the service.

Staff understood their responsibility to report concerns and poor practices. Staff knew how to report any incidents or accidents.

Staff understood their role to wear Personal Protective Equipment (PPE) in line with government guidance.

Systems were in place to engage with staff and people who use the service.

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 (published 21 December 2020).

Why we inspected

The inspection was prompted by concerns received in relation to the quality of care and the management of the service. A decision was made for us to inspect and examine those risks. We undertook a focused inspection to review the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Bramble Home Care Limited on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches of regulations in relation to safe care and treatment and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Bramble Homecare is a domiciliary care service that provides personal care and support to people living in their own homes. The service supported 98 people at the time of the inspection.

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 relatives were positive about the caring nature and approach of staff. They told us they felt safe when staff visited and were confident that any concerns would be dealt with promptly. The service had employed appropriate numbers of staff to deliver the care and support that people required. Appropriate measures had been implemented to minimise and manage people’s individual risks. Where people were supported with medicines, they were supported by staff who had received appropriate training and medicines were managed safely.

Infection prevention measures had been established within the service. Staff had a good understanding of these procedures and people confirmed staff were wearing protective equipment when visiting people in their homes.

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.

The registered manager acted on concerns to ensure people received care which was safe and responsive to their needs. Staff were trained in safeguarding people and protecting them from harm. Any concerns or accidents were reported and acted on.

The registered manager had developed a variety of quality assurance systems to monitor the overall quality of the service provided to people. These systems had led to improvements in the quality of the service being provided to people.

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

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 7 November 2019). At this inspection we found improvements had been made and the rating for this service has changed.

Why we inspected

We carried out an announced comprehensive inspection of this service on 26 September 2019. We found improvements were required in relation to managing people’s call schedules, risk management and the administration of medicines.

We undertook this focused inspection to check improvements had been made in these areas. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Bramble Homecare on our website at www.cqc.org.uk.

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.

Bramble Homecare is a domiciliary care service that provides personal care and support to people living in their own homes. The service supported 100 people at the time of the inspection.

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

There had been a recent change in the management team of Bramble Homecare. The new team had identified that the effectiveness of the systems used to monitor the service had not been sustained and action was needed to improve the quality of care, staffing levels and the systems used to monitor staff development and people’s ongoing care needs. As a result, they were implementing improved systems to monitor the service, however more time was needed to assess if the improved systems would be effective in driving improvements across the service.

Due to recent staff changes, some people had not always experienced care in a timely manner and in line with their care plan and visit schedule. Concerns had been raised with CQC about staff availability and punctuality. This was raised with the manager who was taking action to address the shortfalls in staff and was actively recruiting new staff or delivering care themselves.

People’s care needs were assessed prior to receiving care from the service. Their care plans provided staff with information about their preferred routines and support needs. The management team were actively reviewing people’s care plans and providing staff with more details about people’s support requirements however further recorded information was needed to guide staff in the management of people’s risks and medicinal creams. Progress was being made in identifying and addressing the training and support needs of staff and the reviewing of people’s care plans. However more time was needed to monitor the effective and sustainability of the improvements being made by the new management team.

People and their relatives praised the caring nature of staff and told us all the staff were polite and respectful. People told us they felt safe amongst staff and that their privacy and dignity was continually respected at all times. 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 had been trained in safeguarding people and protecting them from harm. Any concerns or accidents were reported and acted on. The managers reviewed all incident and accidents and took action to reduce the risk of the incidents reoccurring.

The managers and staff were passionate about the care they delivered and were driven to improve the service. They worked in conjunction with families and other health care professionals to improve the lives for people. The management team monitored the quality of the delivery of care through staff observations and feedback from people while the monitoring systems were being developed to ensure people were satisfied with the care they received and to check that the care practices of staff were being maintained.

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 (published 21 March 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.

Bramble Home Care (Tewkesbury) carry on the regulated activity 'personal care' supporting adults with varying care needs to remain in their own homes.

Bramble Home Care (Tewkesbury) had a registered manager in post. 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 heard positive comments about the service such as “Very good”, “No concerns at all, very happy” and “I’m very pleased with them. They have never missed a call and rarely late”.

People were enabled to live safely; risks to their safety were identified, assessed and appropriate action taken. People's medicines were safely managed. People were protected from the risk of being cared for by unsuitable staff because robust recruitment practices were operated.

People were satisfied with their support and the approach and effectiveness of staff. People's individual needs were known to staff who had achieved positive relationships with them. People were treated with kindness and their privacy and dignity was respected.

Staff received support to develop knowledge and skills for their role and were positive about their work with people. The registered manager was accessible to people using the service and staff. Systems were in place to check the quality of the service provided including gaining the views of people who used the service.