Bramble Home Care Limited

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question Requires Improvement. At this assessment the rating has remained Requires Improvement.

This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of legal regulation in relation to safe care and treatment as improvements were needed to the safe management of people’s medicine.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The service had processes to identify and manage safety concerns, incident reporting and reviews. Care staff understood the processes they had to follow if there was an incident. Staff told us they were confident about raising concerns and told us managers were responsive to what they reported. Managers and staff learned lessons from safety occurrences and improved their practice accordingly.

We reviewed how the managers responded to recent incidents and found they had ensured immediate risks were addressed, made appropriate referrals to external healthcare providers and conducted investigations. Learnings and actions from the investigation prompted the managers to implement timely actions. For example, managers to offer specialised training for bariatric moving and handling after 1 person experienced a fall in the community. This ensured any learning from the incident was identified and applied to reduce future risk.

The provider had ensured staff and people had information about people’s specific medical conditions within the electronic care records and in paper files stored at people’s homes. This ensured care staff had access to current information for people because of any learnings after incidents.

The provider had identified an increased number of unsafe discharges and had implemented a co-designed bespoke checklist to aid people’s safe discharge from hospital and to ensure people had all necessary support systems before returning home. This meant people were safeguarded against being placed in isolated and unsafe conditions.

People told us they could raise safety concerns, and they knew who to raise concerns with. One person told us, “I call the office and speak to the ladies, they are very kind.” Another person told us, “I know my son has had to call the office, but they responded quickly and it was all sorted.”

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

There was documentation available in people’s care records for staff and external health agencies which detailed key information relevant to people in the event of needing to move between services. Staff had recently updated people’s pre-admission assessments and condensed as previous assessments were too lengthy and confusing for staff when completing them.

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In [care homes/hospitals], this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service. We found the service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately.

For example, a recent change in the manager had prompted a review of staff knowledge and understanding of safeguarding. The provider created a competency assessment which they used to assess staff. This showed an understanding of the needs of staff within the service and a proactive approach to safeguarding people.

Staff had received additional support during the transition to a new electronic care monitoring system and had been receptive to feedback from the manager. This has led to an increase in safeguarding concerns being reported correctly. People had mental capacity assessments completed and included in their care records.

The service worked with people to understand and manage risks by thinking holistically. They provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

The service had risk assessments to guide care staff which were concise and detailed and clearly provided staff with relevant information. Staff had completed risk assessments to be user friendly and were written in a person-centred and compassionate way.

Training records for staff showed they received high levels of training to enable them to assess people’s care and support needs and provide appropriate support. When people had a specific health need, the provider had organised and delivered bespoke training additional to staff mandatory training. This ensured staff were skilled and knowledge about people’s health condition and support requirements. For example, in response to the needs of people who used the service they had introduced stoma training, bariatric training and enhanced diabetes training. This ensured people’s risks were managed by highly trained staff who received specific training.

After training, staff received competency assessments to ensure their skills and knowledge were of a high standard.

The provider introduced a new tracker to aid them in identifying significant needs people were experiencing to enable them to plan for additional training and support for staff.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

All staff had completed appropriate infection prevention and control training which included training in how to keep people’s homes clean and prevent infections. All staff had completed moving and handling training which included how to safely use and monitor equipment in people’s homes.

The service had environmental risk assessments which provided staff with details of risks relating to people’s environments and gave advice on how to keep people safe.

People’s preferences for cleaning tasks were clearly detailed in their care records.

The provider was in the process of introducing fire evacuation plans for people to guide staff in the actions they should take to the risk of fire and in the event of a fire in people’s homes.

The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

Staff received their rota’s well in advance and office staff monitored these to ensure staff had enough breaks. All staff received up to date information about their care calls through an electronic app staff could always access. Managers were aware of when staff had restrictions on how many hours they could work and ensured they were not allocated shifts which impacted this. The provider had a contingency plan to ensure people’s care calls were covered in the event of emergencies.

The manager told us, “We try to keep continuity as much as possible. We are also keen to make sure staff are given different runs to ensure they are not complacent. We do however want to ensure if clients request certain people this is honoured as much as possible. My aim is to be the manager that I didn't have when I was a carer. I am all about supporting the staff and ensuring they have everything they need and clients have everything they need to have holistic care.”

Care calls were geographically matched to ensure staff were not travelling far distances between people. Staff told us they felt supported by the managers to manage with their care calls. We saw evidence of support being offered when people needed to stay with people longer, for example, when they were waiting for an ambulance.

We reviewed 3 people’s recruitment files and saw people were recruited safely before they started working for the organisation.

The induction programme included mapping to the care certificate. This showed the provider had a keen understanding of the value of training for staff. Training was delivered as a mix of face to face and virtual learning. All staff received numerous competency checks post training, including spot checks while working with people in their homes, knowledge checks when they came into the office and the delivery of mini modules during staff meetings.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

The provider had an infection, prevention and control policy which was clear for staff to follow. The provider had plentiful supplies of personal protective equipment (PPE) including different types of gloves, as some staff had skin sensitivities. The provider supplied staff with gloves, aprons, masks, shoe covers, visors and goggles, ensuring staff could choose which protective equipment best suited the care tasks they were completing. Staff came to the main office to retrieve their supplies. People and relatives told us they had confidence in how the provider would manage an outbreak. One person told us, “There hasn’t been an outbreak this winter, if other people were sick, the staff would tell us, and they would work so it didn’t spread.” A relative told us, “I don’t have any concerns, staff are always wearing PPE.”

The provider did not make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. People were not involved in planning.

Staff had their competence regularly assessed around medicine management to ensure they handled and gave people their medicines safely. However, records we checked showed there were gaps in people’s medicine administration records that were not fully accounted for, and the service’s governance and medication audits had not picked up these concerns. We noted records for the administration of medicines prescribed with variable doses were not accurately completed to show the actual doses given. This meant people were at risk of not having the correct dose for their need, although we found no evidence individuals had come to harm because of this. Records showed some medicines were not given because they were not available and had not been obtained. For a person living with Parkinson’s Disease, their medicine records showed they did not always receive their time-sensitive medicine at the prescribed times. In addition, there was a lack of risk assessment about this. For another person prescribed paracetamol tablets to be given regularly 4 times daily, the scheduled times due for administration were not set a minimum of 4 hours apart for safety. In addition, records showed appropriate 4-hour intervals between doses were not always met. We noted for a person prescribed an inhaled medicine for regular twice daily use, records indicated it was only offered by staff once each day. There was care-planned information available for staff to refer to about people’s medicines, but this did not provide detail about how people prefer to have their medicines given to them. There was some information about some people’s known sensitivities to medicines, however this was not recorded consistently across all documentation. This could have led to checks being missed and medication errors. PRN (pro re nata) medications are"as needed" drugs prescribed for intermittent or short-term conditions, such as pain, nausea, or anxiety. They are not taken on a regular schedule, but rather when specific symptoms arise, requiring clear documentation regarding dose limits, minimum intervals, and purpose. We found there was a lack of guidance available for staff to refer to about their use. For a person with a known history of self-harm with medicines, their care plan inaccurately stated they were currently not taking medication. There was no indication about the safe storage of their medicines, staff monitoring or assessment of risks around their medication. The service had also not assessed the risks around the use of flammable topical medicines for people these medicines were applied to. For people prescribed medicated skin patches, body maps incorrectly showed the frequency at which sites of application of the patches could be repeated. This could have led to an increased risk of skin reactions from the patches. In addition, records did not show staff where previous patches had been applied and there were no records confirming previous patches had been removed for safety. For 1 person prescribed a pain-relief patch for once weekly application, in the most recent 4 -week period, on one occasion records showed the patch had not been applied without explanation and on another scheduled date it was not applied because there was a lack of stock available.