Bramble Home Care Limited

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated this key question Requires Improvement. At this assessment the rating has changed to Good.

This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

This service scored 75 (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 shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

Staff felt there was a culture of collaboration, where people and staff were listened to and communicated with to help promote learning and improvement. One staff member told us, “I think the managers want us to keep learning and improving. We get a message now and then saying we're doing good.” Staff gave positive feedback regarding the cultural shift brought about by the arrival of the new provider and manager. Staff told us, “Everyone is supportive and we all help each other” and “When I started, things were very flaky and unorganised. I have really noticed a shift in the behaviours in the organisation. Things have really improved and things like communication, rotas, mood etc are all better.” We saw the provider had started a ‘support worker of the month’ and their name was displayed on a board in the office.

When we spoke to the provider and the manager we could see they had a clear vision for the service. The manager told us, “My vision is to make sure our support staff are the best trained and deliver the highest standard of care. It's having the highest standards of care and promoting holistic care. I think now our reputation is not as good as we would want it to be, but I want our brand to be recognised as a high-quality care provider.”

The provider had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

At the time of our inspection, the service did not have a registered manager. The manager in post had recently been promoted but had not yet submitted their registration application to CQC.

The provider and manager conducted regular audits and spot checks on the quality of care. We saw appropriate action had been taken in response to concerns. The provider had recently created a bespoke checklist for significant incidents which ensured incidents were effectively investigated and the appropriate external professionals were notified. We observed how use of the checklist prompted the creation of a corresponding action plan for managers to implement. This ensured people’s needs were monitored and met, not just dealt with in the moment. This gave managers the accountability to reflect on the incident and decide if additional measures were required.

The provider fostered a positive culture where people felt they could speak up and their voice would be heard.

Staff told us they were aware of the term ‘Freedom to Speak Up’ and what this meant to them. Staff told us, “Freedom to Speak Up is about reporting concerns, these could be about safety or abuse. I would report to my managers, the CQC and also police.” and “I know how to raise concerns if I see something wrong, or if I’m treated inappropriately by another colleague. I would always raise concerns if they were about a criminal matter.”

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.

The manager told us they provided reasonable adjustments for staff. We had one staff member who needed a reasonable adjustment put in place, and we supported them with to their satisfaction without compromising on service delivery.”

The service had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver good quality, sustainable care, treatment and support. They act on the best information about risk, performance and outcomes, and share this securely with others when appropriate.

The provider had developed a new governance framework. The document detailed information about staff management and supervisors and the actions needed. The framework included details on the on-going service improvement plan, new ‘ready to work checklists’, detailed audit review schedules and the core training cycle. The framework also gave very detailed instructions on where staff could find documents mentioned in the framework.

The provider’s governance systems had identified areas which needed further development such as with staff recruitment files which has triggered a high-level senior leadership meeting and the development of an action plan. We reviewed other action plans and found these to be of a good standard, were detailed and clearly written.

We discussed the provider’s inconsistent approach to the management of staff complaints. This prompted the provider to add this detail immediately to the governance framework and send out communication to all senior staff stating concerns raised by staff were to be recorded as complaints. This meant these would be captured on the complaints audit and ensure a truer reflection of complaints made about the service delivery and staff co-working.

In response to a significant safeguarding event months prior, the provider had developed in conjunction with a senior member of staff, a new ‘emergency protocol for cancelled or missed visits.’ We found the details within the protocol to be thorough, detailed, person-centred and collaborative, meaning responsibility for any cancelled or missed calls was shared by the entire management team. This showed the provider had reflected on the incident and made effective changes to their systems to prevent further incidents which may expose people to harm when their care calls were cancelled or missed.

However, the governance systems the provider used had not identified the concerns we found during our inspection regarding medicines, as referred to in the safe key question under the medicines optimisation quality statement.

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement.

The manager told us how the service shares information and learning with others to improve the service and outcomes for people. They explained “I've booked in additional refresher moving and handling training for staff after an accident. It’s not about being perfect all the time, but about ensuring after an accident we as a team take the time to see where did we go wrong? How can we do better, because people’s safety is of the upmost importance.” There were business plans in place which considered improvements for the coming year. There were evidence individuals, staff and partners were involved. One professional told us, “They [the service] are collaborative when incidents occur. They share relevant information with us, involve appropriate professionals, and implement action plans discussed with our team.”

The service focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contribute to safe, effective practice and research.

The service used an electronic system for completing care plans, risk assessments, daily notes and for staff to use to document when they had completed tasks with people in their own homes. The provider had found some of the pre-programmed forms on the electronic system were not in keeping with the high standards they wanted for the service. The provider coded the electronic system to enable them to create their own forms, systems and processes which were unique and bespoke to the service. For example, the provider shared they had not been satisfied with the previous systems for managing receipts being uploaded when staff made purchases for people. As a result, they had recoded the system to improve the system to manage financial transactions made by staff on behalf of people.

This showed the provider was aware of how to improve safety, ensure meaningful time was spent on an activity and reduced overly complicated processes. As a result, people’s outcomes were improved and their quality of life had shown improvements as well. These were detailed in people’s daily notes and care records.