Brooks Care and Nursing Services Ltd

Brooks Care and Nursing Services is a domiciliary care service providing personal care to people who live in their own homes.

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 our inspection there were 64 people using the service of which 60 people were receiving the regulated activity of personal care.

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

People’s risks had been identified, reviewed, and updated. People received safe care from staff who knew them well. There was a safeguarding policy and the registered managers and staff knew how to identify and report any concerns.

Staff had received an induction and training to enable them to meet people’s needs. We saw supervisions, spot checks, competency checks and meetings for staff were carried out and staff told us they felt supported by the registered managers to perform their role. People were supported with their medicines by trained members of staff where required.

Staff told us they had access to personal protective equipment (PPE) and there were effective infection control measures in place. People confirmed appropriate PPE was worn by staff when being provided with care and support.

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.

We received positive feedback about the leadership and management of the service. Systems and processes were in place to monitor, maintain and improve the quality of 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 and update

The last rating for this service was requires improvement (21 March 2023).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

At our last inspection we recommended the provider seeks advice and guidance from a reputable source about recording lessons learnt to ensure a formal process is in place to monitor and improve the quality of the service and ensure learning is shared with staff. At this inspection we found the provider had a more formal process in place recording lessons learnt, action taken and what changes had been made to improve the quality of service to people.

Why we inspected

At our last inspection of this service on 21 February 2023. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve in relation to medicines management and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements regarding the Warning Notice we previously served in relation to Regulation 17 (good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

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 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 Brooks Care and Nursing Services Limited on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Brooks Care and Nursing Services is a domiciliary care service providing personal care to people who live in their own houses and flats. At the time of our inspection care was being provided to 65 people.

Not everyone who uses domiciliary care services receives 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 the service and what we found

People experienced late care calls and staff did not always stay for the agreed length of time. The provider had not always kept people updated about delays and changes to their care.

People's medicines were not always managed safely and the provider's processes for checking the accuracy of people's medicines records were not robust.

The registered manager's governance arrangements did not always provide assurance the service was well led. Quality assurance systems were not robust and had not identified the shortfalls we found during our inspection. Limited information was available or recorded to demonstrate the registered manager had recognised where improvements were needed, and lessons learned to improve quality of care to people. We have made a recommendation about their process of recording lessons learnt.

People's relatives told us they did not always feel involved in the service and were not always confident their concerns would be responded to promptly. We received mixed feedback about the effectiveness of the culture and leadership of the service.

People were protected by the registered managers prevention and control of infection practices and arrangements. People said they felt safe and had no concerns about their safety or wellbeing. Staff stated they felt supported by the management.

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.

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 May 2018). The service is now requires improvement.

Why we inspected

This inspection was prompted in part due to concerns received about management of people's care and visits. 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.

Enforcement and recommendations

We have identified breaches in relation to medicines management and good governance at this inspection.

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

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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 inspect next.

Brooks Care and Nursing Services Limited is a domiciliary care agency registered to provide personal care for adults living in their own homes. At the time of our inspection care was being provided to 111 people. The service does not provide nursing care. This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community [and specialist housing].

At our previous inspection in June 2017 we found the service was in breach of Regulations 12, 16, 17.18 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and we rated the service inadequate and placed them into special measures. Following the last inspection, we met with the provider to ask the provider to complete an action plan to show what they would do and by when to improve the key questions; Safe, Effective, Caring, Responsive and Well Led to at least Good. At this inspection we found improvements had been made and the service was no longer in breach of the regulations.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall in any of the key questions. Therefore, this service is now out of Special Measures.

Two registered managers were in post who were also the owners of the business. 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.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. There were systems in place to minimise the risk of infection. People were cared for safely by staff who had been recruited and employed after appropriate checks had been completed. People’s needs were met by sufficient numbers of staff. People were supported to take their medication by staff trained to support them.

People were safeguarded from the potential of harm and their freedoms protected. Staff were provided with training in Safeguarding Adults from abuse, Mental Capacity Act (MCA) 2005. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice.

People had sufficient amounts to eat and drink to ensure that their dietary and nutritional needs were met. The service worked well with other professionals to ensure that people's health needs were met. People's care records showed that, where appropriate, support and guidance was sought from health care professionals.

Staff were well trained and attentive to people's needs. Staff were able to demonstrate that they knew people well. Staff treated people with dignity and respect.

The service was responsive to people’s needs. People knew how to make a complaint should they need to. When needed people were provided with the appropriate care and support at the end of their life.

The registered managers had a number of ways of gathering people’s views, staff held regular meetings with people and their relatives and used questionnaires to gain feedback. The registered managers carried out quality monitoring to help ensure the service was running effectively and to make continual improvements.

At our last inspection in January 2017 we found seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to Regulation 9 Person Centred Care, Regulation 11 Need for Consent, Regulation 12 Safe Care and Treatment, Regulation 13 Safeguarding service users from abuse and improper treatment, Regulation16 Receiving and acting on complaints, Regulation17 Good Governance and Regulation 18 Staffing. We also issued the registered provider with a warning notice in relation to Regulation 17. Following the inspection the provider wrote to us to tell us the action they would be taking to ensure they met all the relevant Regulations.

We undertook this announced inspection on the 1, 7 and 12 June 2017 to check that the registered provider had followed their action plan to meet the breaches of regulations. We found that the registered provider had addressed some of the concerns that we had identified at our previous inspection however, there were still areas which required further improvement which the registered provider was working towards.

Two registered managers were in post who were also the owners of the business. 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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to being the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of this registration.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or t varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures. The Care Quality Commission is no considering the appropriate regulatory response to resolve the problems we found during our inspection.

We found that the registered provider had made improvements in their auditing processes since our last inspection. However these had not highlighted the areas we identified during our inspection. There was not always sufficient numbers of care workers deployed to meet people’s needs in line with their preferences and/or commissioned care packages. Some people also experienced late or missed calls. Recruitment procedures were not thorough to ensure people were suitable to work with vulnerable people. The management of medicines was not always safe which meant people did not always get their prescribed medicines as they should. In addition care workers did not receive regular observations of their practice including assessments to ensure they remained competent to administer people’s medication. Although some risks were being better managed than they had been previously, we found at this inspection that some people were still at risk of not receiving appropriate support to keep them safe and maintain their health and well-being.

There was a complaints system in place however not all the people we spoke with felt their concerns would be listened to. Communication between the office and people who used the service, relatives and care workers was still ineffective and several people’s family members expressed their unhappiness and concern.

Although the registered provider had implemented some new systems to monitor and improve the quality of the service provided, these have not been successful in establishing the required improvements in some areas and other improvements have not been embedded and sustained.

Since our last inspection we noted that improvements had been made to procedures in place for the management of safeguarding. Care workers had received training to protect people from harm and abuse and were clear on the procedures to follow if they suspected abuse.

The service was working towards the principles of the Mental Capacity Act 2005 (MCA). Care workers had received MCA training and understood the need to obtain people’s consent prior to providing care and support. Care plan documentation had improved since our last inspection and was more person centred and reflected people’s current care and support needs.

During this inspection we found there were four continued 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.

Brooks Care and Nursing Services Limited is a domiciliary care agency registered to provide personal care for adults living in their own homes. At the time of our inspection care was being provided to 158 people. The service does not provide nursing care.

Two registered managers were in post who were also the owners of the business. 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.

During our inspection we identified a number of concerns about the care, safety and welfare of people who used the service. The quality assurance processes in place at the service were not robust enough to assess, monitor and mitigate the risks relating to the health and welfare of people using the service and to drive service improvement. We found seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of this report.

The service did not always have sufficient numbers of care workers who were effectively deployed to meet people’s needs. Care workers were not allocated travel time between call visits and told us they often had to pick up additional call visits. The service had no systems in place to robustly monitor late and missed call visits.

Care workers understood the risks and signs of potential abuse and the relevant safeguarding processes to follow, however the service did not keep succinct records of safeguarding allegations, accidents and incidents and had no structured procedure in place to analyse these. Also, the service had not submitted notifications relating to allegations of abuse to the Care Quality Commission in line with Regulations. Improvements were required to safely assist people with the management of their medicines and ensure people received their medication as prescribed.

Improvements were required to ensure care workers received regular structured supervision and training to enable them to keep their skills up to date to meet people's needs effectively. Most of the care workers we spoke with had limited knowledge of the Mental Capacity Act 2005 (MCA) and the service had not adhered to the principles of the MCA. People’s nutritional needs were not always met as, although feedback from people was generally positive, we found care plans contained limited information on people’s dietary and nutritional needs and associated risks. Where required people were supported to access healthcare professionals.

Although most people told us that care workers were kind and caring and that they were treated with dignity and respect, some people and their relatives said that care workers did not always know their needs and preferences for how their care and support should be delivered. Improvements were required to ensure care plans contained sufficient information and guidance to ensure that care was provided appropriately by care workers in line with people’s individual needs and that risks relating to people’s health, safety and welfare were mitigated.

There were processes in place to seek the views of people who used the service and those acting on their behalf but it was unclear how this feedback was used effectively to improve the quality of the service. Improvements were required to ensure people’s concerns and complaints were acted upon.