Archived: Brunswick Healthcare

Updated 7 April 2020

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

This inspection was carried out by two inspectors.

Service and service type

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats. The provider was also the manager registered with the Care Quality Commission. This means that they are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was announced. We gave the service 48 hours' notice of the inspection. This was because it is a small service and we needed to be sure that the registered manager would be in the office to support the inspection. Inspection activity started on 2 March 2020 and ended on 3 March 2020. This included phone calls to staff, people and a relative. We visited the office location on 2 March 2020.

What we did before inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from Healthwatch and the local authority. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all of this information to plan our inspection.

During the inspection

We spoke with four people who used the service and one relative about their experience of the care provided. We spoke with six members of staff including the nominated individual who is responsible for supervising the management of the service on behalf of the provider (who was also the registered manager), care coordinator, office manager, training coordinator and care workers.

We reviewed a range of records. This included two people’s care records and two medication records. We looked at four staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records.

Updated 7 April 2020

About the service

Brunswick Healthcare is a domiciliary care agency which provides personal care and support to people with a variety of needs including older people, people living with dementia and physical disability. The agency's office is located in Hove in East Sussex. At the time of our inspection the service was providing personal care to six people.

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

The registered manager did not have effective oversight of the service and had actively been on site on only three occasions since January 2019. This meant staff felt isolated, unsupported and discouraged. The registered manager had not submitted statutory notifications to the CQC as required. The registered manager acted to address these concerns during the inspection.

At the last inspection quality assurance systems were not always being used to ensure accurate records were maintained and to drive improvements. We recommended the registered manager review and implement robust systems for monitoring all aspects of the service to ensure the quality and safety of the service remained good. At this inspection the registered manager had failed to ensure quality assurance tools were in place and effective at identifying, implementing and sustaining improvements. The registered manager had not engaged with and involved people using the service, the public and staff to improve the service.

Due to the availability of the care coordinator there were enough staff to care for people safely. This had impacted on their time to oversee the quality of care people received. This had not impacted people’s delivery of care or their safety however, more staff were required to ensure the care coordinator was able to do their role more effectively.

Not all staff had received supervision to gain feedback on their performance, identify training needs and discuss any concerns. The registered manager had not ensured staff received training according to national guidance to ensure their skills remained current.

People said they felt safe and were protected from harm. Staff had a good understanding of what safeguarding meant and the procedures for reporting any issues of harm to people. All the staff we spoke with were confident any concerns they raised would be followed up appropriately by the care coordinator.

The staff recruitment procedures ensured appropriate pre-employment checks were completed to ensure only suitable staff worked at the service. Policies and procedures were in place to ensure the safe ordering, administration, storage and disposal of medicines. Medicines were managed safely. Effective practices were in place to protect people from infection.

The care coordinator and training coordinator carried out spot checks to monitor the quality of the service provided and to seek the views of the people who were supported. People had a choice of meals and told us they had plenty to eat and drink.

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. People received appropriate healthcare support as and when needed and staff knew what to do to request assistance.

People were supported by kind and caring staff who knew them well. People spoke highly of the staff who looked after them and said they were treated with dignity and respect. People were involved in day to day decisions affecting their care. Complaints were investigated and managed appropriately in line with the provider's policy.

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 14 July 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified one breach of the Care Quality Commission (Registration) Regulations 2009. The registered manager had not notified us of incidences as required.

We identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The registered manager had not established systems and processes to audit and monitor the safety and quality of the service provided. The registered manager had failed to provide appropriate support, supervision and appraisal as is necessary to enable staff to carry out their duties. The registered manager had failed to display their rating on their website.

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 registered manager to understand what they will do to improve the standards of quality and safety. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.