Archived: Brunswick Healthcare

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.

Brunswick Healthcare Limited has been registered with the Care Quality Commission (CQC) since October 2010. Since this time, a new provider had taken over the management of Brunswick Healthcare Limited. This change occurred on 19 January 2017. The new provider had retained the previous staff team, administrator and care co-ordinator. This was the first comprehensive inspection since the provider registered with CQC to provide personal care to people. As such, they had not yet received a CQC rating.

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, younger adults, people with a learning disability, autistic spectrum disorder, physical disability or sensory impairment and people who need support with their mental health. The agency's office is located in Hove in East Sussex. At the time of our inspection the service was providing personal care to seven people.

The registered manager had left the service in January 2017. The managing director who was also the provider was in the process of applying to be the registered manager, and had submitted an application to register with the Care Quality Commission (CQC). 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 the inspection the provider was present.

We found the provider was supportive to the administrator, care co-ordinator and staff. Everyone we spoke with told us the new provider had kept them informed of any changes. They said there had been no impact on the quality of service people received during the transfer of ownership.

People and care workers spoke highly of the care co-ordinator and the company. People expressed satisfaction with the service they received. Despite this, we found that quality assurance systems were not always being used to ensure accurate records were maintained and to drive improvements. We have made a recommendation about this in the main body of the report.

Risks to people's wellbeing and safety had been effectively mitigated. We found individual risks had been assessed and recorded in people's care plans. Examples of risk assessments relating to personal care included moving and handling, nutrition, falls and continence support. Health care needs were met well, with prompt referrals made when necessary.

People told us they felt safe receiving the care and support provided by the service. Staff understood and knew the signs of potential abuse and knew what to do if they needed to raise a safeguarding concern. Training schedules confirmed staff had received training in safeguarding adults at risk.

Robust recruitment and selection procedures were in place and appropriate checks had been made before staff began work at the service. There were sufficient levels of staff to protect people's health, safety and welfare in a consistent and reliable way.

Policies and procedures were in place to ensure the safe ordering, administration, storage and disposal of medicines. Medicines were managed safely.

The management team and staff had an understanding of the Mental Capacity Act 2005 and consent to care and treatment.

People chose their own food and drink and were supported to maintain a balanced diet where this was required.

People said staff were caring and kind and their individual needs were met. Staff knew people well and demonstrated they had a good understanding of people's needs and choices. Staff treated people with kindness, compassion and respect. Staff recognised people's right to privacy and promoted their dignity.

We looked at care records and found good standards of person centred care planning. Care plans represented people's needs, preferences and life stories to enable staff to fully understand people's needs and wishes. The good level of person centred care meant people led independent lifestyles, maintained relationships and were fully involved in the local community.

There was a complaints policy and information regarding the complaints procedure was available. Complaints were listened to, investigated in a timely manner, and used to improve the service. Feedback from people was positive regarding the standard of care they received.

Staff felt supported by management, they said they were well trained and understood what was expected of them. Staff were encouraged to provide feedback and report concerns to improve the service.

The provider had developed an open and positive culture, which focussed on improving the experience for people and staff. He welcomed suggestions for improvement and acted on these.