Archived: Bronte Care Services

Bronte Care Services is a domiciliary care agency. It provides personal care to people living in their own homes and flats. At the time of the inspection the service was providing personal care to 61 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

Most people, relatives and staff told us the service had improved since the last inspection. People and relatives were generally happy with call times and said they were normally supported by the same staff. Staff confirmed there had been improvements, which included how runs were coordinated and planned.

Recruitment was not always managed safely. We identified not all the required pre-employment checks had been carried out to ensure people were safe.

The provider had introduced a range of new electronic systems to improve the quality of the service. Audit and checking systems needed refining to ensure they were appropriate to monitor this new system.

Staff were knowledgeable about people and the topics we asked them about. They received training to carry out their role. The registered manager had introduced a programme of supervision and appraisal to ensure staff were fully supported in their role.

People’s care needs were assessed, and they received person centred care from staff who knew them well. People’s care plans had been recently reviewed. They received appropriate support with their nutrition and health needs. The way people’s medicines were managed had been improved.

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. Staff encouraged people to make decisions about their own care, and promoted people’s rights to dignity, independence and privacy.

The registered manager had introduced a range of quality checks and audits. They had increased the size of the management team and initiated a range of changes which had led to positive outcomes for people and staff. The registered manager was committed to the ongoing improvement 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 inadequate (published 7 September 2019) There were multiple breaches of regulations and the service was placed in Special Measures. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to safe recruitment. Please see the action we have told the provider to take at the end of this report

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People’s experience of using this service:

Recruitment was safe although we identified areas where improvements were needed to ensure the process was consistent and robust. Call scheduling and the deployment of staff was poorly planned and inefficient. People told us they did not get a rota and never knew which staff were coming to provide their call.

Staff had received training although people and relatives felt staff were not always sufficiently skilled. Staff had not received regular supervision, field-based performance checks or annual appraisals.

People did not feel all staff were caring and kind although staff took steps to maintain peoples dignity and privacy. 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 supported this practice. Although there was no evidence in care records that people had consented to their care package.

The management of people’s medicines was not always safe, and records were not sufficiently detailed to ensure robust auditing could be completed. Staffs’ competency to administer people’s medicines had not been assessed.

People received support to eat and drink although poor call scheduling sometimes meant their meal times were inconsistent.

Risk assessments were in place and were reviewed and updated, although where a person needed to be transferred using a hoist, insufficient information was recorded. There was no evidence to suggest people were involved in the care planning process.

Some people told us the care records in their homes had not been updated although the electronic records we reviewed in the office evidenced they had recently been reviewed. Not all care records contained sufficient detail to ensure person centred care.

People and their families did not feel the service was well led. Systems of governance had been implemented but audits had not always been completed at regular intervals and were not sufficiently robust.

Where things went wrong, lessons were not learned, and improvements had not been made.

Rating at last inspection:

At the last inspection the service was rated requires improvement (published 10 May 2018).

Why we inspected:

This was a planned inspection based on the rating awarded at the last inspection.

Enforcement:

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 act in line with our enforcement procedures to begin the process of preventing the provider from operating this service.

This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. 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 to 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.

During this inspection, we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, related with person-centered care, safe care and treatment, staffing and good governance. You can see what action we told the provider to take at the back of the full version of the 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 continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned for future dates.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Bronte Care Services is a community based domiciliary care service which provides personal care and support to adults and children living in their own homes. The service is operated from offices in Bingley, West Yorkshire and supports people in Bingley, Keighley and surrounding areas. At the time of the inspection 85 people were using the service.

Our last inspection took place on 11 and 12 July 2017 and at that time we found the service was not meeting three of the regulations we looked at. These related to person centred care, safe care and treatment and good governance.

On this inspection we found the registered provider had carried out a full audit of the policies, procedures and systems and improvements had been made in some areas of service delivery. However, we found improvements were required to ensure people who used the service received safe, effective and responsive care and support.

For example, we found the audit system had not identified that at times staff were not always arriving on time or staying the correct length when visiting people or that travelling time was not routinely being taken in to account when completing staff rotas.

In addition, whilst most people who used the service were complementary about the care staff providing their care and support, some were critical of the management of the service and thought there was a lack of communication and accountability.

There were sufficient number of staff employed for operational purposes although people had mixed views about the way they were deployed. There was a staff recruitment process in place to ensure only people suitable to work in the caring profession were employed. However, the registered provider did not always ensure references were taken from the applicant’s last employer.

Training records showed staff received training in a range of topics relevant to their roles. However, they did not distinguish between whether staff had attended practical and theoretical moving and handling training. This meant we could not be sure all staff had been trained to use equipment such as hoists and slide sheets correctly.

Staff were able to describe how individual people preferred their care and support delivered and the importance of treating people and their property with respect.

Records showed, if required, people were assisted to access other healthcare professionals and their medicines were administered as prescribed.

Where risks to people’s health, safety and welfare had been identified appropriate risk assessments were in place which showed what action had been taken to mitigate the risk. If people required staff to assist or support them to prepare food and drink information was present within their support plan and staff told us they encouraged people to eat a healthy diet.

The support plans we looked at provided sufficient information to enable staff to provide the care and support people required and were reviewed on a regular basis to make sure they provided accurate and up to date information. The staff we spoke with told us they used the support plans as working documents and they provided sufficient information to enable them to carry out their role effectively and in people's best interest. However, some people who used the service told us they had not been involved in reviewing their support plan.

The registered provider demonstrated a good understanding of their responsibilities under the Mental Capacity Act 2005 (MCA) and staff demonstrated good knowledge of the people they supported and their capacity to make decisions.

There was a complaints procedure available which enabled people to raise any concerns or complaints about the care or support they received. However, we were concerned that that minor concerns and verbal complaints were not consistently being logged.

We found three 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 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.”

Bronte Care Service provides personal care to people in their own homes in Bingley and the surrounding areas. At the time of the inspection there were 95 people using the service.

The registered provider is a single provider and therefore manages the service on a daily basis. 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.

Medicines were not managed safely. We found a number of discrepancies where we could not confirm whether people had received their medicines as prescribed. Where medicines had been left out for people to take later, this had not been recorded in a clear way.

We saw a high number of missed calls. This indicated people who used the service had been put at risk of harm from these missed calls. People told us they were not happy with the service due to the lack of continuity with their care workers; in that care workers were often changed and the service did not let them know about these changes. Staff told us they did not have travel time so they were always running late. People told us and we saw a record of a number of late or short calls which meant people’s individual needs were not met.

People told us they felt safe receiving care and support from the service; however, we found risk factors were not well documented. Risks associated with people’s care and support were not always consistently documented and was not used to produce meaningful guidance to staff to help minimise those risks.

People told us staff were generally kind to them and treated them with dignity and respect. They said staff were well trained to carry out their role. People were supported by staff who had received induction training which included shadowing more experienced staff. We looked at the provider’s training matrix. This is a document which lists training staff have received and the dates completed. This showed staff received training in a number of subjects.

We saw recruitment was safely managed to ensure staff were suitable to work with vulnerable adults. However, we found staff did not always receive regular supervision and annual appraisals.

The provider told us there were sufficient staff employed to enable the service to provide care and support to people. However, we found rota’s had no travel time and calls were unreliable. Staff were not always deployed in the right places at the right time.

Staff told us the provider conducted regular unannounced spot checks to make sure they were doing things correctly. They said they came unannounced and checked their working practices such as how they speak to people, how they completed care plans and whether they moved people safely. However, we found some staff members had not had a spot check for several months.

Staff told us that care plans were usually kept up to date but said if there was a change to people’s needs it would sometimes take weeks for the care plan to be updated. One staff member told us, “Office staff should improve communication, such as letting carers know about changes more promptly.”

People told us they were happy with the support they received to have a healthy diet. Staff were able to recognise and report when people’s healthcare needs changed.

The service had systems in place to deal with concerns and complaints. However, some people told us complaints had not been appropriately managed and complaints had not been consistently recorded.

We did not find adequately robust governance systems in place. Audits were not comprehensive or meaningful and the service did not always respond to concerns raised.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities)