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Burton Home Care

Overall: Requires improvement read more about inspection ratings

Unit 3, Kingfisher Court, Pinhoe Trading Estate, Venny Bridge, Exeter, Devon, EX4 8JN (01392) 340222

Provided and run by:
Mr Nigel Roy Burton

All Inspections

8 June 2021

During an inspection looking at part of the service

About the service

Burton Home Care is a domiciliary care service, which provides support for adults in the community, who require assistance with personal care, including those living with dementia, physical disabilities, mental health needs and sensory impairments. At the time of our inspection there were 35 people who used the service.

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

The provider had not been aware of the requirement to submit statutory notifications, which meant legal requirements had not been met.

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, however further improvements were required which had not been identified by the provider. The provider acted immediately in response to feedback given and the improvements were made.

Recruitment checks were carried out for staff before they started working at the service to ensure they were safe to work with vulnerable people. However, improvements were needed.

People's needs were assessed before they started using the service and regularly reviewed. Risk assessments and care plans were comprehensive. They provided the guidance staff needed to understand and minimise risks and meet people’s needs. When people needed support with taking their medicines, this was provided safely.

People were protected from the risk of abuse and avoidable harm. Lessons learnt from accidents and incidents were used to prevent reoccurrences.

People were supported to live healthier lives, with staff supporting and contacting health care professionals when needed. Staff worked in partnership with other professionals to ensure people received the right support.

A detailed Covid 19 risk assessment was in place and reviewed monthly. Staff were tested weekly for Covid 19 and had received their vaccinations. All had completed relevant training and kept up to date with relevant guidance. They were provided with the recommended PPE, enabling them to support people safely.

Staff received a comprehensive induction, training and supervision to support them in their role, and were encouraged and supported in their professional development. They felt valued by the management team and their hard work was recognised and rewarded. People spoke highly of the knowledge and skills of staff and the quality of the support they received. Comments included, “This is the best company, I would recommend them” and, “All the girls are lovely, just lovely. They will do anything for you.”

The provider and management team led an open, transparent and person-centred service which helped people and staff feel valued and supported. They were committed to continuing to learn and improve, responding immediately to feedback given during the inspection and addressing any concerns raised.

Clear processes were in place to ensure effective monitoring and accountability. There was a quality assurance programme which was informed by feedback from people, relatives and staff.

We have made a recommendation about recruitment practices.

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 (published 29 August 2019) and there were multiple breaches of regulations. At this inspection enough improvement had not been sustained and the provider was still in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

We carried out an announced comprehensive inspection of this service on 09 and 12 July 2019. 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 the need for consent, and governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well Led which contain those requirements. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has not changed and remains requires improvement. This is based on the findings at this inspection.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to the failure to submit statutory notifications and governance.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Burton Home Care on our website at www.cqc.org.uk.

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.

9 July 2019

During a routine inspection

About the service:

Burton Home Care is a domiciliary care service, which provides support for adults in the community, who require assistance with personal care, including those living with dementia, physical disabilities, mental health needs and sensory impairments. At the time of our inspection there were 52 people who used the service.

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

People were at risk of receiving unsafe care because the information in some risk assessments was inaccurate and did not always provide the guidance staff needed to understand and minimise risks. Measures in place to protect people were not consistently followed by staff.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

The systems in place to monitor the quality and safety of the service were not effective, because they did not identify the issues we found during the inspection.

People's needs were assessed before they started using the service and regularly reviewed. When people needed support with taking their medicines, this was provided safely.

People were supported to live healthier lives, with staff supporting and contacting health care professionals when needed. Staff worked in partnership with other professionals to ensure people received the right support.

People were protected from the risk of abuse and avoidable harm. Lessons learnt from accidents and incidents were used to prevent reoccurrences. Staff followed appropriate infection control practices and robust recruitment checks were carried out for staff before they started working at the service.

People received personalised care. They told us they did not feel rushed during their care visits. They were supported by staff who knew them well and understood their needs. One person told us, “They understand me and my little ways. People told us they were involved in decisions about their care and regularly asked for their views by the office. They knew how to raise a concern and were confident it would be addressed.

Staff received a comprehensive induction, training and supervision to support them in their role. The provider was in the process of developing the training package to include the Mental Capacity Act (2005), dementia and end of life care.

The provider led an open, transparent and person-centred service. Staff felt well supported by the provider and management team and their hard work was recognised and rewarded. The provider was committed to continuing to learn and improve the quality and safety of the service provided, for the benefit of the people they supported and their local community.

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

Why we inspected

This was a planned inspection based on the previous rating. We have found evidence that the provider needs to make improvements. Please see the 'Safe', 'Effective' and 'Well-led' key question sections of this full report.

Rating at last inspection and update.

The last rating for this service was requires improvement (published 26 July 2018). The service remains rated requires improvement. This service has been rated requires improvement for two consecutive inspections.

Enforcement:

We have identified breaches of regulation in relation to the assessment of risk, the need for consent and maintaining effective systems and processes to monitor the quality and safety of the service and to drive improvement.

Follow up :

We will request an action plan for the provider to understand what they will do to improve the standards of equality and safety. We will also meet with the provider following this report being published to discuss how they will make changes to ensure they will improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme . If we receive any concerning information we may inspect sooner.

22 May 2018

During a routine inspection

The inspection took place on 22 and 25 May 2018 and 15 June 2018 and was announced. This was the first inspection of the service since it was registered in March 2017.

Burton Home Care is a domiciliary care agency. It provides personal care to older adults and younger adults living with a disability people living in their own houses and flats in the community. At the time of the inspection the service was providing 350 hours of support to 32 people.

Burton Home Care was managed by a person who was registered with the Care Quality Commission as the provider and registered manager for the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. 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 service was not always safe because risk assessments, did not consistently provide the information and guidance staff needed to understand and minimise risks, particularly when people were at risk of choking. This concern was discussed with the registered manager and field care supervisor. They responded by reviewing all risk assessments and care plans, and amending them where necessary to ensure their accuracy and help keep people safe.

There was a risk that people’s rights were not protected because they had been assumed to have the capacity to make decisions about their care. However, their capacity assessment, information in their care records or feedback by family members suggested this may not be the case. In addition consent forms had not always been signed, where people had been asked to consent to the support being provided and information being shared. We discussed this with the registered manager and field care supervisor who responded by reviewing all of the capacity assessments and consent forms to ensure they were correct and people’s rights were protected.

There were systems in place to regularly monitor the service and make improvements where necessary. This included regular audits of care records, which had not identified some of the issues we found. We discussed this with the registered manager and field care supervisor who then carried out an audit of all care records and were considering how their quality monitoring processes could be more effective. Although, there was a positive and immediate response to the concerns raised and action was taken, more time is needed to allow the changes to become embedded into practice.

Other quality monitoring processes included feedback from the people using the service and the staff supporting them, and unannounced spot checks of staff practice. In addition an electronic monitoring system allowed office staff to monitor visit times and duration and ensure people were supported in line with their care plans. The management team themselves provided hands on care, and knew the people using the service well. This provided additional opportunities to ask people about the quality of the support they were receiving.

People told us the service was well run, and praised the management team and all the staff. The management team had learnt from their experience as care workers for larger companies, and, although the registered manager was increasing the level of service provision, they planned to keep the service small so that the quality of support could be maintained. One person said, “If there was an award for care companies there is only one care company that would be up there.” The registered manager had an open and transparent management style, and welcomed the feedback given during the inspection. They were committed to learning from any mistakes and acted immediately to address the concerns raised.

Staff told us they felt well supported. They received regular supervision and attended quarterly staff meetings where they were able to express their views about the development of the service. They completed a comprehensive induction and mandatory training on a range of topics which was refreshed every 12 months. This was delivered face to face by the registered manager, who was a qualified and experienced trainer. Bespoke training was arranged if required to enable staff to understand and meet people’s specific needs.

People told us they felt safe. They said they received a consistent and reliable service. Burton Home Care had a system for identifying the most vulnerable people, which meant their needs would be prioritised if there were any problems affecting service provision. They did not accept referrals unless they had the capacity, skills and experience to support the person effectively. Rounds had been carefully planned to ensure people had a consistent team of care staff with enough time to meet their needs and the flexibility to respond to any additional requests for support. People were confident they could raise any complaints or concerns with the provider and these would be dealt with promptly and satisfactorily.

People were protected from abuse and harm because staff had completed training in safeguarding adults, and knew how to recognise and report safeguarding concerns. Burton Homecare had worked closely with the local authority and other agencies to report and investigate safeguarding concerns and take any action necessary to keep people safe.

Before people began receiving a service an assessment was carried out to assess any risks to the person using the service and to the staff supporting them. A care plan was drawn up with each person and reviewed with them regularly. The care plans explained how to support and encourage people to remain independent. They contained easy to read and clear information about the support the person needed and how they wanted it to be provided, including any support they might need with communication. This enabled staff to provide safe and effective care.

People’s health needs were monitored and prompt action was taken to support people to seek advice and treatment from health and social care professionals where necessary. Where people needed assistance with medicines, staff had received training and knew how to support people safely.

The service was caring. People were supported by staff who knew them well and understood their needs. We heard many examples of praise for care and kindness of the staff. Comments from people included,” They are absolutely brilliant, I am more relaxed than I have been for years. They have made such a difference to my life, let alone my husbands. The carers know us and we know them. “

The registered manager was committed to promoting equality, diversity and human rights at Burton Home Care, ensuring staff shared their values and increasing staff awareness through training. Care records reflected the diverse needs of people using the service including those related to disability and faith. These needs were recorded in care plans and staff we spoke to had a good understanding of them.