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Burton Home Care Requires improvement

Reports


Inspection carried out on 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 mon

Inspection carried out on 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 servi