We carried out a review of the data available to us about Browns Short Break Respite Limited on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Browns Short Break Respite Limited, you can give feedback on this service.
Browns Short Breaks Respite Ltd is a service that provides domiciliary care and a supported living. In addition, the service provides short term residential care and support for up to four people. All of these services are provided from the same address.
The service supports people living in their own tenancy with up to 24hr support. Staff support up to two people living in their homes at one time. Some people receive support through the night by a member of staff who sleeps on the premises in an allocated bedroom. In addition, people received domiciliary care and support within their homes, community and whilst away from home.
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.
The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.
People’s experience of using this service and what we found
We have made a recommendation about establishing people’s best interest decisions. Although 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; systems in the service did not fully support this practice. The registered manager took immediate action to seek further guidance in this area.
We have made a recommendation about the current system in place for reviewing the quality and safety of the service. Although checks were taking place, the monitoring system did not demonstrate when areas of improvement that had been identified would be addressed.
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 did not support this practice.
People felt safe using the service and were protected from abuse and the risk of abuse. Procedures were in place for the safe management of medicines and people received them on time. Safe recruitment practices were followed. Infection control practices were followed to minimise the risk of the spread of infection and regular safety checks were carried out on the environment and equipment.
Systems were in place to monitor the quality of the service that people received. People's needs and choices were assessed prior to moving into the service. People received care and support from experienced staff who received training and supported for their role. People were supported to have a nutritious and balanced diet and their healthcare needs were met.
People and their family members and felt the service met their needs and positive relationships had been formed with the staff delivering care and support.
People and their family members had access to information about how to make a complaint about the service.
Systems were in place to monitor the quality of the service that people received. The registered manager sought information and guidance from other agencies to continually develop the service.
The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.
The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.
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 (report published 12 June 2017).
Why we inspected
This was a planned inspection based on the previous rating.
Brown's Short Break Respite Limited provides personal care and support to people living in their own homes. Since the last inspection the registered provider had registered with the CQC to offer a residential respite service for up to four people. There were two people staying at the residential respite service at the time of our inspection. There were 60 people being supported within their own homes. Both services are based at the same location in the Parr area of St. Helens. The inspection process included the experiences of people living in their own homes and those using the residential respite service.
The last inspection of Brown's Short Break Respite Limited was carried out in August 2015 and we found that the service was meeting all the requirements of the Health and Social Care Act 2008 and associated Regulations.
The service had a registered manager who had been in post since January 2012. 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.
The registered provider followed robust recruitment procedures which helped to ensure that only staff suitable to work with vulnerable people were employed to work at the service. All staff undertook an induction process and completed mandatory training essential to their roles. There were enough staff in place to meet the needs of the people supported.
Prior to people using the service their needs were assessed and risk assessments were put in place. People's care plans included their social and medical histories, likes, dislikes and preferences. Care plans were regularly reviewed and updated as required following any changes.
People told us they felt safe and stated they had no concerns about the way they were treated by staff. The registered provider had safeguarding policies and procedures in place for staff to follow. Staff demonstrated a good understanding of abuse and the action they would be required to take should someone be at risk of harm.
People told us that they had regular staff supporting, them who were kind, caring and well-trained for their role. They told us staff treated them with dignity and respect. Staff told us they felt supported and always had access to a member of the management team whenever they were working.
Staff were confident about dealing with emergency situations and they had details of people and services they may need to contact for advice, guidance or support any time of the day or night. People had personal emergency evacuation plans (PEEPS) in place.
The Care Quality Commission is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005 and to report on what we find. We saw the policies and guidance were available to staff in relation to the MCA. Staff had a basic understanding of the principles of the Act. Care planning documents included consideration of the MCA which meant that people's rights were protected.
People's views about the service were sought by annually through questionnaires and also through care review meetings. The registered provider used this information to further develop the service.
The registered provider had systems in place for the monitoring and auditing of the service. This information was used to improve and develop the service.
This was an announced inspection, carried out on 21 and 26 August 2015.
The service provides care and support to people living in their own homes. The office is based in the Parr area of St Helens.
The service has had a manager registered with CQC since January 2012. 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.
The last inspection of Browns Short Break Respite Limited was carried out in August and September 2014 and we found that the service was not meeting all the regulations that were assessed. The registered provider sent us an action plan outlining how and when they intended to meet the regulations. During this inspection we found that the required improvements had been made within the timescale set by the registered provider.
Improvements had been made to ensure people could access their care plans and be fully involved in the reviewing of them. Pictures and symbols were used so that people who had difficulty reading could access their care records.
People told us they liked the staff and that they felt safe during the time they received a service. Family members had no concerns about their relative’s safety and the way their relative was treated. Staff knew what their responsibilities were for responding to any concerns they had about a person’s safety, including allegations of abuse. Training provided to staff and information made available to them helped to ensure people were safeguarded from abuse and avoidable harm.
An assessment of people’s needs was carried out and appropriate care plans were developed to meet people’s needs. Care plans were person centred and detailed people’s preferences with regards to how they wished their care and support to be provided. Care plans were regularly reviewed with the involvement of the person the care plans were for and other significant people such as family members and relevant health and social care professionals.
Processes for recruiting staff were safe and thorough to ensure staff were suitable for their role. People’s needs were understood and met by the right amount of skilled and experienced staff.
Staff ensured that people received the care and support they needed and were confident about what to do in an emergency situation. Medication was managed safely and people received their medication at the right times.
The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS) and to report on what we find. Policies and procedures were in place to guide staff in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The registered manager understood what their responsibilities were for ensuring decisions were made in people’s best interests.
Staff received an appropriate level of support and training relevant to the work they carried out and meeting the needs of people who used the service. People told us they liked the staff and family members told us they were confident that their relative had received the right care and support. People built positive and trusting relationships with staff and people said staff were caring, kind, respectful and polite.
The culture of the service was positive and open. People who used the service and their family members described the registered manager as being approachable and supportive. The quality of the service was regularly checked and people’s views about the service was obtained and acted upon.
' Is the service safe?
' Is the service effective?
' Is the service caring?
' Is the service responsive?
' Is the service well-led?
This is a summary of what we found.
Is the service safe?
We saw that people had been cared for in their own homes and the service had checked if this was safe, clean and hygienic. There were risk assessments in place to check if suitable equipment was available in people's homes to assist staff with meeting their needs. We were told by people using the service that the staff arrived on time and stayed for the correct amount of time. Comments included, 'I always get a call if they are running late or they need to send a different person'. We saw that a member of the management team was on call and available in case of emergencies.
We saw that the service was able to recognise and take appropriate action to protect people from the potential risks of abuse or harm.
Is the service effective?
On the first day of our inspection we found that staff training was not consistent and some staff training was not up to date. The manager was aware of this and had recruited a training coordinator to manage and deliver training. On the second day of our inspection we were shown a plan that showed the dates that each member of staff was to attend training. Supervision of staff in order to make sure that they developed and maintained their skills was consistently done by a member of the management team.
Is the service caring?
We spoke with two relatives and two people who used the service they told us the staff were 'fantastic', 'can't fault them' and 'always helpful'.
Is the service responsive?
People's needs had been assessed before they received a service. Care records were not always consistent we saw that care records were not in the same format and were not person centred concentrating on medical needs and tasks rather than the person and their individual needs. Some people's preferences, interests and diverse needs were included in the care planning. The majority of the care plans viewed did not include people's preferences, their interests or any diverse need. The manager told us that they were aware of this and had arranged person centred training for staff to assist them in the future.
Is the service well-led?
The service had a manager in place who was registered with CQC. We looked at how the manager made sure that the quality of the service being provided was appropriate. We saw that there was a variety of arrangements in place to make sure that the quality of the service was monitored.
Comments from staff were positive and they told us that they 'loved working here', 'really well supported' and 'could not work anywhere else'.
At this visit we found action had been taken to address some of the issues identified at our previous visits and improvements had been made.
Care plans had been reviewed in order to provide staff with instructions as to how to meet people's needs. Changes to people's needs included care and medicines, these were not always communicated to the main office in order for them to update the care records correctly. As result we saw that some changes to people's needs had not been actioned.
The service had given staff instructions on how to report and document changes however staff were not all following those instructions. We saw that senior staff were checking records such as daily records and medication records. The records checked by senior staff contained issues such as medications concerns, safety concerns and inappropriate care. These documented concerns had not been recognised by the senior staff checking the records as a result people were placed at risk.
We saw that the service had increased its checks on the quality of the service and policies and procedures had been updated. The managers had recruited external professionals to assist them increasing the quality of the service and this had assisted them to make the improvements that have been put into place.
We noted that improvements in the written communication of the service, including care plans and medicines were needed. Staff relied on good relationships with families and people who used the service in order to determine the care they needed to deliver.
Arrangements to monitor the quality of the service had commenced but were insufficient to improve the quality of the service and reduce the risks to people.
Staff records showed that they were recruited with the skills they needed to undertake the job role. Checks on their suitability to work with vulnerable people were in place.
Guidance to staff such as policies and procedures were not sufficient to make sure that staff could deliver care as needed. Policies were not reflective of the practices in place within the service.
We visited three people in their own homes with their permission and spoke with two others who were visiting the premises on the day of our inspection They told us, "The girls are very supportive", 'We have a few problems but that's been ironed out now. We get the same carers all the time and that really helps', 'If they are running late they ring me and let me know. I always know who is coming to see me', 'The records the staff had weren't clear so I wrote one for them. They told me they thought it had great information in it' and "I can't fault them they are all lovely. It's taken me some time to get used to people coming here but I'm glad I have them now."
We also received a number of positive comments,
'The carers are not so bad', 'The staff are alright, they treat me fine and with respect,'
'I have no problems with the staff at all', 'I couldn't be better treated if they were my own family', 'I have no complaints, whatsoever', 'They (staff) treat me very well. They are always courteous, can't speak too highly of them' and 'They (staff) have been marvellous, can't fault them at all'.
Staff told us that they were kept informed of changes in people's condition and had received relevant training.
We received information from social services regarding some areas within the service that needed to be improved and actions that the service had already taken to increase the quality of the service provided.
We have asked or pharmacist inspectors to review medication management in the next few months