We carried out a review of the data available to us about Bromley 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 Bromley, you can give feedback on this service.
People’s experience of using this service and what we found
There were safeguarding adults’ procedures in place, the provider and staff understood these procedures. Risks to people were assessed and staff were aware of the action to take to minimise risks where they were identified.
People received support from trained staff to take their medicines safely. Recruitment checks were carried out before staff started work and there were enough staff to meet people’s needs. The provider and staff were following the current government guidance in relation to COVID 19.
Staff received training relevant to people’s needs. People’s care needs were assessed, and care plans were in place to ensure staff could support them safely. People received support to maintain a balanced diet.
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 support this practice.
People were treated in a caring and respectful manner and they were consulted about their care needs. Relatives said they knew how to make a complaint if they were unhappy with the service. People had access to end of life care and support if it was required.
There were effective systems in place to monitor the quality of service. Staff said they were happy working at the service, and they received good support from the provider. The provider took people and their relatives views into account through satisfaction surveys and telephone monitoring calls.
The provider had a business continuity plan in place that made provisions for safe care in the event of an emergency. The provider and staff worked with health care providers to plan and deliver an effective 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 requires improvement (published 18 August 2021) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.
Why we inspected
This inspection was carried out to follow up on action we told the provider to take at the last inspection.
The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
People’s experience of using this service
During this inspection, we found the service failed to make enough improvements to address the concerns identified at the last inspection and comply with our regulations. People’s care records were not kept under review and did not reflect people’s current care and support needs. Risks to people’s health and safety were not effectively assessed. The provider’s systems for monitoring the quality and safety of the services provided to people were not operating effectively.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. However, decisions made about people’s care did not always consider current guidance on recording ‘best interests decisions’ in line with the Mental Capacity Act 2005.
A relative spoke positively about the service. They said they felt their loved one was safe and their needs were being met. There were enough staff deployed to meet people's needs. Staff followed appropriate infection control practices. The provider had systems in place to record and respond to accidents and incidents.
Staff were supported through training to ensure they performed their roles effectively. People were supported with their meals and had access to healthcare services when needed. Staff had the knowledge and experience to support people's needs and said they were well supported by the registered manager.
Why we inspected
This inspection was carried out to follow up on action we told the provider to take at the last inspection.
The last rating for this service was requires improvement (published 26 July 2019). The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.
We will meet with the provider following this report being published to discuss how they will make changes to ensure they 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.
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 have identified breaches in relation to Regulations 11 (Need for consent), 12 (Safe Care and Treatment) and 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 at this inspection.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
'Bromley' is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to older adults. Two people were using the service at the time of our inspection.
People’s experience of using this service and what we found
The provider had failed to ensure that medicines were managed safely. There was no guidance in the care plans for staff to know how or when to support people to take medicines which had a specific administration process. Staff had completed online training in the safe administration of medicines. However, assessments to ensure staff were competent to handle medicines had not been completed.
The provider had not displayed the previous inspection rating on their website and in their office.
The provider had failed to maintain a record of decisions made in people’s best interests. 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. We have made a recommendation about ensuring the provider follows the principles of The Mental Capacity Act (2005).
The provider’s quality assurance systems had failed to identify the concerns we found at this inspection.
People were supported by effectively deployed staff. One relative told us, “We have not had any missed visits. The carers turn up on time and let my [loved one] or myself know if they are delayed.”
The provider carried out satisfactory background checks for all staff before they started working. However, one external consultant’s recruitment checks were not available, and this required improvement.
The registered manager completed risk assessments and risk management plans included guidance for staff for people who used the service.
People and their relatives gave us positive feedback about their safety and told us staff treated them well. One relative told us, “I definitely feel my relative is safe in the hands of the carers.”
The registered manager and staff understood what abuse was, the types of abuse, and the signs to look for. Staff knew the procedure for whistle-blowing and said they would use it if they needed to. The provider had a system to manage accidents and incidents to reduce the likelihood of them happening again.
People were protected from the risk of infection. One person told us, “They [staff] wear aprons and gloves.” One relative said, “I know the carers wear protective gloves.”
People and their relatives confirmed staff obtained consent from them before delivering care to them. People’s needs were assessed to ensure these could be met by the service.
The provider trained staff to support people and meet their needs. One relative told us, “The carer is very good and very professional.” Staff supported people to eat and drink enough to meet their needs. People were supported to maintain good health.
Staff supported people and showed an understanding of equality and diversity. One relative told us, “They [staff] contacted the priest for us who now visits. I did not know could be done, and it has made me very happy.” People’s care plans included details about their ethnicity, preferred faith and culture. People and their relatives had been involved in making decisions about their care and support. People were treated with dignity, and their privacy was respected.
The provider had a policy and procedure to provide end-of-life support to people. However, no-one using the service required end-of-life support at the time of our inspection.
We saw some good practice at the service, they had an on-call system to make sure staff had support outside office working hours and staff confirmed this was available to them. One person told us, “I can recommend the company because they [staff] are kind and not intrusive.” On relative said, “I think the service is good and well managed.” There was a positive culture in the service, where people and their relatives’ opinions were sought to make service improvements. The provider remained committed to working in partnership with other agencies and services to promote the service and to achieve positive outcomes for people.
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 November 2018) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, enough improvement had not been made and the provider was still in breach of regulations. This is the second time the service has been rated as requires improvement.
Why we inspected
This was a planned inspection based on the previous rating.
Enforcement:
We have identified continuous breaches in relation to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 at this inspection. The systems and processes for managing people’s medicines were not always safe.
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 request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.
The service had a registered manager in post. 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.
This was the first inspection of the service. At this inspection we found breaches of regulations because risks to people had not been adequately assessed, and there was not always guidance in place for staff on how to manage identified risks safely. The provider had not followed safe recruitment practices. Medicines were not always safely managed. There were insufficient staff available to cover any staff absence. Whilst people received person-centred care from staff, their care plans were not up to date or accurate. The provider’s systems for monitoring the quality and safety of the service were not effective.
You can see what action we told the provider to take at the back of the full version of the report.
We also found improvement was required because assessments of people’s needs were not always comprehensive. Staff received an induction, and were supported in their roles through the provider’s training programme, but they did not always demonstrate a sound understanding of areas in which they had been trained. The registered manager was not always aware of current best practice in operating a domiciliary care agency.
We have made a recommendation about best practice in carrying out risk assessments and developing people’s care plans.
People were protected from the risk of abuse because staff were aware of the provider’s procedures for reporting abuse allegations. Staff sought people’s consent when offering them support. 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. Staff were aware of the need to report any incidents or accidents so that lessons could be learned to reduce the likelihood of repeat occurrence.
People were supported to maintain a balanced diet where this was part of their assessed needs. They had access to a range of healthcare services in order to help maintain good health. The registered manager worked with other services, such as people’s GPs, to ensure they received effective, joined up care. Staff were aware of the steps to take to protect people from the risk of infection.
Staff treated people with kindness and compassion. They respected people’s privacy and treated them with dignity. People were involved in making decisions about the support they received. The provider had a complaints procedure which gave guidance to people on what they could expect if they made a complaint. None of the people using the service required end-of-life care at the time of our inspection.
People spoke positively about the management of the service. The registered manager was in regular contact with people and their relatives, to gain their views on the service they received. Staff told us the service had a positive working culture, and said they felt well supported by the registered manager. The registered manager was committed to working openly with other agencies, such as local authority safeguarding teams, if required.
This is the first time the service has been rated Requires Improvement.