Brisen Company Limited

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

Risk assessments and risk management plans were not always in place or were not adequate. People's medicines were not always safely managed. There was not a robust safeguarding process in place to keep people safe. Appropriate recruitment checks were not carried out before staff joined the service. There was a system in place to log and investigate accidents and incidents, but these were not analysed, and any learning was not disseminated to staff. Records showed people’s independence was not always promoted.

Staff had not received adequate training. Staff were not always supported through regular supervision. Governance systems were not effective at identifying and reducing risks to people's safety. There was a lack of oversight and effective leadership of the service.

People or their relatives were involved in planning their care and support and their care plans but these were not reviewed regularly. People’s privacy, dignity and independence was maintained. People were protected from the risk of infection. People’s end of life care wishes was recorded in their care files. Staff were deployed to meet people's needs in a timely manner. People were supported to eat and drink. The provider had not received any complaints since the last inspection. Regular feedback had been sought from people about the service.

Rating:

The last rating of the service was Inadequate (published on 06 October 2022) when we carried out a comprehensive inspection.

At our last inspection we found breaches of the regulations in relation to regulations 9 (person-centred care), 10 (dignity and respect), 12 (safe care and treatment), 13 (safeguarding service users from abuse and improper treatment), 14 (Nutrition), 16 (receiving and acting on complaints), 17 (good governance), 18 (staffing) and 19 (recruitment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We had told the provider what action they needed to take to ensure the safety of people who used the service. At this inspection we found that the provider had made some improvement but remained 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. At this inspection we found that the provider had made some improvement but still remained in breach of regulations 9 (person-centred care), 12 (safe care and treatment), 13 (safeguarding service users from abuse and improper treatment), 18 (staffing) and 19 (recruitment) and 17 (good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We identified breaches in relation to lack of risks assessments, risk management plans, detailed care plans, medicines management, safeguarding, staffing, recruitment practice. There were no robust systems in place to assess and monitor the quality of the service provided. There was a lack of effective oversight and leadership of the service.

Enforcement:

This service has been in Special Measures since August 2022. During this inspection the provider demonstrated that improvements had been made. The service is no longer rated as inadequate overall; therefore, this service is no longer in Special Measures.

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 Brisen Company Limited on our website at www.cqc.org.uk.

Follow up We will meet with the provide to discuss how they will make changes to ensure they improve their rating to at least good. We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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

We found the provider had failed to ensure appropriate assessments of risks to people were completed. Risk management plans were not always in place to manage these risks, which included distressed behaviour, medicines, nutrition, moving and handling, falls, skin integrity, and where people had health conditions such as a stroke, Parkinson’s Disease, or diabetes. People's medicines were not always safely managed. There was not a robust safeguarding process in place to keep people safe.

Staff were not effectively deployed to meet people's needs in a timely manner. Appropriate recruitment checks were not carried out before staff joined the service. There was a system in place to log and investigate accidents and incidents, but these were not analysed, and any learning was not disseminated to staff. People’s independence was not always promoted. People’s end of life care wishes, were not always recorded in their care files. Staff had not received adequate training. Staff were not always supported through regular supervision. The provider did not have a robust complaints system in place to manage people's complaints effectively.

People or their relatives were not always involved in planning their care and support and their support plans were not reviewed regularly. People’s consent to care and support was not always been documented. Regular feedback had not been sought from people. Where feedback had been sought, the provider did not always act to rectify any shortfalls which had been identified. Governance systems were not effective at identifying and reducing risks to people's safety. There was a lack of oversight and effective leadership of the service.

People were protected from the risk of infection.

Rating:

The last rating of the service was Inadequate (published on 06 October 2022) when we carried out a comprehensive inspection.

At our last inspection we found breaches of the regulations in relation to regulations 9(person-centred care), 10 (dignity and respect), 12 (safe care and treatment), 13 (safeguarding service users from abuse and improper treatment), 16 (receiving and acting on complaints), 17 (good governance), 18 (staffing) and 19 (recruitment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We had told the provider what action they needed to take to ensure the safety of people who used the service. However, at this inspection, we found the provider remained in breach of regulations. This service has been in Special Measures since October 2022. During this inspection the provider demonstrated that improvements had not been made. The service remains inadequate and continues to be in special measures.

Why we inspected:

This inspection was carried out to follow up on action we told the provider to take at the last inspection. We also identified breaches in relation to lack of risks assessments, risk management plans, detailed support plans, medicines management, staffing, recruitment practice, complaints. There were no robust systems in place to assess and monitor the quality of the service provided. There was a lack of effective oversight and leadership of the service.

Enforcement:

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.

The overall rating for this service is 'Inadequate' and the service remains in 'special measures'. This means we will keep the service under review. 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.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Brisen Company Limited on our website at www.cqc.org.uk.

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

The provider failed to ensure appropriate assessments of risks to people were completed, or risk assessments were not updated. Risk management plans were not always in place to manage these risks, which included, health conditions, moving and handling, falls, medicines, skin integrity and diabetes. People's medicines were not always safely managed.

Staff were not deployed to meet people's needs in a timely manner. People and relatives told us that staff were frequently late, this sometimes meant that at times a family member had to support as the second carer.

People and their relatives told us that people did not always feel safe. Appropriate recruitment checks were not carried out before staff joined the service.

Potential safeguarding concerns were not always reported to CQC. There was not a robust system in place to record accidents and incidents. These were not analysed and learning was not disseminated to staff.

People were not always protected from the risk of infection as not all staff wore Personal Protective Equipment (PPE). Staff were not always supported through regular supervisions.

Assessments were not always carried out prior to people joining the service to ensure that people's needs could be met and were not used to develop care plans. Staff did not always receive adequate training. People’s privacy and dignity and their independence was not always promoted. People’s end of life care wishes was not recorded in their care files. The complaint system to manage people concerns was not effective.

People and/or their relatives were not involved in planning their care and support, Care plans were not always reviewed and/or updated. People's consent to care and support was not always documented.

Feedback was not always sought from people about the service, where feedback had been sought, the provider did not always act upon and rectify shortfalls identified. Governance and audit systems were not effective at identifying and reducing risks to people's safety. There was a lack of effective leadership and oversight of the service.

Rating:

The last rating of the service was Good (published on 21 March 2021) when we carried out a comprehensive inspection.

Why we inspected:

We received concerns about late visits, staff recruitment, neglect and poor medicines management. As a result, we undertook a comprehensive inspection. We identified breaches in relation to lack of person-centred care, risks, care plans, medicines management, recruitment practice, and there were no robust systems in place to assess and monitor the quality of the service provided. There was a lack of effective leadership and oversight of the service.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Brisen Company Limited on our website at www.cqc.org.uk.

Enforcement:

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 closely and discuss ongoing concerns with the local authority. If we receive any concerning information we may inspect sooner.

The overall rating for this service is 'Inadequate' and the service therefore is in 'special measures'. This means we will keep the service under review. 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.

People’s experience of using this service:

¿ Staff understood signs to recognise abuse and how to report suspected abuse. Staff knew actions to take to protect people from abuse.

¿ Risks to people were assessed and plans put in place to reduce identified risk.

¿ Staff were sufficient and adequately deployed to support people with their needs.

¿ The service had a policy and procedure on the safe management of medicines. No one was receiving support with their medicines when we visited.

¿ Staff were trained to reduce the risk of infection.

¿ The service had systems in place to report incidents and accidents and staff knew about these procedures.

¿ The registered manager involved people and their relatives in the assessment of their needs. They planned people’s care based on their assessed needs and preferences.

¿ Staff were supported through training and supervision to provide effective care to people.

¿ Where required, people received support from staff to meet their nutritional needs.

¿ People were supported to access the health care services they needed to maintain their health. The registered manager liaised effectively with other services to ensure people received well-coordinated care.

¿ 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 and the registered manager understood their roles and responsibilities under the Mental Capacity Act (MCA) 2005. Staff involved people in their care delivery and ensured people consented before they delivered care.

¿ People told us that staff treated them with kindness and respected them as individuals.

¿ Staff respected people’s dignity and privacy. People were encouraged to maintain their independence as much as possible.

¿ People and their relatives told us that they were involved in their care and their choices and preferences were respected.

¿ Staff supported people in a way which met their individual needs. Staff respected people’s diversity. The service considered people’s language needs and communicated with them in the way they understood.

¿ People knew how to report their concerns or complaints about the service.

¿ The registered manager had experience in providing end of life care. At the time of our visit no one was receiving end of life care.

¿ The registered manager assessed and monitored the quality of service delivered through spot checks, monitoring visits and audits.

¿ The service ensured that the service delivered to people met their needs.

¿ The registered manager understood their role and responsibilities in line with their registration requirements.

¿ People, relatives and staff were involved and engaged in planning and delivering the service.

¿ The registered manager worked in partnership with the local authority to develop the service and meet people’s needs.

Rating at last inspection: This was the first inspection of the service since they registered with the CQC in January 2018.

Why we inspected: This was a planned inspection based on our guidance about newly registered services.

Follow up: We will continue to review information we receive about the service until we return to visit as part of our re-inspection programme. If any concerning information is received we may inspect sooner.