Archived: Bromyard Home Care Agency Limited

Bromyard Home Care Agency Limited is a service providing personal care to people in their own homes. At the time of the inspection 24 people were receiving care.

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 and what we found

Governance systems had improved but required additional time to embed to reduce risks to people further. Governance systems in relation to the recording of to staff competencies to administer people’s medicines and processes for ensuring people received their medication as planned required further development. The provider gave us their assurances they would promptly address this. The provider planned to review their key policies so they could demonstrate these followed the most recent best practice guidance.

People, relatives and staff told us communication with the registered manager was good. They were confident if they made any suggestions for improvements these would be addressed without delay . People and relatives said the staff focused on people’s needs and described the culture of the service as warm, open and honest. Staff told us Bromyard Home Care Agency Limited was a good place to work because they felt supported and listened to.

People told us staff talked with them about their safety and took appropriate steps to assess their safety needs. Staff had received training to recognise abuse and were confident any concerns they escalated would be addressed. There was a consistent staff team supporting people who knew their safety needs well. Information was available to support staff to administer people’s medicines safely.

People were positive about the skills and knowledge staff had developed to care for them. People were involved in assessing their care needs and their views were taken into account when their care plans were developed. People’s families were consulted as part of this process where appropriate. This helped people to achieve good health and well-being outcomes. Staff worked with other health and social care professionals to ensure people’s health needs were 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.

Rating at last inspection and update.

The last rating for this service was Requires Improvement, (last report published 28 April 2020) and there were multiple breaches of regulation. At this inspection we found improvements had been made and the provider was no longer in breach of regulations. However, at this inspection further time was required to embed these improvements and to continue to develop governance systems and practice.

The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

We undertook this focused inspection to confirm the provider 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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Bromyard Home Care Agency Limited 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.

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

The risks to people had not always been assessed and kept under review. Written guidance for staff on the management of risks to people was not clear or up to date. People’s medicines were not managed safely. The information recorded on medicines records was not clear or complete. The provider had not adhered to safe recruitment practices to check the suitability of prospective staff before they started work with people.

We were not assured people’s needs and wishes were comprehensively and holistically assessed. Staff training had not been kept up to date and they did not receive formal supervision and appraisal. Staff induction processes were not sufficiently robust. People were supported to have maximum choice and control of their lives and staff did support them in the least restrictive way possible and in their best interests. However, the policies and systems in the service did not fully support this practice. The shortfalls in the quality and safety of people's care that we identified during our inspection did not reflect a caring service. People’s right to privacy was not always fully promoted.

People’s care plans did not always provide staff with clear and up to date guidance or promote a person-centred approach. The provider had not developed or implemented any formal quality assurance systems or processes to enable them to assess, monitor and drive improvement in the quality and safety of people’s care. The records maintained in relation to people’s care, staff employed and the overall management of the service were not always accurate, complete and up-to-date. The management team did not have a clear understanding of regulatory requirements upon the service.

People received a punctual and reliable service. Staff understood how to recognise and report potential abuse involving the people who used the service. Steps had been taken to protect people, staff and others from the risk of infections. Staff knew how to report incident and accidents involving people.

People and their relatives had confidence in staff members’ knowledge and skills. They received the level of support they needed to prepare meals and drinks. Staff helped people seek professional medical advice and treatment when they needed this.

People and their relatives told us staff adopted a kind and caring approach towards people’s day-to-day care and support. They felt able to express their views to staff and management whenever they wished.

People and their relatives knew how to raise complaints and concerns with the provider and felt comfortable doing so. Staff worked with community health and social care professionals to ensure people’s end-of-life needs and wishes were identified and addressed.

People, their relatives, staff and community professionals spoke positively about their working relationships with the management team. They found management open, approachable and supportive. Staff were enthusiastic in their work and felt valued by the provider.

Rating at last inspection

This is the first inspection for this newly registered service.

Why we inspected

This was a planned inspection based upon the service’s registration date.

Enforcement

We have identified four breaches of the Regulations at this inspection. These relate to the lack of safe and robust procedures for assessing and reviewing risks to people and managing their medicines. The provider had also failed to appropriately check the suitability of prospective staff. In addition, staff had not received appropriate training, supervision and appraisal, and the provider had not ensured effective governance of the service.

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 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.

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