Briars Homecare Services Limited

People’s experience of using this service:

People supported by the service received personalised care which was responsive to their individual needs. Staff had a good understanding of the care and support people required and provided this with care and patience.

People’s care and support had been planned proactively and in partnership with them. People felt consulted and listened to about how their care would be delivered. Care plans were organised and had identified the care and support people required. We found they were informative about care people had received.

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.

Procedures were in place to record safeguarding concerns, accidents and incidents and take necessary action as required. We saw the registered manager had cooperated and worked in partnership with the local authority when safeguarding concerns had been brought to their attention. People supported by the service told us they felt safe in the care of staff who supported them.

People spoken with referred to the registered manager and her staff as kind and caring people. They told us they liked the staff who supported them who provided a reliable service which didn’t let them down.

People were supported to have access to healthcare professionals and their healthcare needs had been met. The service worked in partnership with other organisations to ensure they followed good practice and people in their care were safe.

The service had a complaints procedure which was made available to people and their family when they commenced using the service. The people we spoke with told us they were happy with their service and had no complaints.

The registered manager used a variety of methods to assess and monitor the quality of the service. These included regular audits and satisfaction surveys to seek their views about the service provided.

Rating at last inspection: Good. (Report published 22 February 2017).

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: The next scheduled inspection will be in keeping with the overall rating. We will continue to monitor information we receive from and about the service. We may inspect sooner if we receive concerning information about the service.

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

Briars Homecare Services Limited provides support people to live as independently as they can in the community. This includes personal care shopping, activities and appointments to people who live in their own homes. The office base is located in a residential area of Thornton Cleveleys. At the time of our inspection Briars Homecare provided services to over 100 people.

At the last comprehensive inspection on 16 & 30 November 2015 the service was rated overall as requiring improvement as the safe and effective domains required improvement to risk assessments, the number staff who supported individuals and staff training.

There was a registered manager in place. 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.

People told us they had been visited by senior staff before their support began who carried out an assessment of their needs.

We spoke with people who received a service and their relatives. People we spoke with told us they felt safe. They told us they received patient and safe care and they liked the staff who supported them. They said staff were friendly and respectful, punctual and conscientious. There were procedures in place to protect people from abuse and unsafe care. We saw risk assessments were in place which provided guidance for staff. This minimised risks to people.

People told us they were supported by the same group of staff who they knew and liked. They told us they had confidence in their staff team as they were familiar with their needs and preferences and gave them the care and support they were supposed to provide.

Recruitment and selection was carried out safely with appropriate checks made before new staff could start working for the service. Staff had the skills, knowledge and experience needed to care for people.

Staff understood the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS). Staff had not needed to make an application when we inspected.

Staff supported people to have a nutritious dietary and fluid intake, assisting them to prepare and eat food and drinks as they needed.

Staff supported people with medicines safely. People able to manage their own medicines were encouraged to do so.

Staff received training to carry out their role and were knowledgeable how to support and care for people. They had the skills, knowledge and experience to provide safe and effective support.

Care plans were in place detailing how people wished to be supported. People who received support or where appropriate their relatives were involved in making decisions about their care. Their consent and agreement were sought before providing care.

People who used the service and their relatives knew how to raise a concern or to make a complaint. The complaints procedure was available and people said they were encouraged to raise any concerns.

Senior staff monitored the support staff provided to people. They checked staff arrived on time and supported people in the way people wanted. Audits of care records and risk assessments were carried out regularly. People and their relatives were encouraged to complete surveys about the quality of their care.

We asked the registered provider to provide us with an action plan demonstrating what they were doing to address the issues of non-compliance. We received the final action plan in June 2014. This detailed the procedures put in place to address the shortfalls. We used this inspection to see what actions had been taken to address the areas of none compliance.

During the course of this inspection we spoke with four people in their own home that used the service and two relatives of one of the people, who were visiting. We also spoke with the four members of staff that were supporting these people. On another day we spoke by telephone with another three people who used the service, and contacted another four members' of staff for their views and opinions. This helped us to gather further evidence to establish what improvements had been made.

Generally we noted that although some good improvement had been made in most areas, there were still other areas that required strengthening.

At the last inspection in April 2014, staff did not necessarily have an understanding of the individual needs, wants and wishes of each people they were supporting. This was because there were missing or incomplete records including risk assessments, risk management plans or care plans in peoples' homes. It was also noted that a copy of this important information was not held at the office base. This did not protect people using the service or guide and advise the staff that supported them.

At this inspection we saw that the provider had introduced appropriate measures to improve the information contained in care plans. This provided a holistic account of the individual's assessed needs and wishes in order to guide and direct staff. Care plans, risk assessments and risk management plans were available in each of the homes we visited with a copy of the information also held at the office base.

In April 2014 we concluded that the records relating to the administration of medication were haphazard and incomplete, with many gaps and omissions without explanation. Whilst it seemed probable that the medication had been administered, the drug administration record did not necessarily reflect this. This practice did not ensure that the drug administration record (MAR) for each person was completed accurately, or confirm that the person had received their medication as prescribed. This put people at risk of harm.

At this inspection we noted that improvements had been made. However there still remained evidence of unexplained gaps on the MAR sheet. This meant that either people had not been given, or prompted to take, their medication as prescribed or the MAR record did not give a true account why the medication had not been given/prompted.

At our previous inspection, although the agency's recruitment policy and procedure was robust, this had not necessarily been followed before new members of staff had been allowed to take up their employment at the agency. For example we saw three instances of members of staff starting their employment at the service before all the required references had been received and deemed to be satisfactory. This meant that the personal qualities and attributes of the individual were not necessarily known prior to them working for the agency. This did not help to keep people safe or ensure that only suitable people were employed at the agency.

At this inspection we saw that in respect of recently appointed staff, the home's recruitment policy and procedure had been followed. People had only been appointed when the required references and clearances had been received and deemed satisfactory.

At our last inspection in April 2014 we found that the registered manager did not have suitable arrangements in place to ensure that staff received adequate supervision. This was because the practices in place, did not direct the supervisor to look at all elements of the care workers role and responsibility. This was particularly relevant to maintaining accurate records.

At this inspection we noted that again improvements had been made. The range of topics covered during supervision had been extended. This incorporated in the main, an assessment of the ability of the care worker to follow the policies and procedures of the agency in relation to maintaining complete and accurate records.

A range of systems remained in place to monitor the quality of the service being delivered. Although there was improvement in some areas such as the record used to assess the competency of the care worker, other documents, for example Medication Administration Records (MAR), remained incomplete. There was also no formal monitoring system in place to audit the medication records or to establish the exact reason for the unaccounted gaps in the MAR sheets. This meant that there was no formal process to check if medication had been administered by staff, as prescribed.

Record keeping at our last inspection, was found to be inadequate. This did not protect people. Although some improvements, particularly in relation to care plans and risk assessments was noted, further improvement was still needed in other areas such as accurate recording on medication administration records.

This helped us gather sufficient evidence to answer our five questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection. We completed four home visits to people who used the service and also spoke with the staff that supported them. We looked at records and had a telephone discussion with the relative of a person who received support from the agency.

The detailed evidence supporting our summary can be read in our full report.

Is the service safe?

People told us that they felt safe. We were told that staff were kind and caring. People also told us that they felt respected by the people that supported them and that their dignity was protected.

Some staff did not know about the personal care plans or risk management plans of people they were supporting because these were not available in most of the homes we visited. This put people at unnecessary risk of harm.

Recruitment practice were not always sufficiently robust to ensure that newly appointed staff had the necessary personal attributes, skills and experience to deliver a safe service. This did not help to protect people using the service.

The internal quality monitoring systems in place did not focus on important areas in relation record keeping. This meant that important records were missing or incomplete. Staff had failed to report omissions in record keeping. This did not keep people safe.

Medication records we saw were incomplete. Therefore it was not possible to be confident that medication had been prompted/administered as prescribed. These practices did not protect people or keep them safe.

We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to assessment, care plans and risk management plans, staff recruitment, medication, assessing and monitoring the service provision and record keeping.

It the service effective?

We were told that each person's health and care needs had been assessed prior to the service commencing. This was to make sure that the agency could provide the level of care and support required. However in some of the home's we visited there was no assessment of needs or care plan available. This was because although the documents supporting the assessment of needs and care plan was in the house, the documents had not been completed. It was therefore not possible to confirm that the needs of people were being met.

We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to ensuring that people are properly assessed and that a detailed and accurate care plan is available in each person's home.

Is the service caring?

All of the people we visited and the relative we spoke with by telephone, spoke very positively of the care and support provided by the staff team. One person told us, 'The carers are brilliant. I have not found one that I dislike, I like the way they act'. Another person said, 'They (the carers) are brilliant with me, they really are. If you want me to say anything bad I cannot find it'. A third person simply said, 'I have nothing to complain about, they come and chat and have a laugh and make sure that I am OK'.

People using the service, their relatives, friends or other professionals did not have opportunity to complete customer satisfaction surveys about the service they received from the agency. We were told by the registered manager that this was because when surveys had been distributed, few if any had been returned. We saw records to confirm that four monthly review visits did take place that enabled people to express any concerns. However we were not shown any formal evaluation of outcomes or detail of actions taken as a result of any comments made.

We have asked the provider to tell us how they will make improvements in relation to learning from the information they receive from people.

Is the service responsive?

We saw that people had been given a copy of the agency's complaint procedure when they started using the service. We saw a copy of this in each person's home that we visited.

We also saw written reports of incidents that had occurred. This included the date and time of the incident and the name of the person completing the form. We saw that the registered manager had taken action on the information received and had involved other appropriate agencies. This meant that the information had been acted upon in order to keep people safe. However although detail of some incidents were recorded, the outcome was sometimes missing from the records. We were told by the registered manager that outcomes would have been verbally discussed and action taken as required. However because of incomplete record keeping, it was not possible to confirm that all incidents had been reviewed and appropriate action taken.

Is the service well led?

The service had some quality assurance systems in place however records seen by us showed that not all the shortfalls had been identified and addressed. The system did not systematically ensure that all the necessary documentation was completed or that record keeping was robust and routinely applied. Although staff had received appropriate training, for example in completing medication administration records and had access to the policy and procedure regarding medication, there was significant shortfall in this area. The quality assurance systems in place had not picked this up meaning that people were put at unnecessary risk of harm.

People told us that there was a good consistency of staff that visited, with the same small group of care workers generally being allocated. This was especially important for people who received several visits a day from the agency.

The people we spoke with confirmed that they knew who to contact should they have any worries of concerns. Contact details of the agency, plus details of how to make a complaint or raise a concern were given to each person to be kept in their home, along with other information such as their care plan.

People were pleased with the level of care and support provided. One person said, 'I am pleased with the service, I cannot complain about anything, they are a good company really'. Another person told us, 'They have coffee and cake with me sometimes. They are smashing, kind and helpful. You can have a laugh with them and they cheer me up'.