Break Barriers Nottingham Ltd

Break Barriers Nottingham Ltd is a domiciliary care agency which supports people in their own homes living in the Nottinghamshire area. 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. At the time of inspection 57 people received support with personal care.

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

There was an increased risk of staff not managing people’s medicines consistently and safely because medicines records were not always accurate.

Whilst staff worked well with other health and social care professionals once they were involved, the referrals to the external agencies were not always made in a timely manner.

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. However, some mental capacity assessments required further work to ensure they were completed thoroughly and as per the best practise guidance.

The quality assurance systems were not always effective in monitoring the quality of the service. A range of checks were completed; however, they had not identified the shortfalls we found during the inspection. Learning from errors and improving care was delayed at times because the providers response to addressing shortfalls was at times reactive rather than proactive.

People had care plans which reflected their individual needs. When risks to people’s health and wellbeing were identified, appropriate mitigating action plans were put in place. Staff knew people’s needs and people told us they knew and were comfortable with the staff delivering care and support.

There were enough staff to meet the needs of the people using the service. People received their care visits on time.

People were safe from the risk of abuse. Staff understood what concerns should be reported and knew how to report them.

Staff had received appropriate training to carry out their role safely.

People received support from kind and caring staff. Staff were respectful and promoted people’s independence. People and their relatives were involved in decisions about their care, which was regularly reviewed.

People felt the staff supported them with their personal goals and remaining as independent as possible. People’s communication needs were recorded in their care plans and staff were aware of how to best communicate with people in their preferred way.

People, their relatives and staff spoke highly about the management. They had confidence in the leadership and felt they could report any issues or concerns.

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 outstanding (published 8 September 2017).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

The overall rating for the service has changed from outstating to requires improvement based on the findings of this inspection.

Follow up

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 continue to monitor information we receive about the service, which will help inform when we next inspect.

There was a registered manager in post who was out of the country on the first day of our inspection. 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. In this report when we speak about both the charitable body and the registered manager we refer to them as being, ‘the registered persons’.

At the last inspection in April 2015 the service was rated Good. At this inspection we found the service remained Good overall but outstanding in being a responsive service.

People received safe and effective care from staff. Staff had a good understanding of the various types of harm and their roles and responsibilities in reporting any safeguarding concerns.

Risks to people's individual needs and their home environment had been assessed. Staff had information available about how to meet people’s needs, including action required to reduce and manage known risks.

There were sufficient numbers of staff to meet people’s care needs and staff were recruited safely. Staff received regular training and supervision and were able to reflect on the care and support they delivered and identified further training requirements.

People received their medicines as prescribed. Staff were able to explain the process they followed when supporting people to safely take their medication. Records we checked confirmed this.

People’s rights were protected under the Mental Capacity Act 2005. Suitable arrangements had been made to obtain consent to care and treatment in line with legislation and guidance. People were supported to eat and drink sufficient amounts to meet their nutritional needs. External health professionals were involved in people’s care when required.

The service was outstandingly responsive and caring. People's care plans clearly reflected their individual needs and personal wishes. People and their relatives were fully involved in the development of their care plans and these were reviewed regularly. There were varied activities that respected people’s cultural diversity that suited everybody’s individual needs. Advocacy information was made available to people. The service encouraged feedback from all people involved with the service.

A complaints process was in place. People were able to make a complaint and felt confident that staff and the registered manager would respond appropriately.

People were extremely complimentary of all aspects of the service provided and spoke very positively of both staff and the management team. People received care and support from kind, caring and compassionate staff, who respected their privacy and dignity at all times.

People had full confidence in the registered manager and the way the service was run. The vision and values of the staff team were person-centred and made sure people were at the heart of the service.