Britannia Homecare Limited is a domiciliary care agency that provides personal care to people in their own homes living in and around East Surrey. People who receive a service include those living with physical frailty due to the progression of age. The agency also provides services to people living with dementia and people with mental health needs. At the time of the inspection, the agency was providing a service to 202 people of which 117 were receiving personal care as part of their package of care. There had been no registered manager in post since 29 January 2018. 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. Two managers had submitted applications to the CQC to become joint registered managers.
We last carried out an inspection of this agency on 7 June 2016 when the service was rated as requires improvement in the safe domain. We recommended that the registered provider reviewed systems and structures to improve visit call times. We also recommended that the registered provider reviewed medicines procedures to ensure accurate records were maintained. We found similar shortfalls at this inspection.
During this inspection we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This related to medicines management. We also made five recommendations to the registered provider in relation to staff deployment, recruitment processes, staff training, risks related to people’s dietary needs and good record keeping. You can see what action we told the provider to take at the back of the full version of this report.
There were insufficient numbers of staff to care for people and as such management decided to hand back packages of care to the local authority in order to ensure they could provide suitable care to people. However, deployment of staff needed to be improved as we found people had mixed views about the timings of their visits and call times allocated by the agency did not always allow for sufficient travelling time between visits.
Medicines were not always managed safely. There were unexplained gaps in medicine administration records and body maps were not being used to record the use of creams and pain patches. Accidents and incidents were recorded and risk to people had been identified. .
Recording on food and fluid charts was lacking which meant people may be at risk of malnutrition or dehydration.
Staff did not always receive training at regular intervals to ensure that they received the most up to date training although management had an action plan in place to address this.
People were protected against the risk of infection. Staff had infection control training and had access to the necessary equipment. People were protected from the risk of abuse because appropriate safeguarding procedures were in place.
Management had started to address shortfalls within the agency. They had introduced an audit system which had identified shortfalls and were not working to an action plan to address these.
People’s care plans did not always include a sufficient amount of information to ensure that staff knew exactly what care they should be providing. People’s end of life wishes were not recorded to help staff understand people’s preferences. We did find however that new-style care plans were being introduced to make information clearer.
People’s choices were considered and they were involved in making decisions about their care. People told us they were encouraged to be independent and that they were cared for by staff who were kind and caring and showed them respect and dignity. People were encouraged to feed back their view about the service they received. People could telephone the office in and out of hours if they needed to speak to someone about the care they received. They also told us they would know how to make a complaint.
People were supported at mealtimes and staff ensured that people had enough food in their homes. Staff responded to the needs of people by contacting health and social care professionals where necessary.
There was a clear vision with the new management structure. The team recognised the shortfalls in the service and were taking steps to make improvements. Staff told us that there was a positive working culture. They also told us they felt supported and that managers were available and approachable. Staff felt that they could contribute their ideas on how to improve the service. Staff said management gave constructive feedback at supervision. Communication was good between staff and management and between management and people who used the service. Management encouraged working with outside agencies and were working with the Surrey quality assurance team with the aim of driving improvement.