Archived: Brunelcare Domiciliary Care Services North Somerset

At the last inspection in February 2017, we rated the service as 'Requires Improvement'. You can read the report from our last comprehensive inspection by selecting the 'all reports' link for Brunelcare Domiciliary Care Services North Somerset on our website at www.cqc.org.uk.

At this inspection, we found the provider had made the necessary improvements.

There were enough staff to carry out visits in a timely way and ensure people's needs were met.

The service had clear information about what decisions people could or could not make regarding their care.

People and relatives felt the service was safe. Policies and procedures were in place to keep people safe such as safeguarding, whistleblowing and health and safety. Staff were trained in safeguarding and understood the importance of acknowledging poor practice and reporting their concerns to the provider.

We found that safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work.

Medicines were managed safely.

The provider had systems in place to record accidents, incidents and safeguarding concerns.

Infection control procedures were followed. Staff had access to personal protective equipment. Plans were in place to cover emergency situations. The provider carried out assessments before planning support to meet people's individual needs.

Staff were trained in a range of subjects to meet the needs of the service. Staff were supported and received regular supervision. Referrals to health and social care professionals were made when necessary to ensure healthcare was monitored.

Staff provided support and guidance with nutritional needs when required.

Staff gained consent before any intervention with the person.

People and relatives felt staff were caring in their approach with people. Staffing rotas were developed to try to ensure staff had time to complete planned care without being rushed.

The culture within the service was one which promoted personalised care tailored to people's needs. Staff respected people's privacy and dignity ensuring their independence was promoted. Care plans were individualised and contained information on how to care for the person in a person centred way.

The provider used a variety of methods to gain information when developing care plans. For example, information from family members and health and social care professionals. The person and their relatives, if appropriate, were involved in how they preferred their care to be delivered.

The provider had a system and process in place to manage complaints.

The provider had a quality assurance process in place to ensure the quality of the care provided was monitored. People and relatives views and opinions were sought and used in the monitoring of the service.

The provider maintained links with and worked in partnership with organisations to ensure best practice and national guidance was incorporated into the quality of care provided. Staff felt the management team were open, approachable and supportive.

There was a registered manager in post. 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.

The service was mostly safe but people had been put at risk by calls being missed. We spoke with the registered manager about these missed calls and they explained there were measures in place to reduce this risk. No one had been harmed as a result of a missed visit.

People were confident in the skills of the staff and where staff needed specific training to support people safely this was provided. Training was not however all up to date for staff. There was a plan in place to respond to the risks that this created and to ensure training was current for all staff.

Staff understood how people made choices about the care they received, and encouraged people to make decisions about their care. Records, however, did not reflect that care was being delivered within the framework of the Mental Capacity Act 2005. We spoke with the registered manager about this and they began to address the omission straight away. We have made a recommendation about the recording of MCA decisions.

People were positive about the care and support they received. They told us staff treated them kindly and we saw people were comfortable with staff in their homes. Staff were consistent in their knowledge of people’s care needs and spoke with confidence about the care they provided to meet those needs. They were motivated to provide the best care they could and told us they felt supported in their roles. Staff kept accurate records about the care they provided and these records were used to review people’s care.

There were enough safely recruited staff to ensure people received their visits as planned. People told us they received visits on time and that they were contacted if the care worker was running late due to traffic or an emergency. They told us that this did not happen often and that they felt confident they could rely on the carers. Staff treated people and each other with respect and kindness throughout our inspection.

People felt safe. They were protected from harm because staff understood the risks they faced and how to reduce these risks. Staff knew how to identify and respond to abuse; including how to contact agencies they should report concerns about people’s care to.

People’s medicines and creams were administered safely. There were systems in place to ensure time dependent medicines were administered appropriately.

People had access to health care professionals and were supported to maintain their health by staff. Staff understood changes in people’s health and shared the information necessary for people to receive safe care. Where people had their food and drink prepared by staff they told us this was prepared to their satisfaction. People were left with access to appropriate drinks and food between visits.

Management were committed to making continual improvements to the quality of care people received. There were systems in place to review and monitor the quality of the service people received including feedback from people and staff.

People told us their regular care worker knew their needs well and how they liked things to be done. A person who used the services said "the carers are good. They do exactly what I want them to do. They are reliable. I look forward to them coming everyday' and "I am happy with the agency. They are respectful".

During our inspection we spoke with the manager, two team leaders, and 12 members of staff. Staff we spoke with had a good knowledge of the people they supported. They were able to give detailed information about their care needs and their preferences when delivering care.

Most people we spoke with said that the agency arranged a replacement care worker when their regular care worker was away and almost all said that replacement care workers provided them with good care. People and their relatives said they had no concerns about the care they received from care workers.

We found that systems were in place to ensure people were safeguarded from abuse.

We found that staff were trained and supported to deliver care to a suitable standard.

The provider had an effective system in place to monitor the quality of the service to ensure people received safe care.

People told us that they were happy with Brunelcare care workers. One person told us 'I have no complaints. The staff are well trained and very professional. They go that extra mile'. Another person said 'the staff are respectful. Nobody is rude to me. I have confidence in the staff and they definitely make me feel safe'. A third person said 'the staff are well trained. There is a care plan in place which is kept under review by the senior carer. I know I can rely on them'.

We spoke with five members of staff who confirmed that they felt well supported by the management team and that the training provided was of a good standard. Records confirmed that there was a satisfactory recruitment system in place and there were robust arrangements in place to monitor the quality of the service provided. Overall we found the service to be compliant in all outcome areas that we inspected.