Brunelcare Domiciliary Care Services Somerset

Brunelcare Domiciliary Services Somerset is a domiciliary care service that was providing personal care to 215 people aged 65 and over at the time of the inspection.

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

Since our last inspection people’s care plans had been significantly improved. They included specific details of how staff should work with people to meet their needs. This included how to support people who required modified diets.

People told us the service helped them to feel and stay safe. Their relatives agreed. People’s risks were assessed, recorded and support provided to minimise these without being unduly restrictive.

Most visits happened at the times scheduled although some people had experienced delays due to staff sickness during the COVID-19 pandemic. The service was trialling a new process to ensure better deployment of staff and visit timings. The service had assessed people’s dependency to enable them to prioritise visits in the event of emergencies or unplanned staff shortages. A missed visits protocol had been introduced to ensure robust oversight and follow up where required.

Spot checks took place to ensure staff were competent to support people. A relative told us, “The carers are very professional and my [family member] tends to have a senior carer who has set the high standard for other carers.”

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.

Staff enjoyed their roles and felt proud working for the service. They felt supported by their colleagues. One staff member said, “I love my job, my clients and all the staff there. It's a great place to work.”

Professionals were unanimous in their praise of the service. Strong links had been developed with GP surgeries and reablement teams that were contributing to positive outcomes and goal setting for people.

The service worked closely with commissioners to support people’s timely discharge from hospital and assessment for ongoing care and support. They had also partnered with commissioners, a private company and a selected group of people in a telecare pilot where sensors and health monitoring devices were embedded in their homes.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 4 May 2019).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out a comprehensive inspection of this service on 26 February 2019. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Brunelcare Domiciliary Services Somerset on our website at www.cqc.org.uk.

Follow up

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

People’s experience of using this service:

People told us that they had experienced late visits and at times visits had been cancelled.

Care plans did not always contain detailed guidance for staff. This meant that staff may always be clear about the level and type of support that people required.

People told us that they received support to eat and drink. However, guidance for people eating a modified diet did not always include details about suitable types of food or fluid.

People and staff spoke positively about the management team. People felt comfortable to complain and raise concerns with staff, team leaders and the management team.

People told us that staff who visited with them were caring and took actions to protect their dignity and privacy.

People told us that they received a safe service. Staff spoke positively about the actions that they would take if they suspected a person was experiencing abuse and was at risk of harm.

Staff sought peoples’ consent before starting to provide their care and people’s choices were respected by staff.

Rating at last inspection: Good (September 2016)

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

Enforcement: We found one breach of the Health and Social Care Act 2008 (Regulated Activities Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009.

Follow up: We will review the report on actions the provider intends to take following the inspection. We will continue to monitor the service through the information we receive. We will inspect in line with our inspection programme or sooner if required.

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

The last inspection of the service was carried out in February 2014. No concerns were identified with the care being provided to people at that inspection.

Brunelcare provides personal care to people living in the Sedgemoor areas of Bridgwater, Highbridge, Burnham-on-Sea and surrounding villages. At the time of this inspection they were providing personal care for approximately 480 people. They provide a re-ablement service, supporting people to return to independent living, and a core team service for long term personal care packages. They also provide a domestic service to people living in their own homes.

There is 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.

People who received personal care and support from Brunelcare told us they were happy with the service provided. They said the manager and staff were open and approachable and cared about their personal preferences and kept them involved in decision making around their care. One person said, “I know I can ring the office and they will listen, they are all very nice and I can even talk with the supervisor if I want to.” Another person said, “They are very good, they listen to what I want and that is what they do. They know how to look after me which is most important.”

People were supported by sufficient numbers of staff who had a clear knowledge and understanding of their personal needs, likes and dislikes. We observed staff took time to talk with people during our home visits. One person said, “I always see the same team of staff and they never make me feel rushed.” Another person said, “They are all very good I know who is coming and if someone is running late they always ring and let me know.”

People’s care needs were recorded and reviewed regularly with team leaders, senior care workers and the person receiving the care or a relevant representative. All care plans included written consent to care. Care workers had comprehensive information and guidance in care plans to deliver consistent care the way people preferred. One person’s care plan clearly showed how they liked a later call as they liked a lie in in the mornings, whilst another person’s showed they needed an early call so they could follow their social commitments.

People were protected from abuse because the provider had systems in place to ensure checks of new staffs characters and suitability to work with vulnerable adults were carried out. Staff had also received training in protecting vulnerable people from abuse. People said they felt safe when being cared for; we observed people were happy and relaxed with care workers during our home visits.

Staff told us they received “excellent” training, staff attended the organisations mandatory training which included regular updates of subjects such as, manual handling, dementia awareness, medication, safeguarding vulnerable adults, infection control, health and safety, food hygiene, first aid and nutrition. They also attended training in areas specific to people’s needs such as diabetes care, stoma care and awareness of Huntingdon’s chorea. Staff were also supported to attain a nationally recognised qualification such as an NVQ or diploma in health and social care

Brunelcare’s key philosophy is “Helping people make the most of their lives.” The registered manager also had a clear vision for the agency which was to provide a service that, “across the board provided good, consistent, and flexible care for all customers. Learning from mistakes and making sure we share and pass on what we learnt to our other services.” Their vision and values were communicated to staff through staff meetings and supervisions. All the staff spoken with were passionate about providing care that supported people to achieve their goals and maintain independence.

Most people were able to access health care professionals independently but assistance could be provided if requested. Staff monitored people’s health with their consent and could direct to healthcare professionals as appropriate.

The agency had a complaints policy and procedure that was included in people’s care plans in large print. People said they were aware of the procedure and had numbers they could ring. People and staff spoken with said they felt confident they could raise concerns with the manager and senior staff. Records showed the agency responded to concerns and complaints and learnt from the issues raised.

There were systems in place to monitor the care provided and people’s views and opinions were sought on a daily basis. Suggestions for change were listened to and actions taken to improve the service provided. All incidents and accidents were monitored, trends identified and learning shared with staff to put into practice.

We visited seven people supported by the agency. We saw the agency effectively supported people to be independent and remain at home. This was confirmed by the responses to questionnaires sent by CQC which had 100% agreement. We were told 'my relative only needs two sessions a day of thirty minutes each but during that time they enable him to stay in his own home and have the personal care he needs in a way that is friendly and generally helpful. It took my family months to persuade my father to accept the help he desperately needed but now after his experience with the carers he says it is the best thing he ever did.'

People told us the service was safe, we heard 'I am always treated with dignity and respect. I have several mobility issues and care is carried out at my pace, a great comfort' and 'I always feel safe if on my own with carers.'

We were told by people who used the service the staff were very caring. We were told by a relative 'the manager sometimes rings to give suggestions on how they could make things a bit easier. She has increased the time the carers spend in the home. The carers always ring if my mother is a bit poorly so I can visit and check up on her.'

We heard people found the service was responsive to their needs. We were told 'the management are easy to get hold of if the shift needs changing when I have an appointment' and 'I have no problems with care, care workers are supportive when they come, and have been support to my husband when on a few occasions I have been admitted to hospital.'

We found from our inspection and from the response to the questionnaires, overall people and relatives seemed very satisfied with the service being provided by Brunelcare. Respondents also made a number of positive comments, particularly about the carers themselves, we were told 'all care workers are good but a few individuals are exceptional'.

People using the service told us they were very happy with the care. One said, 'I have been in a much better condition since the visits began, I am very pleased with the service.' also 'They are always polite and caring and I feel safe with all the people who visit.'

Another person told us, 'They are very good and I am respected and treated properly.'

Both people spoken with who used the service told us they knew how to complain and one told us, 'I had a to make a minor complaint, the manager visited on the day and the issue was resolved. I am very pleased.'

The staff spoken with confirmed that they had received training and support. One staff member told us, 'I have received training and support to get into the job, it has been really good.'

Another member of staff told us, 'I am clear about who I should report concerns to and would always report and discuss any concerns with my line manager.'

We looked at five staff records and these showed that all the information needed to ensure that people are safety employed were available. We also looked at five care records. We saw that all the information needed to ensure that individual peoples' needs were met and the person had been involved in this was recorded.