Archived: Bramble Home Care

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

At the time of the inspection Bramble Home Care was providing personal care to 29 people. We spoke with eight people, a mixture of people who use the service and family members, to get their views on the care provided. We also observed staff on one visit.

Is the service safe?

People told us they felt safe with the staff who visited them. One person told us, 'I feel safe ' they're nice people." One relative told us, 'We had a gut feeling (about staff) and both have been good."

Safeguarding procedures were robust and staff were knowledgeable about how they would spot the signs of abuse and how they would report them.

We observed staff working with people in a way that respected people's rights and dignity.

Staff knew about people's risk management plans and these were discussed in the office throughout the day. People were not put at unnecessary risk but also had access to choice and remained in control of decisions about their care and lives.

The staff planning the rotas took people's care needs into account when making decisions about the skills and experience required. Staff had completed a range of training to support them in their roles. This helped to ensure that people's needs were being met.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

Is the service effective?

People who use the service and their relatives told us they were happy with the care they received and felt their needs were being met. One person told us, 'The main reason they come is, I have medication I have to take because of my health problems and I'm inclined to forget things. They remind me." One relative told us, 'They have her care plan and they know the situation."

In particular, people and their relatives made comments about the reliability of the service. The rota system in place ensured staff were given enough travel time between visits so they could reach their next appointment in good time. One relative told us, 'We're really chuffed, they actually keep to time and it makes a huge difference." One relative commented that staff were sometimes a bit too early to arrive but told us that this was the exception and they had brought the issue up with management, who were resolving it.

It was clear from our observations and from speaking with staff that they understood people's care and support needs well.

Is the service caring?

We asked people and their relatives for their opinions about the staff that supported them. Feedback from people was positive, for example, 'They're friendly and approachable', 'They get along well with my wife', 'They look after (person)', 'They're all very nice, chatty and willing to help'.

People using the service, their relatives and friends completed an annual satisfaction survey. Where shortfalls or concerns were raised these were taken on board and dealt with.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes. One relative told us, 'Before they started two people came to talk about mum'.it was really nice, they asked about her life before she became ill ' it was about the person."

We observed staff working sensitively with people, particularly with those who were less able to verbally communicate their wishes.

Is the service responsive?

On the day of our inspection we spoke with a district nurse who was visiting one person at their home because staff had alerted them to a problem with the person's catheter. This meant the service worked well with other agencies and services to make sure people received care in a coherent way.

We noted that people's care plans were reviewed regularly to ensure the care being provided was appropriate when people's needs changed.

In particular, people who use the service and their relatives made comments about the flexibility of the service. One relative told us, 'They've been very accommodating, quick and flexible. We changed the starting day." Another person told us 'They're very accommodating if I want something from the shops. Anything I want, they do it."

Is the service well-led?

Staff told us they were clear about their roles and responsibilities. Where issues arose these were escalated and actioned appropriately.

People made comments such as, 'Everything's fine ' no complaints' and 'I'm very pleased with the service I can't think of any way it could be improved." People told us they felt able to raise issues with staff and felt these would be addressed. One relative told us 'I'd phone the number on the folder if I had an issue."

The service had a quality assurance system in place, and records showed that identified problems and opportunities to change things for the better were addressed promptly. As a result the quality of the service was continuously improving. One relative told us, 'At the core of what we do want is quality of care for mum and we've been very pleased with how it's gone."

During our visit we spoke with two people who used the service, two relatives and four members of staff.

Everyone we spoke with told us they were very happy with the service provided by Bramble Home Care. Relatives we spoke with told us, 'very good service' and 'very pleased with the service'. Everyone told us they had regular staff visiting them and they knew the time staff were going to arrive. They told us that the office kept them informed if there were any changes to the timing of visits or if staff were running late. Everyone told us they knew how to contact the office, within and outside of office hours, and calls were always answered.

Staff we spoke with told us they always asked people for their consent before providing any care. This was confirmed by the people we spoke with who used the service. Care plans were personalised to the individual and gave comprehensive information about how the person wanted their care and support to be provided. Appropriate arrangements were in place to support people to take their medication. Appropriate checks were undertaken before staff began work. There were effective recruitment and selection processes in place.

Everyone we spoke with told us that Bramble Home Care provided a good service to the people they cared for. They also told us that staff were very caring and paid a lot of attention to detail, ensuring that people received the care they needed. Two relatives told us they had regular staff and one relative told us that there had been lots of changes to staff and the service had not always been consistent. However, they added that this had improved recently and the service now provided regular staff.

Relatives we spoke with told us "I don't know where we would be without them', 'Staff always ask if there is anything else they can do' and 'The staff try very hard and are good and caring'. Relatives also told us that staff were competent in their role and understood the needs of the people they cared for. Care plans were personalised and individual to each person's needs and covered all aspects of each person's daily living and communication needs.

We found some shortfalls in record keeping because the review of care plans and associated documents was inconsistent. There was no systematic programme in place to ensure that all care documents were regularly reviewed.