Archived: Brookes Homecare Services

Brookes Homecare Services is a domiciliary care service which provides personal care and support to people in their own homes. At the time of the inspection there were 51 people using the service. Everyone using the service lived within the London Boroughs of Harrow, Brent and Lambeth Council.

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

People were safe and protected from avoidable harm. Care workers had received training and they knew how to identify and report concerns. There were effective systems and processes in place to minimise risks to people. These had been kept under review to ensure people's safety and wellbeing were monitored and managed appropriately. Care workers had been recruited using appropriate checks and thorough assessments. There were systems in place to ensure proper and safe use of medicines. People were protected from the risks associated with poor infection control because the service had processes in place to reduce the risk of infection and cross contamination.

Care workers had received regular training and support, so they could carry out their roles effectively. They had also received an induction before they could provide care and support to people. People’s care was tailored to their needs. There were arrangements to ensure people's nutritional needs were met. People had access to healthcare services. The service worked with a range of health and social care professionals.

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. When people were unable to make decisions about their care and support, the principles of the Mental Capacity Act (2005) were followed.

People's privacy and dignity was respected. Care plans described how people should be supported so that their privacy and dignity were upheld. Individual care plans considered people's values, beliefs, and wishes. This meant there were established ways of working which were person centred and not discriminatory. Confidential information, such as care records were only accessed by staff authorised to view it.

People received person centred care. Their assessments showed they had been involved in the assessment process. Care workers were knowledgeable about people’s needs and they could describe to us how people liked to be supported. There was a complaints procedure in place, which people’s relatives were aware of.

Quality assurance processes such as audits and spot checks were used to drive improvements. However. even though, incidents were appropriately escalated and investigated, the results were not widely shared with staff to raise awareness. The registered manager told us improvements were going to be made in relation to this.

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 Good (published 16 May 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At the last inspection, the service was rated Good. At this inspection we found the service remained Good.

At our last inspection the service was in breach of Regulation 9. The provider had not ensured that people received personalised care that was responsive to their needs. People’s assessments were not reviewed regularly. At this inspection we saw that people's individual needs had been routinely reviewed to ensure care plans provided the most current information for staff to follow. We saw any agreed changes arising from discussions between staff and people were written down with updates on how progress was being made. People confirmed their needs were being met.

Risk assessments and risk management plans to reduce the likelihood of harm were in place. There were safe recruitment procedures in place to help protect people from the risks of being cared for by staff assessed to be unfit or unsuitable.

Care workers had received training in relevant areas of their work. This training enabled them to support people effectively.

People were supported to eat and drink in a safe manner. Their support plans included an assessment of their nutrition and hydration needs.

Staff understood their responsibilities in relation to the Mental Capacity Act 2005. People told us and we saw from their records they were involved in making decisions about their care and support and their consent was sought and documented.

People told us they were treated with dignity and respect. Care workers understood the need to protect people’s privacy and dignity.

The service encouraged people to raise any concerns they had and responded to them in a timely manner.

There were systems in place to continually monitor the quality of the service and people were asked for their opinions and action plans were developed where required to address areas for improvements.

The service had 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.

Regular care staff understood the needs of people they supported. They were able to tell us detailed information about people's needs. The registered manager told us that care plans were reviewed on a quarterly basis or more frequently if required. People also confirmed reviews took place, however, we found no evidence in their care plans to confirm this. As a result there was no central track record to establish when people were due for their periodic reviews. This is important to make sure care plans remained up to date and reflect changes. This remained an area that needs improvement.

People told us they felt safe. There were arrangements in place to help safeguard them from the risk of abuse. There were appropriate policies and procedures in place to inform staff how to report potential or suspected abuse. Staff understood what constituted abuse and were aware of the steps to take to protect people.

People had risk assessments and risk management plans to reduce the likelihood of harm. The provider ensured there were safe recruitment procedures in place to help protect people from the risks of being cared for by staff assessed to be unfit or unsuitable.

Staff told us and we saw from their records that they had received training in relevant areas of their work. This training enabled staff to support people effectively.

Staff understood their responsibilities in relation to the Mental Capacity Act 2005. People told us they were involved in making decisions about their care. We saw their consent was sought and documented.

People had capacity to choose and eat nutritious meals. People told us they chose what they ate and staff occasionally supported them with meals.

People told us they were treated with dignity and respect. Staff understood the need to protect people’s privacy and dignity.

The provider had a system in place for responding to any concerns and complaints and people knew how to raise concerns.

Staff gave positive feedback about the management of the service. The registered manager was approachable and fully engaged with providing good quality care for people who used the service.

The provider had systems in place to continually monitor the quality of the service and people were asked for their opinions and action plans were developed where required to address areas for improvements.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the back of the full version of this report

We spoke with one person receiving care, two care staff and reviewed care plans of people receiving care.

Below is a summary of what we found. The summary describes what one person using the service and staff told us and the records we looked at. We were not able to speak with the other person using the service.

If you want to see evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

Safeguarding procedures were in place and some staff had received safeguarding training and were aware of action to take in response to safeguarding incidents or allegations. Care was planned and delivered in a way that ensured people were safe. We noted that although people's care files did not contain risk assessments, the manager and staff were aware of the needs of people. The provider showed us evidence that they had submitted applications for Disclosure and Barring (DBS) checks for two of the three staff who did not have appropriate criminal checks.

Is the service effective?

Feedback from a person receiving care indicated that the service was effective and responsive to the needs of people. A person receiving care told us, 'Staff help me to attend appointments and shopping.' The care plans reflected the needs of people and amount of hours and what support should be provided at each visit. The care plan and the assessments provided information about the person's routines.

Is the service caring?

A person receiving care told us that staff and the manager were caring. The person told us, 'The manager phoned last week to check how I was feeling and to check if there were any issues.' The person told us that staff were kind and respectful.

Is the service responsive?

Feedback from a person receiving care indicated that the service was responsive to the needs of people. For example, the person confirmed that support was provided according to their needs and preferences. The person receiving support told us, 'My carer takes my requests and needs into consideration.' This meant care was planned and delivered in line with people's individual needs.

Is the service well-led?

The service had a registered manager who was knowledgeable regarding his role and responsibilities. However, arrangements for monitoring the quality of care provided were not recorded. The manager told us he conducted regular audits on health and safety and other aspects of care, including telephone monitoring and spot checks. A person receiving care confirmed that the manager had visited and telephoned to check if they had any concerns about the quality of care.

During our inspection we spoke with the registered manager, two care staff and the representative of one person who was going to receive care from the provider.

The care staff we spoke with were aware of the importance of treating people with respect and dignity.

We looked at one care plan during our inspection and saw that this was prepared appropriately.

We observed that the provider had a safeguarding policy and staff we spoke with were aware of what action to take if they suspected abuse.

There was a lack of evidence available to confirm that appropriate checks had been carried out for members of staff.

The provider had an effective system to assess and monitor the quality of service people received.

We noted that records we looked at were up to date and were stored safely and could be located when required.