We carried out a review of the data available to us about Burgundy Care Services Ltd on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Burgundy Care Services Ltd, you can give feedback on this service.
Burgundy Care Services is a domiciliary care service, providing personal care and support to people living in and around Holmfirth, Denby Dale and the surrounding villages. 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. On the day of inspection 36 people were receiving the regulated activity of personal care.
People’s experience of using this service and what we found
People and their relatives spoke highly of the care provided by Burgundy Care Services.
People and their relatives told us they felt safe using the service. There were enough staff available to meet people's needs. People and their relatives told us staff arrived at the planned time and stayed for the specified period. Pre-employment checks had been carried out for care staff. These helped to ensure only suitable applicants were offered work with the service. People received the support they needed to take their medicines safely. Staff followed the correct infection control practices.
People's needs were assessed before they started using the service and the information was used to develop person-centred care plans. The provider appropriately supported staff through induction, training and supervision. All staff had completed a range of training which gave them the skills and knowledge to care for people in their own homes. 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. The provider worked collaboratively with healthcare services to help people maintain good health.
The service was well managed. Governance systems were in place to ensure all aspects of the service were reviewed and checked regularly.
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 30 August 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 an announced comprehensive inspection of this service on 4 and 23 July 2019. A breach of legal requirements was found (Regulation 19, Fit and proper persons employed).
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, Effective 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 Burgundy Care Services 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.
Burgundy Care Services Ltd is a domiciliary care service providing support with personal care to people living in their own homes. 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. At the time of our inspection the service was supporting 23 people with the regulated activity of personal care.
People’s experience of using this service and what we found
Recruitment practices did not follow best practice which ensured people were protected from harm.
Staff had been trained and people told us they had the skills to care for them. Improvements were required in how the provider assessed staff competency. Staff told us they were supported by management although they had not received a regular appraisal of their performance.
We have made a recommendation for the provider to seek guidance in relation to performance appraisal.
People and their relatives told us they felt safe receiving this service. Staff had received safeguarding training and knew how to protect people from harm. Some risks to people had been assessed, monitored and reviewed. However, not all risks had been identified to ensure management plans were in place.
People and their relatives spoke highly about the care staff who supported them. They told us they were kind, compassionate, respectful and listened to them. Positive and supportive relationships had been developed between people, their relatives, and staff.
There had been an improvement in the quality of some of the care plans with the introduction of new paperwork and the registered manager was in the process of refining the content of care plans. The service had moved to electronic call monitoring and recording, but this was in its early days and more work was required to ensure it was used appropriately.
The provider had purchased a quality assurance system which included a comprehensive set of policies and procedures relating to all aspects of service delivery. These evidenced up to legislation and best practice. The quality assurance system contained an audit against CQC key lines of enquiry, although the provider had not yet fully utilised this. Improvements were needed in how the service assessed, monitored and used their systems to drive up quality.
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 requires improvement ((published 6 July 2018). This service has been rated requires improvement for the last two consecutive inspections
Why we inspected
This was a planned inspection based on the previous rating.
Enforcement
We have identified breaches in relation to fit and proper persons employed.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
The inspection took place on 11 May 2018 and was announced. We also contacted staff and people using the service and their relatives following the site visit. The service was last inspected in 2015 and was not in breach of the regulations at that time. Burgundy Care Services Limited is a domiciliary care agency. It provides personal care to people living in their own homes in the community. Not everyone using Burgundy Care Services Limited receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the time of this inspection they supported 70 people in their own homes, 23 of whom received personal care.
There was a registered manager in post who had been registered since the company started in 2011. 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.
Staff had received training in safeguarding adults and children. They demonstrated a good understanding of how to recognise abuse and ensure people were safeguarded.
Risk assessments were in place in relation to the environment and for people using the service. Not all risks had been assessed to enable management plans to be developed which would provide guidance for staff to follow to keep people safe from harm.
Accidents and incidents, although infrequent, were recorded on the electronic system.
Recruitment practices were on the whole in line with best practice but some improvements were required.
The management of medicines did not follow current best practice. There was no written record of the medicine support given to a person for each individual medicine on every occasion, to provide a clear record of all medicines administered or applied.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; Staff were able to describe how they would support people to make decisions if they lacked capacity and how they would act in their best interests when providing care.
People who used the service and their relatives spoke highly about staff and told us they were caring. They said staff were respectful at all times and ensured their privacy was maintained. Staff had time to sit and chat and people did not feel rushed during their care and support.
Care plans were not recorded in a person-centred way to enable an understanding of the person’s personal history, individual preferences, interests and aspirations. They lacked information about the person’s strengths, levels of independence and quality of life.
Complaints were recorded on their electronic system but these were not compiled to show how the service had analysed and responded to information gathered or used this information to make improvements to the service.
There was a lack of systems and processed including regular audits which meant the registered provider was unable to identify where quality and safety needed to improve. Up to date nationally recognised guidance had not been embedded in policies nor implemented by the registered manager.
There was no satisfaction survey completed to compile and analyse the information gained about the service which would have demonstrated how they were acting on the views of people using the service and professionals to drive improvements.
We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safe care and treatment and good governance. You can see what action we told the provider to take at the back of the full version of the report.
This inspection took place on 6 August 2015 and was announced. The registered provider was given 48 hours’ notice because the location provides a domiciliary care service; we needed to be sure the manager would be available to meet with us.
Burgundy Care and Support Services was set up in 2011 and providesOn the day of our inspection 37 people were receiving support with personal care.
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.
Staff and the management team had received training in safeguarding vulnerable adults and all the staff we spoke with were able to describe what actions they would take if they suspected abuse to ensure the people they supported were safe from harm
The service had a general risk assessment tool which covered potential risk at the property, personal safety of staff, household equipment, physical assistance to transfer or mobilise, personal care tasks, and medication. Risks were managed and reduced although there was a lack of detail around some areas of risk such as specific risk assessments around bathing.
The service enabled staff to access training to ensure the staff had the knowledge and skills to perform in their role. Staff told us they were encouraged to increase their knowledge and skills by taking advantage of the training on offer.
Staff had received training in the Mental Capacity Act 2005. Staff sought consent from people in line with legislation and supported people who lacked capacity to make decisions about their care.
People who used the service and their relatives told us staff were caring. They told us staff did not rush them and they had time to chat. They told us the staff were respectful at all times and ensured their privacy was maintained.
People received care that met their needs, choices and preferences and they were involved in the review of their service.
People knew who to complain to and had every confidence that any concerns would be acted on and resolved.
Staff enjoyed working at the service and had great pride in their work. They felt confident in and supported by the management and the culture of the organisation was good.
Certain aspects of the service such as time spent with people, and missed calls was constantly monitored by the registered manager but there was a lack of documented audits of the quality or the safety of the services provided to the people who used the service. This meant the service could not easily demonstrate the quality of the service they were providing even though all the people who we spoke with and professionals spoke highly of the service provided.
The service had also not always met their regulatory requirements by sending notifications to the Care Quality Commission relating to a safeguarding although they had managed the risks and referred to the local authority as required. They had not provided the Commission with a Provider Information Return (PIR) as had deleted the email from the CQC believing it to be spam.