Britannia Homecare Limited is a domiciliary care agency that provides personal care to people in their own homes living in and around East Surrey. People who receive a service include those living with physical frailty due to the progression of age. The agency also provides services to people living with dementia and people with mental health needs. At the time of the inspection, the agency was providing a service to 202 people of which 117 were receiving personal care as part of their package of care.

There had been no registered manager in post since 29 January 2018. 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. Two managers had submitted applications to the CQC to become joint registered managers.

We last carried out an inspection of this agency on 7 June 2016 when the service was rated as requires improvement in the safe domain. We recommended that the registered provider reviewed systems and structures to improve visit call times. We also recommended that the registered provider reviewed medicines procedures to ensure accurate records were maintained. We found similar shortfalls at this inspection.

During this inspection we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This related to medicines management. We also made five recommendations to the registered provider in relation to staff deployment, recruitment processes, staff training, risks related to people’s dietary needs and good record keeping. You can see what action we told the provider to take at the back of the full version of this report.

There were insufficient numbers of staff to care for people and as such management decided to hand back packages of care to the local authority in order to ensure they could provide suitable care to people. However, deployment of staff needed to be improved as we found people had mixed views about the timings of their visits and call times allocated by the agency did not always allow for sufficient travelling time between visits.

Medicines were not always managed safely. There were unexplained gaps in medicine administration records and body maps were not being used to record the use of creams and pain patches. Accidents and incidents were recorded and risk to people had been identified. .

Recording on food and fluid charts was lacking which meant people may be at risk of malnutrition or dehydration.

Staff did not always receive training at regular intervals to ensure that they received the most up to date training although management had an action plan in place to address this.

People were protected against the risk of infection. Staff had infection control training and had access to the necessary equipment. People were protected from the risk of abuse because appropriate safeguarding procedures were in place.

Management had started to address shortfalls within the agency. They had introduced an audit system which had identified shortfalls and were not working to an action plan to address these.

People’s care plans did not always include a sufficient amount of information to ensure that staff knew exactly what care they should be providing. People’s end of life wishes were not recorded to help staff understand people’s preferences. We did find however that new-style care plans were being introduced to make information clearer.

People’s choices were considered and they were involved in making decisions about their care. People told us they were encouraged to be independent and that they were cared for by staff who were kind and caring and showed them respect and dignity. People were encouraged to feed back their view about the service they received. People could telephone the

The inspection was announced and took place on 07 June 2016.

Britannia Homecare Limited is a large domiciliary care agency that provides personal care to people in their own homes who live in and around East Surrey. People who receive a service include those living physical frailty or memory loss due to the progression of age. The agency also provides services to people living with dementia and people with mental health needs. At the time of this inspection the agency was providing a service to 266 people of which 188 were receiving personal care as part of their package of care. Visits ranged from 15 minute calls to nine hours.

During our inspection the registered manager was present. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 we spoke with were generally happy with the service they received and complimented the care workers who supported them. People felt they were treated with kindness and said their privacy and dignity was always respected. People's care and support plans contained information about what was important to them and how care should be delivered. People were involved in reviewing care plans with members of the management team.

People had mixed views about the timing of their visits but said that recently these had improved. The agency had taken steps to make the required improvements. Work in this area should continue. We have made a recommendation about this in the main body of our report.

Care workers knew how to keep people safe. They understood their responsibilities under safeguarding procedures and were confident the management team would act swiftly and deal with any issues appropriately. Recruitment procedures ensured care was provided by staff who were safe to support people in their own homes.

People said that they were happy with the support they received to manage their medicines. The agency had systems for medicine management that would benefit from further development to offer greater protection to people. We have made a recommendation about this in the main body of our report.

People's consent to care and treatment was considered. Staff understood the requirements under the Mental Capacity Act 2005 and about people's capacity to make decisions.

Risks to people had been identified and assessed and information was provided to staff on how to care for people safely and mitigate any risks. Development of risk management procedures will offer further protection to people. We have made a recommendation about this in the main body of our report.

People were happy with the support they received to eat and drink. Changes in people's health care needs and their support was reviewed when required. If people required input from other healthcare professionals, this was arranged.

Complaints and concerns were investigated and responded to appropriately. People who used the service felt able to make requests and express their opinions and views. A formal complaints process was in place that people were aware of.

The registered manager was committed to continuous improvement and feedback from people, whether positive or negative was used as an opportunity for improvement. Quality assurance systems were in place and used to monitor the quality of service provided to people. Further development of aspects of quality monitoring will help to drive improvements. We have made a recommendation about this in the main body of our report.

Care workers were committed and said that the registered manager and the management team were approachable and supportive. Care workers were supported to provide appropriate care to people because they were trained, supervised and received appraisals. They felt confident w

We sent out questionnaires to people who used the service, to relatives, friends and advocate to ask them about the care they received. We analysed the results of the survey which showed that overall people who used the service, relatives/ friends seemed satisfied with the service provided by Britannia Homecare Limited.

One relative commented that “Britannia Home Care company seems to be well run. My mum knows who's coming at what time. She likes all the girls and looks forward to their call. She chats to them while they're working and they are all very friendly and personable.” Another relative commented that “Carers are friendly and patient and supportive. I am extremely satisfied with the care my mother receives.”

The registered manager named in this report had left the service at the time of our visit. They are still showing on our register as the registered manager for the service at the time of our inspection. A new manager has been appointed for this service and a registration application is pending with the Care Quality Commission (CQC).

We found that people who used the service were involved in making decisions about the care they needed or made aware of their plan of care.

We found there was a medicines management process in place and that staff had been trained to ensure people were either prompted to take their medicine or where care staff administered medicine, this was done in a safe way.

We found that the provider assessed the level of care people needed and the availability of staff to provide the care, before they agreed to deliver a care package.

We found the provider had a process in place to monitor the quality of the service they provided. However, this process was being further developed to take into account the views and comments of people who used the service and or their representatives to improve the service provided.

People told us that they were generally happy with the service provided by the agency.

People told us that they, or their relatives were involved in the initial care planning and that staff were well trained and knew what they were doing.

People told us “Overall I am very satisfied indeed with Britannia”. And staff “appeared to know what they were doing and they talked about training courses they had been on”. People also told us that agency staff followed care plans closely.

People told us that some times staff were late at the weekends but that usually the office would let them know. They also said that there had been times when they had needed assistance immediately and “they were fantastic about this and someone always came within a very short time”.

People told us that they felt safe with the agency staff and that the staff carried identification badges.

We spoke to eleven people who use the service or their representative and all spoke

positively about the service received. People made comments such as "very good all

round", "very happy" and "very good care".

People using the service told us they appreciated having regular staff for the majority of

their visits and said staff were friendly but professional. We were told that care and

support is provided in the way people preferred and any matters raised to office based

staff are dealt with promptly and effectively.

Britannia Homecare Ltd is a domiciliary care agency providing personal care for people in their own homes. At the time of our visit the service supported over 360 people.

The service had a registered manager who was responsible for the day to day operation of the agency. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service and has the legal responsibility for meeting the requirements of the law with the provider.

The people we spoke with were happy with the standards of care and support given by the staff. One person told us, “They are pleasant people and always willing to do what I want.” Another person said, “Carers are friendly and diligent.” A relative told us, “My family member receives excellent care.” We did get some feedback about one-off issues that had occurred, but people told us that when they had raised these with the service they had been put right.

The service had systems in place to keep people safe. Assessments of  risks to people from foreseeable hazards had been developed and reviewed. Staff understood their role and responsibility for keeping people safe. However not all the checks completed on staff before they started working for the service were as robust as they should be. This meant they were not meeting the requirements of the regulations.

People’s needs and choices had been clearly documented in their care plans. One person told us “They ask my permission and work to the pattern I like, It’s brilliant.” A second person told us “Yes they know my health needs. They explain and talk with me. They show an interest in my health. They record what they do in my book. They sit and have a chat.” Another person said “They do respect when I do things myself, like cleaning my teeth.”

Where people’s needs changed the service acted quickly to ensure people received the care and treatment they required.

People who used the service and their family members that we spoke with all agreed that people were supported by kind and caring staff. Staff were able to tell us about the people they regularly supported, for example their personal histories and their interests. We saw that staff received training which enabled them to meet the needs of  people that used the service. However we saw two examples where staff were required to prepare meals but did not have up to date food hygiene training. People also told us that staff could sometimes be late and they didn’t get a call from the office to let them know.

People told us they were involved in the planning and review of their care. Where people were unable to do this the service considered the person’s capacity under the Mental Capacity Act 2005. Staff were aware of what they needed to do if a decision needed to be made for someone who lacked the capacity to make it for themselves.

The registered manager provided good leadership and support to the staff. They were also involved in day to day monitoring of the standards of care and support that were provided to people that used the service. The registered manager and provider were aware of the issues around late calls, and the service was in the process of recruiting more staff. This ensured that people received care and support that met their needs, and enabled them to keep living in their own homes.