About the service: Browncross Healthcare Limited (Domiciliary Services) is a domiciliary care agency. It provides personal care to people living in their own homes. It provides a service to older people and younger disabled adults. At the time of the inspection they were supporting 61 people in the London Boroughs of Bexley, Barking and Dagenham and Camden. This included reablement care for a period of up to six weeks and urgent discharge to access care, where people received support immediately after being discharged from hospital.

People’s experience of using this service:

People and their relatives were positive about the caring nature of their regular care workers.

People told us staff were sensitive when providing personal care which helped them to feel comfortable and ensured their dignity was respected.

People and their relatives felt the service was personalised and the provider listened to them if they had any concerns. With reablement and urgent discharge care, the provider tried to be as flexible as possible to meet their needs.

People were given regular opportunities to give feedback about the service and felt the provider was approachable. Issues were discussed across the organisation as a learning opportunity and the provider had been proactive in addressing areas that needed improvement.

People were cared for by staff who felt valued and supported in their role. Care workers spoke positively about the support they received and how they were encouraged to improve the quality of care.

The provider worked closely with a range of health and social care professionals to ensure people received effective care and support. Staff had demonstrations from occupational therapists to help with safe moving and handling procedures.

Rating at last inspection: At the last inspection the service was rated Good. (Report published 5 May 2017).

Why we inspected: This was a planned comprehensive inspection based on the outcome of the previous inspection. We had been in regular contact with the provider to monitor the size of the service.

Follow up: We will continue to monitor information and intelligence we receive about the service until we return to visit as per our re-inspection guidelines. We may inspect sooner if any concerning information is received.

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

This inspection took place on 4 April 2017 and was announced.

At our previous inspection on 23 and 25 August 2016 a breach of legal requirements was found. After the inspection, the provider wrote to us to say what they would do to meet the legal requirements in relation to notifications.

We undertook this focussed inspection to check that they had followed their plan and to confirm that they now met the legal requirements in relation to the breach found. This report only covers our findings in relation to this requirement. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Browncross Healthcare Limited’ on our website at www.cqc.org.uk’

There was a registered manager in post at the time of our inspection. 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.

Browncross Healthcare Limited is a domiciliary care agency which provides personal care and support to people in their own homes. At the time of our visit the service was providing personal care and support to 55 people in the London Boroughs of Bexley, Camden and Barking and Dagenham.

At our previous inspection we found that the provider did not always notify the CQC of notifiable incidents.

At this inspection, we found that improvements had been made.

The provider was aware of the type of incidents that they were required to notify the Care Quality Commission (CQC) of and had reviewed their notifications protocol. Records of the notifications were kept with additional information added as investigations were carried out.

This inspection took place on 23 August and 25 August 2016 and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we needed to be sure that someone would be in. At our previous inspection on the 27 and 28 August 2015 we found the provider was in breach of six regulations relating to person centred care, consent, safe care and treatment, safeguarding service users from abuse and improper treatment, good governance and notification of incidents.

After the comprehensive inspection, the provider told us what they would do to meet legal requirements in relation to managing risks to people’s safety and welfare, consent, governance, and person centred care. We carried out this inspection to check that they had followed their plan and to confirm that they now met legal requirements. During this inspection we found that improvements had been made.

Browncross Healthcare Limited is a domiciliary care agency which provides personal care and support to people in their own homes. At the time of our visit the service was providing personal care and support to 49 people in the London Boroughs of Bexley, Camden and Barking and Dagenham. All of the people using the service were funded by their local authority.

There was a registered manager in post at the time of our inspection. 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.

The provider had updated their medicines policy in January 2016 which took into account the concerns raised at the last inspection and was reviewed again in May 2016. Staff had completed training in medicines which was refreshed annually.

People’s risks were managed and care plans contained appropriate risk assessments which were updated regularly when people’s needs changed. The provider had a robust recruitment process and staff had the necessary checks to ensure they were suitable to work with people using the service. People had regular care workers to ensure they received consistent levels of care.

People and their relatives told us they felt safe using the service and care workers understood how to protect people from abuse. Staff were confident that any concerns would be investigated and dealt with. All staff had received training in safeguarding adults from abuse and had a good understanding of how to identify and report any concerns.

Care workers received an induction training programme to support them in meeting people’s needs effectively and were always introduced to people before starting work with them. They shadowed more experienced staff before they started to deliver personal care independently and received regular supervision from management. They told us they felt supported and were happy with the supervision they received and the content of the training available.

Staff understood the principles of the Mental Capacity Act 2005 (MCA). Care workers respected people’s decisions and gained people’s consent before they provided personal care.

Care workers were aware of people’s dietary needs and food preferences. Care workers told us they notified the office if they had any concerns about people’s health and we saw evidence of this in people’s daily logs and minutes of meetings. We also saw people were supported to maintain their health and well-being through access to health and social care professionals, such as GPs, district nurses and social services.

People and their relatives told us care workers were kind and caring and knew how to provide the care and support they required. Care workers understood the importance of getting to know the people they supported to develop positive caring relationships.

People told us that staff respecte

A single inspector carried out this inspection. The focus of the inspection was to answer our five questions: Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

The detailed evidence supporting our summary can be read in our full report.

Is the service safe?

Care and treatment was planned and delivered in a way that was intended to ensure people’s safety and welfare. If the service identified that someone was at risk, for example of having a fall, then they put strategies in place to minimise those risks.

People were cared for, or supported by, suitably qualified, skilled and experienced staff. The service carried out in-house training which covered key skills that care staff may need to carry out their job. New members of staff were carefully checked in terms of their suitability for the role. For example, the service followed-up on references, required photographic identification, and carried out Disclosure and Barring Service (DBS) checks.

Is the service effective?

We found that people's needs had been assessed and suitable care plans were in place. These were regularly reviewed. The service was also able to accommodate requests in relation to providing care that was in line with people's religious persuasion, or cultural and linguistic background.

People’s health, safety and welfare was protected when more than one provider was involved in their care and treatment, or when they moved between different services. This was because the provider worked in co-operation with others.

Is the service caring?

People’s privacy, dignity and independence were respected. People’s views and experiences were taken into account in the way the service was provided and delivered in relation to their care. People told us that the care staff were polite and respectful. For example, one of the people using the service told us "the care staff are courteous and helpful. I enjoy their company."

Care staff knew what was required and were following each person's care plan. The people using the service were generally satisfied with the care they received. One person said "They are really nice and very helpful. If there are ever any problems, then they can usually find a solution."

Is the service responsive?

We examined how the service responded to complaints as well as what actions they took. We looked at responses to any adverse incidents involving people who used the service. We saw that the service responded to these issues by carrying out investigations and then took actions to resolve any problems.

Is the service well led?

The provider had effective systems to regularly assess and monitor the quality of service that people received. For example, people using the service were regularly visited by care co-ordinators in order to elicit their views about the quality of the care. The service had also carried out a survey with the people using the service about the quality of the care they had received. The provider had taken actions where they identified any poor performance. Members of staff were invited to attend meetings where they could raise any concerns and the quality of care being provided was discussed.

We spoke with four people using the service, the relatives of two other people and five care workers. We also looked at six people’s care plans and other records. Everybody we spoke with was happy with the care and support they received. One person using the service told us, “my care workers are lovely, I would not want to be without them.” A relative of another person said, “they take very good care of [my relative]. We have had no problems and I am sure they would sort out any issues.”

People told us they were consulted about how their care was provided. We saw that people’s care needs were assessed and recorded in their care plans. Risk assessments had been carried out and information was updated as required.

Staff training and procedures were in place to make sure any medication needs could be safely met, although none of the people using the service at the time of this inspection needed any support from their care workers to take medication.

Following our last inspection we asked the provider to improve the recording of staff training, supervision and appraisals. We found during this visit that staff training, supervision and appraisals were well recorded.

There were systems in place to monitor the quality of the service. Regular spot checks were carried out and customer satisfaction surveys were used to gather the views and experiences of people using the service.

We spoke with the relatives of four people who were using the service. All said that their relative had an assessment of their needs prior to receiving care from Browncross Healthcare Limited. One person said that there had been “teething problems” when their relative’s care package started but these had “been worked out”. This person also said that they “think care plans could be more detailed but we were consulted about our [relative’s] preferences”.

One person told us they are “happy with the care, once we get a care worker who becomes a regular and knows what our [relative] needs, then the care goes well”. Another relative told us "lovely carer, provides respite care for my [relative], an absolute gem, rings me up if she is going to be held up, can really trust her.”

Relatives of people using the service told us that they felt consulted about their family members’ needs but no one said that they had been asked to comment on the quality of the service.

People said that they were spoken to respectfully by staff and that they were polite.

Most said that they had had an assessment of their needs prior to receiving care from Browncross Healthcare Limited. Some commented that they would like to have more communication with Browncross Healthcare Limited to discuss their care.

The people who spoke with us said that they believe that they are receiving good care and that Browncross Care Limited was delivering the care needs that had been identified in their assessment. Punctuality and attitude of some staff had previously been raised as a concern by some people, although when this had been raised with the agency they said that it was responded to.

This inspection took place on 27 and 28 August 2015 and was announced. We gave the provider 48 hours’ notice of the inspection because the service is a domiciliary agency and we needed to be sure that someone would be available. The provider met the regulations we inspected at their last inspection which took place on 12 June 2014.

Browncross Healthcare Limited provides a domiciliary care service to people in their own homes. At the time of the inspection 80 people were using the service. The service had a registered manager in place. 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 safeguarding training and could identify types of abuse. Whilst the service had in place safeguarding procedures to protect people, people who used the service were not always protected from the potential risk of abuse and improper treatment as the safeguarding procedures were not consistently followed.

Medicines procedures were in place, however these were not sufficiently robust to protect the wellbeing of people in relation to PRN (as required) medicines and the medicines policy.

Risks to people were assessed including risks associated with moving and handling, health and personal care, falls and home environment. There were policies in place on how to deal with a range of emergencies and staff had used these procedures to keep people safe. There were sufficient numbers of staff to meet people’s needs. Staffing levels were assessed and monitored on an ongoing basis through regular contact with people. Staffing levels were flexible and allocated based on individual needs.

Care workers were knowledgeable about the code of conduct policy and treating people equally. All staff were vetted prior to commencing work. Criminal record checks were made on all staffand essential recruitment documents and records were sought and in place.

The provider’s practice was not always consistent in accordance with the principles of the Mental Capacity Act 2005 in order to protect the rights of people.

People who used the service expressed mixed views about the quality of care they received. People overall were very happy with their regular care staff, but less so of replacement staff, whom they found were not as knowledgeable or skilled. Staff received core induction, mandatory training and updates. Field supervisors and care managers assessed the knowledge and skills of care staff and observed their practice whilst on duty. Staff received supervision and annual appraisals.

People were supported to meet their nutrition and hydration, maintain good health, and have access to ongoing healthcare support. The provider kept records of regular contact with professionals.

People who used the service and their relatives told us that staff were kind and caring. Most spoke highly of the regular care staff and said they were treated with dignity and respect. However a number of other people or their relatives said they experienced a lack of responsiveness from office and care staff when care was much later than the scheduled time, which had an impact on them.

People were asked about their needs, care preferences, such as preferred times of care before and during their service to make sure the agreed times still suited their needs. Staff understood about people’s needs in relation to their cultural and religious beliefs and respected these.

Care plans were developed in consultation with people and their relatives. But not all were signed by people or their representatives to show they agreed with their plans and that they reflected discussions about how people wished to be supported.

Staff were familiar with peoples’ needs, however people’s needs were not always clearly stated in their care plans, including their preferences, how best to support them and care arrangements with family members. This increased the risk of people not receiving adequate support to meet their needs and wishes.

People who used the service and their relatives expressed mixed feedback about the care staff’s punctuality. Some were very happy and said that care staff were never late. Others said calls could be very late (over the agency’s 30 minute allowance) or missed altogether. This had a negative impact on those for whom care was late or missed. Some stated there was a noticeable difference in the knowledge and care provided by new or replacement workers. People were who used the ‘reablement’ part of the service made good progress in their rehabilitation towards independence at home, for example, after hospital discharge. This was by using the short term care service provided by the agency.

People were advised about the complaints procedure and knew how to complain. However there were mixed views about the provider’s handling of complaints.

The provider had failed to inform the Care Quality Commission of relevant notifiable incidents or events that affected the safety and welfare of people. Regulations require that these incidents must be reported.

Staff spoke highly of the management and said they were available whenever they needed and that they received good support.

The majority of comments in records from home visits, monitoring calls and the latest annual survey showed that people were satisfied with their care. However we were concerned about the extent of mixed experiences expressed to us verbally and feedback from people and their relatives about their care, the organisation and management of the service. The provider used a number of ways to monitor the quality of care.

However, whilst the provider had systems in place to monitor the quality of service, the systems and audits were not sufficiently robust. They had not highlighted the concerns we found during our inspection.

The provider had not identified that the lack of effective quality monitoring systems increased the risk of the service not being run effectively and of areas requiring improvement not being identified and addressed.

We identified seven breaches of regulations. You can see what action we have told the provider to take at the back of this report.