We inspected Burbage Homecare on 19 April 2018. The visit was announced. The provider was given 48 hours’ notice of our visit because the location provides a domiciliary care service. We needed to be sure that someone would be in the office. The service provided domiciliary care and support to people living in Leicestershire. At the time of our inspection there were 65 people using the service.

Not everyone using Burbage Homecare received the regulated activity; personal care. CQC only inspects the service being received by people provided with personal care, help with tasks related to personal hygiene and eating. Where they did we also took into account any wider social care provided.

At the last inspection in February 2017, the service was rated ‘Requires Improvement’. At this inspection we found the service remained ‘Requires Improvement’.

The service had a registered manager. The registered manager was also the provider. 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.

We found concerns with regard to the timings of people’s calls. The majority of people we spoke with told us they never knew when support workers would arrive to carry out their care and support and some had experienced missed calls. Concerns were also found with regard to the regularity of support workers, with people not knowing who would be visiting them.

People told us they felt safe with the support workers who visited them on a regular basis but not so much with the support workers who were new to them.

The staff team had received training on the safeguarding of adults and were aware of their responsibilities for keeping people safe from avoidable harm or abuse. The provider/registered manager and the management team were aware of their responsibilities for keeping people safe, though processes had not always been followed.

People had the opportunity to be involved in how the service was run through the use of surveys. However, it was not always evident that people’s views had been taken on board or addressed.

Systems in place to monitor the quality and safety of the service being provided were not always effective.

People’s care and support needs had been identified and risks presented to either the people using the service or the staff team had been assessed and managed.

Checks had been carried out when new members of staff had been employed to make sure they were suitable and safe to work at the service. Support workers had been suitably inducted and relevant training had been provided to enable them to appropriately support the people using the service.

Support workers had received training in the handling of medicines during their induction and their competency had been checked. People were not always supported with their medicines as prescribed by their GP due to not having regular call times.

A formal complaints process was in place and people knew who to talk to if they had a concern of any kind. People told us whilst they were aware of the process, they did not feel this was always effective.

People were supported to maintain good health. They were supported to access relevant healthcare services such as their GP when needed and they received on-going healthcare support. Nutritional assessments had been carried out and people were supported to have enough to eat and drink.

People told us the support workers were kind and they were treated in a caring and respectful manner. They told us their care and support was provided in a way they wished for and preferred.

Plans of care had been developed with the people using the service and with people who knew them well. We did note not all of the plans checked were up to date however, this was b

We inspected the service on 1 February 2017. We gave two days’ notice of our inspection because we needed to be sure the registered manager would be available. We spoke with people over the telephone on 8 February 2017 to gain their feedback on the service provided.

Burbage Homecare Limited provides personal care and support for people in their own homes. At the time of our inspection 85 people were receiving personal care and support from the service.

There was a registered manager in place. It is a requirement that the service has a registered manager. 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 did not display their rating from the latest CQC report. This is a legal requirement to inform people about our judgement about the quality of the service provided. The provider told us they would make sure the rating was displayed.

The provider’s checking of the quality of the service was not always effective. For example, checks on people’s care records were not consistently carried out and had not identified some of the areas that we had during our visit. The manager told us they would make improvements to their quality checking to make sure people received a high quality service.

People and staff had opportunities to give feedback to the provider about the quality of the service.

Both people and staff felt that improvements could be made to communication from the provider’s office and the arrangements of people’s care calls. The provider was working to make improvements in these areas.

Risks to people’s health and well-being were not always assessed and did not always focus on people’s specific requirements. For example, where a person required support to move position, guidance was not available for staff to protect the person from avoidable harm. We saw that other risks to people’s health and well-being were assessed and staff had guidance to follow. This included guidance for staff to help people to relax when they were anxious.

People’s medicine records were not always competed accurately. The provider told us they would make improvements to their checking processes to address this. People received their prescribed medicines when they required them and staff knew their responsibilities to handle it safely.

Staff did not always arrive at the agreed times and people did not always have regular staff to provide their care and support. We found the same concerns during our last inspection visit on 23 February 2015. The provider was taking action to make improvements.

The provider did not always follow the requirements of the Mental Capacity Act 2005. They were taking action to make improvements including planning to assess a person’s mental capacity following a decline in their health. Staff understood their responsibilities under the Act including when a decision could be made in a person’s best interest.

People were involved and contributed to the planning of their care and support. The review of people’s care requirements was being undertaken. The recording in people’s care records did not detail their involvement in their review. The provider said they would make improvements to their recording as people, where they could, were involved.

People were satisfied with the number of staff available to offer them care and support. The provider was recruiting more staff to make sure people’s care calls always took place. The provider’s recruitment procedure was safe and they carried out checks on the suitability of prospective staff.

People felt safe with the staff that offered them care and support. Staff understood their responsibilities to help people to remain safe including the reporting of suspicions of or

We carried out our inspection on 23 February and 2 March 2015. The inspection was announced.  The provider was given 48 hours’ notice because the location provides a domiciliary care service and staff are often out of the office providing care. We needed to be sure that they would be in. Our inspection was planned at short notice because of concerns we received that people using the service were not receiving home visits at times they expected or required.  

Burbage Home Care provides domiciliary care for in the region of 130 people. The service provides for home care visits for older people.

The service had a registered manager. 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 and associated Regulations about how the service is run.

When we inspected the service in April 2014 we found that an aspect of the provider’s procedures for monitoring the quality of the service required improvement. This related to the checking of care worker’s daily records for evidence that peoples care needs were met. The provider implemented improvements and we saw this process was now effective.  

Staff understood and put into practice the provider’s procedures for safeguarding people from abuse and avoidable harm. They advised people using the service about how to keep safe and how to raise concerns. The provider had enough suitably skilled staff to be able to meet the needs of people using the service but had experienced high turnover of staff. A recruitment exercise was underway at the time of our inspection. Staff prompted people to take their own medicines and acted appropriately if people decided not to take their medicines.

People using the service were supported by staff who had received relevant and appropriate training. Staff were supported through effective supervision. They understood the relevance to their work of the Mental Capacity Act 2005 and knew how to seek people’s consent before they provided care and support.

Staff supported people with their nutritional needs. They supported people who required help to prepare meals. People were supported to access relevant health services when they needed to.

People using the service and relatives told us that staff were considerate and caring. However, people told us that they often did not know which care workers would be visiting them. They also told us that care workers often came late. Some people required two care workers to support them but there had been occasions when only one care worker came or a second care worker arrived later than the first.

People were involved in the assessments of their needs and in reviews of their plan of care. They were provided with information about their care and support options and were involved in decisions about their care and support. However, their preferences about times of home care visits had not always been met. Care worker’s respected people’s privacy and dignity.

People knew how to raise concerns with the provider if they needed to, either through the provider’s complaints procedure or contacting the office.

Changes to the way the service was managed and organised were underway at the time of our inspection. The provider was seeking to improve the way home visits were planned and organised. They were engaging with people who used the service and their relatives as part of that process.  Changes were also being introduced to the way the provider monitored the quality of the service.

We gathered evidence against the outcomes we inspected to help answer our five key questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? We gathered information from people who used the service by telephoning them and their relatives.

Below is a summary of what we found. The summary is based on evidence we collected from speaking with people who used the service, their representatives, the staff supporting them and from looking at records. If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

People told us they felt safe. The provider had safeguarding procedures that were robust and staff understood how to safeguard people they supported. People told us that they felt their rights and dignity were respected. One person told us, "The carers are professional and respectful." Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. Some people told us that they had raised concerns about the service in the past and that the provider had responded by making improvements. The provider's systems reduced the risks to people and helped the service to continually improve.

Staff told us they referred to people's care plans when providing care. People told us that care workers always carried out the care routines that were detailed in their care plans. This showed that people received the care and support they expected, and they had not been put at unnecessary risk by care workers not delivering appropriate care.

The provider had effective procedures that ensured people were cared for by staff who had the right skills and experience. The provider had effective recruitment procedures and had provided staff with relevant training and support. This helped to ensure that people's needs were met by staff who understood people's needs. People told us that it was important to them that they had regular care workers. The provider had sought to ensure that people received care and support from the same team of care workers; and people told us that had happened most of the time.

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The provider had procedures in place that identified good and poor practice. Staff received refresher or additional training if their care practice had been identified as falling below expected standards. The provider had an effective complaints procedure that ensured complaints were thoroughly investigated. The provider ensured that lessons were learnt from complaints and incidents and risks to people were effectively managed.

Is the service effective?

People's health and care needs were assessed with them or their representatives. People or their representatives were involved in the development of their plans of care. Specialist input into care plans had been provided by other health and social care professionals. Care plans were regularly reviewed and kept up to date. That meant people's care plans reflected their current needs.

Is the service caring?

We asked eleven people for their opinions about the service and staff that supported them. People were complimentary about the service. One person told us, "They are a small agency that do a very good job." Another person told us, "They are absolutely perfect at their job." People told us that what mattered most to them was that they were supported by care workers they knew; that care workers came at times they expected and completed all care routines. People told us that care workers were usually punctual and that they had not minded when care workers were a few minutes late. They told us that care workers had carried out the care routines they expected. They described care workers as kind and caring.

We spoke with care workers who demonstrated that they genuinely cared for and understood the needs of the people they supported. Care workers knew what their responsibilities were in relation to identifying and reporting abuse.

People who used the service, their representatives provided feed-back through an annual satisfaction survey. The provider had responded to what people had said. 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 in their care plans and care and support had been provided in accordance with people's wishes.

Is the service responsive?

People knew how to make a complaint if they were unhappy. Two people told us that they had raised concerns in the past about care that had been provided. They told us the provider had responded by making improvements. This meant people could be assured that the provider took concerns seriously and investigated them and made improvements.

The provider worked closely with other services to make sure people received support with their health.

Is the service well-led?

The provider had a system for monitoring the quality of service that had been provided. This relied on direct feedback from people who used the service, their relatives and observations of staff when they provided care and support. Other evidence about the delivery of care was in care worker's notes of their visits. However, the provider had not checked the notes to assess whether they provided assurance that appropriate care had been delivered. The provider's monitoring of calls showed that 90% of calls were made within 15 minutes of a scheduled time. Shortly before our inspection the provider had introduced a new system for monitoring punctuality and duration of home care visits.

Problems that had been identified through the provider's quality assurance procedures were addressed promptly. Opportunities to improve things were acted upon. As a result the quality of the service was continuously improving.

Staff we spoke with were clear about their roles and responsibilities. Staff had a good understanding of the aims of the service. Staff were supported through supervision and training and had opportunities to further develop their knowledge and skills. This helped to ensure that people received a good quality service at all times.

We telephoned eight people to gather their thoughts of the service being provided. Five were receiving direct care and three were relatives of people receiving care. We were also able to talk to four support workers and four members of the management team.

We were told that people were involved in deciding what care and support they needed and initial assessments had been completed This showed us that the service assured itself that the individual needs of each person could be met, prior to their care package commencing.

We looked at the care plans and risk assessments for four people. We found that though these documents were in place, some of the care plans did not include all the tasks support workers were required to carry out and not all the risk assessments had been completed in a timely manner.

People told us that they were provided with regular support workers and training records showed us that the support workers were appropriately trained.

Monitoring systems were in place including the use of quality surveys. This provided people with the opportunity to share their thoughts on the support they received and enabled the management team to monitor the quality of service being provided.

People told us that they were satisfied with the care and support they received from Burbage Homecare. One person told us: “They are excellent; I don’t think we could do better.” Another explained: “They treat me very well, I have no concerns.”

We spoke with four people who used the service, five staff and reviewed five care records and five staff files.

All the people we spoke with told us they were happy with their care and their privacy and dignity was respected and one person told us: ”Nobody has ever been rude, most are very pleasant. I know all my carers. ” All the staff we spoke with were knowledgeable about people’s individual needs and how best to communicate them.

All the people we spoke with felt safe. One person told us: ”I have never felt vulnerable.” People who used the service were positively encouraged to report abuse and all the staff we spoke with told us how they would deal with reports of abuse.

There were effective recruitment and selection processes in place. We saw a recruitment pack which detailed a robust process for the recruitment of new staff.

People were given support by the provider to make a comment or complaint where they needed assistance. One member of staff told us: ”When meeting new people I always tell them if they are not happy they shouldn't hesitate to contact us.”

We spoke with three people who use services and one person’s representative. People told us the agency delivered a good service and they were satisfied with the care they received.

People who use services told us, “The carers always treat me with respect and maintain my dignity. I am quite capable of looking after myself. This is my son’s idea.” Another person said, “I think there is a copy of my care plan at home although I am not sure where it is. The carers write up daily notes in a book.”