Burn Brae Care Limited is a domiciliary care service based in Prudhoe, Northumberland which provides personal care and support to people within their own homes. Our last inspection of this service took place in March 2016 where the service was rated as Requires Improvement overall and found to be in breach of two of the Health and Social Care Act (Regulated Activities) Regulations 2014, namely Regulation 12 Safe care and treatment and Regulation 17 Good governance. At this inspection we found that improvements had been made in both of these areas and the provider was now compliant with relevant regulations.

This inspection took place between 30 May 2017 and 30 June 2017. On the 30 and 31 May 2017 we visited the provider’s office base and also people within their own homes who were in receipt of care. Between 31 May and 30 June 2017 we gathered feedback from people, their relatives and staff. This inspection was announced. We gave the provider 48 hours' notice because it is a domiciliary care service and we needed to make sure that someone would be available in the provider’s office to assist us.

A registered manager was in post at the time of our inspection who had been registered with the Commission to manage the carrying on of the regulated activity since October 2010. The registered manager was also the provider and nominated individual of the service. 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.

People were complimentary about the service and the staff who supported them. Staff said that morale was good amongst the wider staff team and they felt supported by the registered manager/provider, who was responsive in their role.

Matters of a safeguarding nature were dealt with appropriately by the service and referred to the relevant local authority safeguarding adults team for investigation and action as necessary. Staff were aware of their own personal responsibility to report matters of a safeguarding nature and to protect the vulnerable people to whom they provided care.

Medicines were safely managed, although records related to the administration of medicines were sometimes not completed accurately by staff to reflect whether people received their medicines as prescribed. We discussed this with the provider to ensure they continued to audit these records and take action where shortfalls were identified in staff practice.

Recruitment processes were robust and appropriate vetting checks were carried out to ensure that new staff employed were suitable to work with vulnerable adults.

Accidents and incidents that occurred during the delivery of care were recorded and monitored. People were supported to remain safe in their own homes and anything of concern that was identified during a care visit by a staff member was reported to office staff for them to take appropriate action. For example, where any health and safety issues were identified within people’s homes, office staff arranged for support to be provided by professionals such as plumbers and electricians.

Risks that people were exposed to in their daily lives had been accessed if this was linked to the care package provided by the service, although some records related to these risks could be improved. We discussed this with the provider who took our feedback on board and said they would continue to improve records within the service.

Staffing levels were determined by people’s needs and the care packages in place. Nobody that we spoke with fed back any concerns about staffing levels. Some staff said that at times they were late for care calls as travel time was not included in their rotas, although overall this was not a regular occurrence.

People told us they were

This inspection took place on 16 and 22 March 2016 and was announced. This was so we could be sure that management would be available in the office as this is a domiciliary care service. We last inspected this service in January 2014 where we found the provider met all of the regulations that we reviewed.

Burn Brae Care Limited is a domiciliary care service based in Prudhoe Northumberland that provides care and support to people within their own homes. The care and support provided ranged from 24 hour care packages to short visits, which for example, supported people to access the community, and provided companionship. Services offered ranged from daytime personal care, overnight care, 'sitting services', enabling services and domestic support. At the time of our inspection the service supported approximately 225 people and employed 76 staff. They provided a service in the Tynedale areas including Prudhoe, Stocksfield, Ovingham, Riding Mill, Slaley and Blanchland. People with end of life care needs, dementia, older persons and learning disabilities were supported by the service.

There was a registered manager in post who was also the nominated individual/registered provider of the service. 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.

People spoke highly of staff whom they said supported them safely and in line with their needs. Systems were in place to protect people from abuse and there were channels available through which staff could raise concerns. Records showed that safeguarding matters had been handled appropriately and referred on to either people's social workers or the relevant local authority safeguarding team for investigation. The provider worked collaboratively with these organisations.

People's needs and risks that they were exposed to in their daily lives were assessed, documented and regularly reviewed. Staff supported people to manage health and safety risks within their own homes. Recruitment processes were thorough and included checks to ensure that staff employed were of good character and appropriately skilled. Staffing levels were determined by people's needs and the number of people using the service.

We identified concerns with the management of medicines which we relayed to the provider. These concerns related to the recording of the administration of medicines and practices that staff had adopted which had not been assessed as safe. This included leaving medicines prepared on the side for people to take themselves. Care planning and risk assessments related to people's medication needs were not robust.

Staff told us they felt supported by the provider and received a lot of training but we concluded they were not supported to retain their skills and keep up to date with current best practice guidance as training was not refreshed on a rolling programme. We have made a recommendation about this which you can find in the body of the full report. Supervisions and appraisals were carried out regularly, as were staff meetings.

CQC monitors the application of the Mental Capacity Act (2005) and deprivation of liberty safeguards. The nominated individual/manager understood their legal responsibility under this act and they assessed people's capacity when their care commenced and on an on-going basis, if necessary. The nominated individual told us that any decisions that may need to be made in people's best interests in the future, would be referred to their care managers and families.

People reported that staff were very caring and supported them in a manner which promoted and protected their privacy, dignity and independence. People said they enjoyed kind and positive relationships with staff and we observed thi

People who used the service said they were pleased with the care and support provided by the carers. Nothing was too much trouble for the carers who were always polite and cheerful. They also said staff were kind and caring.

People said that they were asked about the help they needed when they started using the service and they were consulted about any changes in their care provision.

Staff said there were good training opportunities and it was a good Organisation to work for. Comments included:

"The carers are excellent, I have no complaints. If I did have any concerns I know who to contact."

" I find the carers flexible and they are very helpful and polite."

"I usually have the same carers but I know in holiday time I may have different carers."

We spoke with three people about the care and support they received from this service. People told us they were happy with the service, and with staff. People said, "Smiling friendly staff" and "Nothing is too much trouble." Relative questionnaire comments included, "Staff give the right balance of encouragement and support to maintain my relatives independence."

We viewed care records for three people. We found that care needs were assessed, planned and delivered in a way which met people's individual needs. We found that people had knowledge of, and had consented to, their care plans. People told us, "They know me well but always ask before they help me" and "Reliable, smiling and consistent staff."

We found there were appropriate arrangements in place to assist people with their medication in a safe and suitable manner.

We found that staff were trained and supported in their roles. People told us, "Skilled, happy and reliable, whatever the time or weather."

People's personal records were accurate, fit for purpose and held securely. Other records were kept in an appropriate form.