Guardian House (Bradnet) is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults and younger disabled adults. At the time of the inspection the service was providing personal care to 11 people. The service also provides social inclusion support to a number of other people who use the service. This aspect of the service does not require registration with the Care Quality Commission and is not included within the scope of this inspection.

The inspection took place between the 3 August and 18 August 2018 and was announced. This meant we gave the provider a short amount of notice that we would be visiting.

At the last inspection in May 2017 we rated the service ‘Requires Improvement.’ We found a breach of regulation relating to Good Governance as records relating to staff recruitment and training were not completed and/or poorly organised. Following the last inspection we asked the registered provider to complete an action plan to show what they would do and by when. At this inspection we checked the improvements the registered provider had made.

At this inspection whilst we found most of the specific areas of concern had been addressed, the overall rating of requires improvement remained unchanged. This was because the service were not maintaining a complete record of the care and support given to each service user. The service had introduced a new electronic care recording system, however it was not functioning correctly. As such we were unable to evidence people had consistently received care including the administration of their medicines. This meant the provider was still in breach of regulation 17 of the Health and Social Care Act (2008) Regulated Activities 2014 Regulations.

A manager was registered with the Commission as the registered manager for the service. However, they had left in May 2018 and were in the process of de-registering. Following this, an interim manager had been put in place who was present during the inspection. In addition, a new manager had been recruited who started the day before the inspection. They were in the process of applying to become the registered manager for the service.

Overall people and relatives spoke positively about the care they received from the service. They said it was appropriate and met individual needs. Most people said the timeliness of the service was good, although one person said that they thought there was too much variation in the times of their calls.

People said they received their medicines as prescribed. Whilst we found no evidence people were not receiving their medicines, records relating to the medicine support needed to be clearer and more consistently completed.

Risks to people’s health and safety were assessed and risk assessments were put in place for staff to follow. People said they felt safe using the service. Incidents and accidents were logged, investigated and measures put in place to further improve the safety of the service.

There were enough staff deployed to ensure people received a reliable service. Staff were recruited safely to help ensure they were suitable to work with vulnerable people. Staff received a good range of training and support from the management team.

People’s care needs were assessed and detailed plans of care put in place for staff to follow. People said care needs were met by the service. Where required, staff supported people appropriately at mealtimes. The service liaised with health professionals over people’s healthcare needs.

People said staff were kind and caring and treated them well. People said they felt listened to by the service. We saw people’s views were sought in relation to their care and support and changes made to people’s support plans based on these views. People were encouraged to be as independent as possible.

People’s complaints were listened to and properly investigated. The acti

Bradnet provides domiciliary care services to a range of client groups across Bradford. This includes people with learning disabilities, physical disabilities and older people. At the time of the inspection the service was providing personal care to 12 people. The service also provides social inclusion support to a number of other people who use the service. This aspect of the service does not require registration with the Care Quality Commission and is not included within the scope of this inspection.

The inspection took place between the 22 May 2017 and 1 June 2017 and was announced. This meant we gave the provider a short amount of notice that we would be visiting the office in order to ensure a manager was present.

At the last inspection in May 2016 we found the provider had made some improvements since the previous inspection in November 2015 but was still in breach of four regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We rated the service ‘requires improvement’ overall and in all of the individual domains.

At this inspection we found further improvements had been made to the service. The service had reduced the number of care packages it provided and was able to provide a more person centred service to people. However we found documentation and organisation relating to recruitment and training needed further improvement.

The majority of people were satisfied with the care and support provided by Bradnet and said it met individual needs.

We saw evidence most people received their medicines as prescribed. However the service was in a transitional phase, transferring records to an electronic system. This new system would need fully embedding before we were fully assured that medicines were consistently managed in a safe way. We made a recommendation for the provider to ensure the electronic medicine management system meets the requirements of recognised community medicine management guidance.

People told us they felt safe using Bradnet. Risks to people’s health and safety were assessed and clear and person centred risk assessments put in place.

An electronic call monitoring system had recently been implemented which alerted the office if staff were late or did not attend a call. This helped improve the safety of the service and reduced missed calls.

There were enough staff deployed to ensure people received a reliable and timely service. Appropriate recruitment procedures were in place but we saw they were not consistently followed. During the inspection the manager took immediate action to rectify discrepancies we found.

Staff received regular training and support. However it was difficult to track when training expired through the current training system.

The service was acting within the legal framework of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). People’s consent was gained prior to care and support and people were offered choices around their daily routines.

Where appropriate, people were supported to maintain good nutrition and hydration.

People said staff were kind and caring and treated them well. People were supported by a small group of staff that knew them well. People were introduced to new care workers before care and support was provided. Cultural and spiritual needs were considered.

People said good care was provided by Bradnet. People’s care needs were assessed and clear and person centred plans of care put in place. These were subject to regular review with the person. Care records were in the process of being transferred to an electronic system so staff could receive real time updates as people’s care and support needs changed.

A system was in place to log, investigate and respond to complaints. Most people said they were very satisfied with the service and had no need to complain.

The registered manager was honest and open with us about the current performance of the organisation and took

The inspection took place between the 9 and 18 May 2016 and was announced. This meant we gave the provider a short amount of notice (48 hours) that we would be visiting the office in order to ensure a manager was present.

At the last inspection in November 2015 we found the provider was in breach of seven regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We rated the service ‘inadequate overall and placed the service in special measures.’ At this inspection we checked whether improvements had been made to the service.

Overall, we found a number of improvements had been made to the service, although some risks still remained which needed to be promptly addressed.

Bradnet provides domiciliary care services to a range of client groups across Bradford. This includes people with learning disabilities, physical disabilities, elderly people and children.

A registered manager was not in place with the previous manager deregistering with the commission in August 2015. 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. A new manager had been recruited who told us they were in the process of applying to become

the registered manager for the service.

Feedback from people and relatives had improved since the last inspection with more people speaking positively about the service. A number of people said staff attitude had improved as well as the reliability of the service. However this was not universally the case. For example out of the 19 people or relatives we spoke with, three told us they were still very dissatisfied with the service but others stating that things were good or were improving.

People and relatives said they felt safe in the company of staff. Safeguarding procedures had been followed and we saw evidence they had been followed to help keep people safe.

Risks to people’s health and safety were appropriately managed. Risk assessment documentation was improved and demonstrated the service had sought to understand how to care for people safely.

Medicines were not consistently managed in a safe way. We found documentation of the support people received with their medicines was not always completed in an accurate way.

Improvements had been made to the reliability of the service and staff were deployed in a more effective way. People reported more consistent visit times and less missed calls. However work was still required to the organisation of rota’s to improve reliability further.

Safe recruitment procedures were in place to help ensure staff were of suitable character to work with vulnerable people.

Where required, people were supported appropriately with food and drink.

Staff received a range of training on induction and then at regular intervals. However we identified some staff had not received key training needed to deliver safe and effective care. The service had put in place a structure of spot checks on staff to drive improvement in staff practice. A programme of supervision and appraisal was in place, although some staff had not received timely supervision.

The service had not needed to make any DoLS Applications to the Court of Protection. However where people lacked capacity to make decision for themselves, improvements were needed to the way documentation was completed to evidence decisions were done as part of a best interest process.

Most people told us staff treated them kindly with dignity and respect. This was a significant improvement from the previous inspection. Staff had been provided with a uniform and were required to work to a new code of conduct.

Overall people spoke positively about the quality of care received. They said it was appropr

During our inspection we spoke with five people who used the service or their representatives. The people we spoke with were positive about the care and support they received. People told us they had been consulted about the care packages they received and their support plans had been discussed with them.

People told us they had been given written information about the services the provider offered. One person said, “I was visited by a care co-ordinator before the agency started to provide my support and my main carer was introduced to me before the first visit.” Another person said "I am very pleased with the care and ongoing support I receive from the agency, I have always found the staff to be reliable and conscientious."

We spoke with two care co-ordinators and six care staff and they told us they enjoyed working for the agency and always respected people's rights to privacy and dignity when providing care and support. They also told us they helped and encouraged people to retain their independence and provided care and support in line with their agreed support plan.

People who use the service did not make any specific comments about the essential standards we reviewed.

People who use the service did not make any specific comments about the Outcomes we reviewed.

We spoke to a person who uses the service and the relatives of two other people who use the service and they told us that they were generally happy with the care provided by staff.

Two people told us that they have been involved in reviewing care plans recently. They also told us that they had been provided with information on who to contact if they had any concerns or wanted to make a complaint.

One person told us that the carer had a good relationship and provided good personal care for her relative, but this carer did not carry out any cleaning activities during visits.

Another person who uses the service told us that she had difficulties arranging for additional care support and felt that there was poor communication between the office and general care staff when arranging additional services.

Bradnet provides domiciliary care services to a range of client groups across Bradford. This includes people with learning disabilities, physical disabilities, elderly people and children.

A registered manager was not in place with the previous manager deregistering with the commission in August 2015. 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. A new manager had been recruited who told us they were in the process of applying to become the registered manager for the service.

Most people told us they felt safe in the company of staff who visited their homes.

However most people or their relatives we contacted raised concerns about the overall quality of the service. Prior to the inspection we sent questionnaires to people who used the service and their relatives. Of the eight questionnaires returned, six people voiced concerns about various aspects of the service. When we spoke with people during the inspection we found a high level of dissatisfaction with the service. For example, out of the 16 people or relatives we spoke with who received personal care, 15 people raised concerns about some aspects of the service and 12 expressed major dissatisfaction with the service. We spoke with an addition five people who used the service whom after speaking with them we concluded they were not receiving personal care and thus fall outside our regulatory remit. However three of these people raised significant concerns with the service. This evidence is not discussed within this report; however we passed this information to the local authority who commission the service.

A significant portion of people who used the service lived with relatives. Relatives told us that care staff often arrived late or sometimes not at all, which meant they often had to step in to provide the required care. The service did not deliver appropriate care as care workers often turned up late. We found examples of care workers not completing all the required tasks at each visit.

Risks to people’s health and safety were not properly assessed and mitigated. We found risk assessment documentation was incomplete or missing from some people’s homes. Following incidents, appropriate investigations were not undertaken and risks assessments were not put in place. This meant there was the risk incidents could reoccur.

Staff displayed a good knowledge of the medicines we asked them about and had received recent training in safe management of medicines. However documentation detailing the medicines people were supported with was not consistently in place.

Safe recruitment procedures were not consistently in place because assurance had not been sought that agency staff working on behalf of the provider had their backgrounds and characters checked.

There were insufficient staff to ensure a safe and consistent service was provided. 15 out of 16 people or relatives we spoke with raised timeliness as an issue and a number of people said calls were often missed. Care staff were overly stretched and there was a lack of travel time allocated to carer workers resulting in them not being deployed in the right place at the right time.

The service had taken recent steps to improve training provision with most staff now up-to-date with mandatory training. However 14 out of 16 people or their relatives said there was a lack of continuity of workers which meant care was often delivered by staff who did not know people’s individual needs.

Although most people and their relatives praised some individual staff members and their kindness, 11 people or their relatives we spoke with were able to give us examples of how they had not been treated with dignity and respect by care staff or the management team.

12 people and their relatives told us their complaints were not dealt with appropriately by management. They said meetings and /or promises of positive changes failed to materialise. A complaints system was in place but it failed to record or investigate a number of complaints we identified.

A service improvement plan was in place and the manager and service director showed us their plans to drive improvement in the service over the coming months. They told us they were currently two thirds of the way through the planned improvements. However people and their relatives told us there had been no recent improvement in the service and many told us the service had got progressively worse over the last few months. This showed us the improvement plan so far to be ineffective in improving people’s experiences.

Systems to monitor and improve the service were not adequate. For example there was a lack of spot checks on staff practice, and lack of review of records of daily care and medication.

We identified seven breaches of the Health and Social Care Act 2008 (Regulated Activities ) 2014 Regulations. You can see what action we asked the provider to take at the end of this report.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.