About the service: Brisen Company Limited is a domiciliary care agency. It provides personal care to people living in their own homes as well as reablement services; which meant that people are referred to the service from local authority representatives and health care professionals. The service provides short term care, normally up to six weeks, and therefore the numbers of people receiving support varies on a weekly basis. At the time of the inspection there were 146 people using the service.Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.
People's experience of using this service
The provider failed to ensure appropriate assessments of risks to people were completed, or risk assessments were not updated. Risk management plans were not always in place to manage these risks, which included, health conditions, moving and handling, falls, medicines, skin integrity and diabetes. People's medicines were not always safely managed.
Staff were not deployed to meet people's needs in a timely manner. People and relatives told us that staff were frequently late, this sometimes meant that at times a family member had to support as the second carer.
People and their relatives told us that people did not always feel safe. Appropriate recruitment checks were not carried out before staff joined the service.
Potential safeguarding concerns were not always reported to CQC. There was not a robust system in place to record accidents and incidents. These were not analysed and learning was not disseminated to staff.
People were not always protected from the risk of infection as not all staff wore Personal Protective Equipment (PPE). Staff were not always supported through regular supervisions.
Assessments were not always carried out prior to people joining the service to ensure that people's needs could be met and were not used to develop care plans. Staff did not always receive adequate training. People’s privacy and dignity and their independence was not always promoted. People’s end of life care wishes was not recorded in their care files. The complaint system to manage people concerns was not effective.
People and/or their relatives were not involved in planning their care and support, Care plans were not always reviewed and/or updated. People's consent to care and support was not always documented.
Feedback was not always sought from people about the service, where feedback had been sought, the provider did not always act upon and rectify shortfalls identified. Governance and audit systems were not effective at identifying and reducing risks to people's safety. There was a lack of effective leadership and oversight of the service.
Rating:
The last rating of the service was Good (published on 21 March 2021) when we carried out a comprehensive inspection.
Why we inspected:
We received concerns about late visits, staff recruitment, neglect and poor medicines management. As a result, we undertook a comprehensive inspection. We identified breaches in relation to lack of person-centred care, risks, care plans, medicines management, recruitment practice, and there were no robust systems in place to assess and monitor the quality of the service provided. There was a lack of effective leadership and oversight of the service.
You can see what action we have asked the provider to take at the end of this full report.
You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Brisen Company Limited on our website at www.cqc.org.uk.
Enforcement:
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
Follow up: We will continue to monitor the service closely and discuss ongoing concerns with the local authority. If we receive any concerning information we may inspect sooner.
The overall rating for this service is 'Inadequate' and the service therefore is in 'special measures'. This means we will keep the service under review. 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.