Guardian House

Wright Watson Enterprise Centre (Bradnet) is a domiciliary care agency. It provides personal care to people in their own homes and flats At the time of our inspection the service was providing personal care to 5 people. 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 and what we found

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

The provider had made significant improvements since the last inspection. The changes had led to positive outcomes for people who used the service. Risks to people’s health and safety were assessed and regularly reviewed. Accidents and incidents were closely monitored and there was a culture of learning lessons. Medicines were managed safely.

People received person-centred care and they felt safe and secure. They spoke positively about the care and support provided. Recruitment was managed safely, and people were supported by experienced and consistent staff. Staff received good levels of support, training, and supervision in order to be able to carry out their roles effectively. The provider valued the well-being of the staff team.

The registered manager was approachable and supportive and provided leadership to the team. The culture of the service was open and welcoming, and people were encouraged to express their views. A range of detailed audits and checks were in place to monitor and improve the safety and quality of the service.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 13 March 2020) and there was a breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

At our last inspection we recommended the provider made improvements to staff induction and awareness of safeguarding procedures and monitoring of accidents and incidents. At this inspection we found the provider had acted on these recommendations and made improvements in all the areas identified.

Why we inspected

This inspection was prompted by a review of the information we held about this service. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Wright Watson Enterprise Centre on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Wright Watson Enterprise Centre (known as 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 seven people.

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 and what we found

Although some aspects of risk assessment still needed further work, we concluded people were not at risk using the service. Medicines management had improved, and lessons were learnt when things went wrong. We have made a recommendation about lesson learning processes becoming more formal before the service started to support larger numbers of people. The provider was able to demonstrate staff recruitment was now consistently safe, and there were enough, well-deployed staff to provide a consistent service to people.

The manager had improved the support staff received, and the provider ensured staff had the training they needed. We have made a recommendation about improving induction processes before new staff join the service. People’s rights were respected, although people’s consent to their care needed recording more thoroughly. People had good support with their health, nutrition and hydration.

Staff were caring and showed good respect for people’s privacy and dignity. People received encouragement to maintain their independence whenever possible, and were consulted in decisions about their care. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People received a service which was now consistently managed and reflected their preferences and individual needs, including for any end of life care which may be needed. People were confident their concerns would be listened to.

People, relatives and staff told us the manager had made a positive impact on the service, improving reliability and quality. There was now good oversight of performance in the service, although some systems would benefit from more formalisation before the service began to provide support to more people.

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

Rating at last inspection (and update)

The last rating for this service was Inadequate (published 13 January 2020).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations relating to fit and proper persons employed, person-centred care, staffing and good governance.

At this inspection enough improvement had not been made in relation to a breach of the regulation about safe care and treatment, and the provider was still in breach of this regulation.

This service has been in Special Measures since 13 January 2020. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified a continued breach in relation to the quality of risk assessments at this inspection.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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 and what we found

The service provided a range of care packages including live in support to short personal care visits. Some care packages were well managed with people receiving consistent staff who met their individual needs. However, some people experienced late, or rushed calls and these people said needs were not always fully met.

There were not always enough staff to ensure people received consistent care and support. This especially impacted on people who received several calls a day for personal care. Rota’s were not always realistic with some staff rota’s showing calls scheduled for the same time. Safe recruitment practices were not always followed as the required checks had not been undertaken on staff before they started work. Not all risks to people’s health and safety were assessed and mitigated.

Staff received a range of training relevant to their role however supervisions and appraisals were not always undertaken in a timely way. People said they received appropriate support with food and drink. Staff supported people them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People consented to their care and support, however evidence of this was not readily available. We made a recommendation around ensuring signed copies of consent documentation was kept securely in the office rather than solely in people's homes.

Care was not always person centred as people did not have agreed call times and calls were not always undertaken in a timely way. Complaints were appropriately logged and managed.

Systems to assess, monitor and improve the service were not suitably robust. For example, issues with risk management, recruitment, call times and rota planning should have been prevented from occurring. In some cases, there was no record of care and support provided to people and some records were inaccurate. The service had been in breach of regulations at the last four inspections and continued to be in breach.

Following the inspection the service sent us an action plan detailing how they would control some of the more serious risks we identified during the inspection to reduce the risk of ongoing harm.

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

Rating at last inspection

The last rating for this service was requires improvement (published 18 September 2018) and there was one breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection the service had deteriorated, and the provider was still in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about risk management and staffing levels. A decision was made for us to move the inspection forward to inspect and examine those risks.

We have found evidence that the provider needs to make improvements.

Enforcement

We have identified breaches in relation to risk management, staffing levels, recruitment, person centred care and good governance.

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 have requested and received an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

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 acting manager met with people over any concerns or complaints they had. Most people said they were satisfied with the service.

Staff said they felt well supported and morale was good. They said the acting manager was approachable and effective.

A range of audits and checks were carried out by the service. Due to the electronic care management system not functioning correctly, the service was unable to evidence a full record of people’s care and support.

People’s views were sought and used to make improvements to the service.

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 immediate action to address any shortfalls we identified during the inspection. However issues with training organisation and recruitment which we identified should have been prevented from occurring through the operation of robust systems of quality assurance.

We identified one breach 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 back of the full version of the report.

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 appropriate and met people’s individual needs. Care records we viewed demonstrated a more thorough assessment of people’s needs had been undertaken. We saw evidence of greater consistency with regards to call times and the delivery of care. However there were still some areas which required attention, where staff were not completing all required care tasks or staying for the correct amount of time.

People and relatives were involved in the review of care and support packages and their opinions were regularly sought on how to improve the service.

The service had made improvements to the way complaints were managed. Documentation showed complaints were logged and responded to in a timely way. Where people had complained this was followed up with increased quality reviews and spot checks on staff practice. Although most people were satisfied with the service there were still some remaining concerns to be addressed by the management team.

Overall, people and relatives told us that a number of improvements had been made to the service over recent months with the quality of care improving. Staff also shared this opinion and said that the service was now better organised. The service acknowledged this process was not yet complete, we saw further improvement plans were in place to improve the service further over coming months.

Systems were in place to assess and monitor the service. We saw in some instances these were effective in identifying and rectifying issues. However some issues we identified during the inspection had not been identified through the provider’s audit systems demonstrating they were not sufficiently robust.

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

We were told by people who used the service or their representatives, staff were friendly and polite and respected the wishes of people. We found that people who used the service were treated with dignity and respect.

People who used the service were protected against the risk of abuse. Staff received training in abuse awareness and protecting children and vulnerable adults. The policies and procedures were available to all staff in relation to safeguarding.

We found people were protected from the risk of infection as treatment was delivered in a clean and hygienic environment.

There were effective recruitment and selection processes in place.

The provider had a system in place for gathering, recording and evaluating information about the quality and safety of care the service provided. People who used the service were asked for their views about their care and treatment.

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.