Brisen Company Limited

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last inspection we rated this key question requires improvement. At this assessment the rating has remained requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed. The provider was in breach of legal regulations in relation to people’s safe care and treatment.

This service scored 53 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Due to the ongoing issues we found in relation to safe care and treatment, medicines, good governance and recruitment we could not be assured the provider had created a culture of ongoing learning. The provider did not have a way of collating accidents and incident to analyse trends and themes. They told us they had not had any incidents since the last inspection. However, we found 2 incidents that had been reported by staff. Although we could see the registered manager had taken the necessary action in response to these incidents, the lack of analysis meant we could not be assured they were using these events to promote ongoing learning. Despite the issues we found people and staff were positive about how the provider had made improvements. People told us the registered manager investigated issues or concerns about safety and took action to resolve things. One person told us, “When I first joined the agency my medication wasn’t administered properly but that was 2 years ago and it all got sorted. The staff took it seriously, including the staff and it all got sorted.” Staff told us the registered manager discussed safety incidents and accidents during staff meetings. Staff understood their responsibility to report accidents and incidents to the registered manager. One member of staff told us, “If anything happens when I am working I make the situation safe if I can and make sure people are safe. If I am not sure what to do I contact the office to speak to the registered manager."

The provider has systems and process in place to manage safe transitions including when people moved between services. The registered manager told us they carried out re-assessments of people’s needs if they went into and came back out of hospital to ensure people’s care plan was up to date and accurate. People told us staff recognised when people needed urgent medical help. One person told us, “The staff phoned the ambulance and the staff recognised that I wasn’t well, she took control of the situation which is exactly what I needed at that time.”

At our last inspection, systems and processes were not established and operated effectively to prevent abuse of service users. At this assessment we found the provider had made improvements. Since the last inspection there have not been any safeguarding concerns but the registered manager understood their responsibility to share concerns quickly and appropriately. People told us they felt safe from bullying, harassment, abuse, discrimination, avoidable harm and neglect. They also told us they were satisfied the provider had taken robust action when concerns had been raised. One person told us, “They put loads of safeguarding in place specifically geared towards me and they also provided additional safeguarding training for the staff.” Staff received regular training and showed a good understanding of safeguarding procedures. They knew how to raise concerns and how to escalate them if they were not satisfied with the response.

At the last inspection the provider was failing to ensure people were protected from the risk of harm. Despite some improvements in this area we found further improvements were needed. Some people had a wide range of medical conditions but the risks associated with them were not always clear and guidelines for staff were sometimes incorrect and/or misleading. The provider had assessed the risks associated with some flammable emollient creams however, not all flammable creams had been identified as a risk and guidelines for staff did not contain sufficient information to ensure people and staff understood how to mitigate the risks. There were mobility assessments in place for people with reduced mobility however, the records were inconsistent and conflicting. One person’s care plan stated their mobility had deteriorated and they required support to transfer using a hoist. The mobility risk assessment had not been updated to reflect this and did not contain any guidance about the use of the moving and handling equipment. We raised these concerns with the registered manager and they have taken action to resolve the issues we identified. Despite this swift response to concerns we raised we could not be assured the provider has made sufficient improvement in this area. Despite the ongoing issues with the risk assessments people told us they felt safe and they were informed about the risks to their safety and wellbeing. They also told us risk assessments were discussed with them on a regular basis. One person told us, “Yes they do it all the time, they come to visit my house”. Staff showed a good understanding of the risks to people when we spoke with them and this corresponded to feedback we received from people receiving care.

The service detected and controlled potential risks in the care environment. The service assessed the risk of fire and put personal evacuation plans in place. Despite some good practices, we found staff had identified a hazard in one person’s home but there was no evidence of any follow-up to ensure the person receiving care was aware so that the issue could be resolved. Despite the issues with records staff showed a good understanding of how to keep people’s living spaces safe and free from hazards. One member of staff told us, “I turn off electrical appliances before leaving and make sure there is nothing in the way for people to trip over.”

At the last inspection we found the provider was failing to ensure sufficient numbers of suitably qualified, competent staff were being deployed. The provider did not have a robust system for ensuring people received their care visits on time and staff did not receive adequate training to ensure they were equipped to care for people safely. The provider has made improvements. Staff timekeeping had generally improved since the last inspection however, we found care visits were sometimes changed without any explanation and some people’s visits were sometimes much earlier than scheduled. The registered manager was monitoring the system to identify missed and late calls however, they were not always in the office so we could not be assured this was a robust processes for monitoring staff attendance times. Despite our concerns about the monitoring of staff attendance, people told us they were satisfied with staff timekeeping. Comments included, “They have a system that they have to sign in the time of arrival anyway the staff is always on time” and “If they are running late they always let me know and they always stay their full time.” The provider had also made improvements to the training and competency assessments for staff to ensure they had the skills and knowledge to care for people. There was a wide range of training in place including training in supporting Autistic people and people with a learning disability, mental health conditions and dementia. People told us staff were well trained and understood their needs. Staff told us they had a thorough induction and ongoing training. One member of staff told us, “The induction was very good. I was able to shadow another member of staff who introduced me to the clients and showed me what to do.”

Infection control was appropriately managed. People and their relatives told us that staff always wore personal protective equipment (PPE) and followed safe hygiene processes to reduce the risk of infections. Comments included, “I have a weak immunity system so they have everything in place to keep everything as hygienic as possible” and “The staff have a high standard of cleaning.” Staff we spoke with told us they also had access to PPE. One member of staff said, “I always have plenty of PPE including gloves, aprons, masks and hand sanitizer. There are never any issues with supply.”

At our last inspection we found systems and processes were not put robust to ensure medicines were safely and effectively managed. At this assessment, we found people's medicines were not always managed safely. The provider had introduced an electronic medicine administration (EMAR) record to ensure greater accuracy and oversight of medicines. We found EMARs were not completed correctly and medicines were either missing or had incorrect directions for staff. The directions on the prescription label were not always being followed. One person was being prescribed a medicine for pain 3 times a day, however the directions on the EMAR stated the medicines should be taken twice a day only. The same person was being prescribed a PRN (when required) medicine which was being administered 3 times a day at the person’s request. The staff had not recorded the administration for several months. Staff were also leaving medicines out for the person to take themselves later but this had not been risk assessed to ensure this practice was safe. Another person needed some medicines to be administered via a nebuliser but this was not recorded on their EMAR as given. The registered manager was auditing the medicines but had not identified the issues we found. We raised these issues with the registered manager and they have taken action to resolve the issues we found. We found no evidence that people had been harmed however, the poor management and oversight placed people at risk of harm. Despite the issues we found people were satisfied the provider had made improvements and they felt staff were supporting them to manage their medicines safely. Comments from people included, “When I first joined the agency my medication wasn’t administered properly but that was 2 years ago and it all got sorted” and “There is never a problem with managing medicines.” Staff told us they received regular training and their competency had been assessed.