Agency profile · CQC 1-4654410807

Brisen Care Services

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Provider

Brisen Company Limited

Greenwich · London · Active since 15/0

Requires improvementHome-care★ Owner-managed (director & PSC)RM: Agwu, Francisca

Overall rating

Requires improvement

safeRequires improvement

effectiveRequires improvement

caringGood

responsiveGood

well-ledRequires improvement

Last inspection

1 year ago

26/Mar/2025 - 00:00

Inspected 1 year ago

Overview Inspections (5)Findings (53)Owner-management Methodology

Inspection reports (5)

Single Assessment Framework · 2025-03-26
Framework: SAF · 6 pages · PDF
Date of Assessment: 4 February 2025. Brisen Company Limited is a domiciliary care service which provides personal care to people in their own homes. We carried out this assessment to check whether the warning notice we previously served in relation to breaches of legal regulations had been met. This service is registered for use by autistic people or people with a learning disability. At the time of the assessment, the service was not providing a service to anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group. 3 people were receiving support with personal care. Right Support: People were included in the risk management processes. Staffing levels were sufficient to maintain people's safety and ensure their health and social care needs were met. People and their relatives were involved in the assessment and ongoing review of their needs. People’s communication, personal care and health needs were considered, however guidelines for staff were not always clear. Right Care: People were treated with kindness and compassion by well trained staff that knew them well. Right Culture: The provider worked in partnership with other health and social care professionals. The provider was previously in breach of legal regulations in relation to staff training and support, person-centred care and safeguarding. The provider was no longer in breach of these regulations. The provider was also previously in breach of the legal regulations in relation to recruitment, medicines, safe care and treatment and good governance. The provider remains in breach of these legal regulations. Based on the findings of this assessment the service remains rated requires improvement. We have asked the provider for an action plan in response to the concerns we identified.
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Concerns (18)

criticalMedication management: “Medicines were not always safely managed. People did not always receive their medicines as prescribed which meant they were at risk of harm.”
criticalMissed or late visits: “People and their relatives told us their visits were often late and they were not informed if there were going to be any changes.”
criticalCare planning: “People's care plans only consisted of a list of tasks staff were required to carry out. Therefore, people's needs were not always accurately assessed.”
criticalStaffing levels: “There were not enough staff deployed effectively to meet people's needs in a timely manner.”
criticalSafeguarding: “Potential safeguarding concerns were not always reported to CQC. There was not a robust system in place to record accidents and incidents.”
criticalStaff training: “The provider could not evidence that staff who worked independently had received PEG training to meet service users' needs safely.”
criticalGovernance: “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.”
criticalLeadership: “The registered manager did not have an adequate understanding of their role, regulatory requirements and lacked oversight of the service.”
moderateSupervision / appraisal: “Out of the 14 staff files we reviewed we saw that seven staff members did not have any supervisions within the last year.”
moderateIncident learning: “The provider had failed to carry out analysis of any trends to identify areas where lessons could be learnt and disseminated to staff.”
moderateRecord keeping: “There were no audits carried out in relation to care plan audits, staff files, daily notes and communication books, to identify shortfalls.”
moderatePerson-centred care: “People and/or their relatives were not supported to be involved in decisions about their care. Care records did not capture preferences about culture and religion.”
moderateComplaints handling: “Not all complaints, including verbal, were logged and investigated in line with the provider's complaints procedure.”
moderateInfection control: “Infection control was not always appropriately managed. Some people and relatives told us that staff sometimes wore PPE or not at all.”
moderateCommunication with families: “Relatives told us that communication with the management team was poor. One relative said, 'I have to communicate with the carers as management don't contact me.'”
minorEnd-of-life care: “Care records did not contain advance decisions about people's choices about the end of their life. The registered manager told us they had not explored this.”
minorCultural competency: “People's cultural needs had not always been explored and documented in people's care plans, this included the food they liked and the language they communicated in.”
minorConsent / capacity: “People's consent to care and support was not always documented.”

Inspection report · 2025-02-11

Framework: KLOE · 21 pages · 107 KB · PDF

Requires improvement

safe: Requires improvementeffective: Requires improvementcaring: Requires improvementresponsive: Requires improvementwell-led: Inadequate

Brisen Company Limited remains in breach of multiple regulations following this December 2023 follow-up inspection, with persistent failures in risk assessment, medicines management, recruitment, safeguarding, staff training, and governance. The well-led domain remains Inadequate due to the registered manager's lack of awareness of statutory responsibilities and ineffective oversight systems, resulting in three Warning Notices being issued.

Concerns (15)

criticalMedication management: “not all staff had up to date medicines training and/or had their competency to administer medicines assessed in line with National Institute of Clinical Excellence (NICE) guidance.”
criticalMedication management: “one person's MAR chart containing conflicting medicines information. The instructions were to 'take 3 tablets twice a day', however the MAR chart records 'take 1 tablet in the morning and take 2 tablets at night.'”
criticalCare planning: “People's care plans were not always person-centred and contained minimal information. Records did not always detail how people's specific health needs affected them.”
criticalSafeguarding: “a safeguarding concern that took place in November 2023. However, the provider did inform CQC within our guidance… We were informed of this concern not until 14 days after the incident occurred.”
criticalStaff training: “Staff supporting people living with Parkinsons Disease, continence care, insulin-controlled diabetes, and using specialist equipment had not received adequate training in these areas.”
criticalStaff competency: “staff 'are to use breakaway strategies in the unlikely event the person holds onto carers clothes'… Staff told us they did not know to do this and had not been trained in breakaway strategies.”
criticalGovernance: “since our last inspection in April 2023, there were no staff file or ECM audits carried out until November 2023. This audit did not identify the issues we found at this inspection.”
criticalLeadership: “The registered manager was unaware of the issues identified during the inspection, regarding the lack of risk assessments, poor medicines administration, poor recruitment processes.”
criticalPerson-centred care: “Care plans for people living with specific health conditions encouraged staff to support people in a way that placed them at risk of potential harm and without input from healthcare professionals.”
criticalConsent / capacity: “The provider's medicine policy did not mention covert medicines and did not have clear procedures for giving medicines covertly.”
moderateSupervision / appraisal: “The supervision policy did not stipulate how frequently staff would be supported with supervisions. The frequency of supervision was variable. Some staff had more supervisions than others.”
moderateIncident learning: “the provider failed to carry out analysis of accidents and incidents to identify trends and where lessons learnt were disseminated to staff.”
moderateRecord keeping: “The provider had 3 versions of the training matrix; therefore, the provider could not be assured that all staff training was up to date.”
moderateStaffing levels: “persistent issue of dual location visits, this meant that staff were logged as being at two places at the same time. The provider had not identified this issue.”
minorCultural competency: “Care plans documented 'Be aware of cultural/religious practices that may affect personal care' but did not specify what these were.”

Strengths

· Infection control was appropriately managed; staff always wore PPE and had access to it at each person's home.
· People and relatives reported staff were kind, caring and supportive, and felt safe with their carers.
· End of life care wishes were recorded in care files and people were involved in planning their care.
· No complaints had been received since the last inspection and the complaints system was in place.
· Staff were deployed to meet people's needs in a timely manner; relatives reported staff arrived punctually.

Quality-Statement breakdown (20)

safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Using medicines safelyRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseRequires improvement
safe: Preventing and controlling infectionGood
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Supporting people to eat and drink enoughRequires improvement
effective: Supporting people to live healthier lives and access healthcare servicesRequires improvement

Inspection report · 2023-06-23

Framework: KLOE · 21 pages · 106 KB · PDF

Inadequate

safe: Inadequateeffective: Inadequatecaring: Requires improvementresponsive: Requires improvementwell-led: Inadequate

Brisen Company Limited remained Inadequate across three of five key questions at this April 2023 follow-up inspection, with persistent breaches of regulations covering risk assessment, medicines management, safeguarding, staffing, recruitment, care planning, complaints handling, and governance, all unresolved since the previous October 2022 inspection. The service continues in Special Measures with no demonstrated improvement, placing people at ongoing risk of harm.

Concerns (20)

criticalMedication management: “We analysed three months of care calls on the ECM system prior to the inspection. We identified there were 512 missed calls.”
criticalMedication management: “We reviewed Medicine Administration Records (MAR) for three people...and found a number of gaps on each of the MAR charts where staff had failed to sign.”
criticalMissed or late visits: “512 missed calls. Punctuality was poor, with only 60% of calls delivered within 15 minutes of the planned time and 20% of calls were more than 45 minutes late.”
criticalCare planning: “Some people's care plans were not always person-centred and contained minimal information...no guidance for staff on how to support people with their individual needs effectively.”
criticalSafeguarding: “There was no effective system in place to safeguard people appropriately and manage concerns of abuse. There was no safeguarding file or system in place.”
criticalSafeguarding: “A potential safeguarding had not been reported to CQC until March 2023, a month after the incident and following the demise of the person involved.”
criticalStaff training: “Two staff members had not completed any mandatory training since they joined the service. Three staff members had not completed all mandatory training since joining.”
criticalStaffing levels: “Staff were not effectively deployed to meet people's needs in a timely manner. The provider failed to ensure that they had an effective call monitoring system (ECM) in place.”
criticalStaff competency: “The provider did not follow safe recruitment practices...accepted a basic (not enhanced) DBS check that a staff member had carried out themselves.”
criticalGovernance: “Since our last inspection in August 2022, there were no regular medicine audits carried out for all people using the service.”
criticalLeadership: “The registered manager did not adequately understand their role, regulatory requirements and lacked leadership and oversight of the service.”
moderateSupervision / appraisal: “Three staff members had not been supported with regular supervisions since our last inspection in August 2022.”
moderateIncident learning: “The provider failed to carry out analysis of accidents and incidents to identify trends and where lessons learnt were disseminated to staff.”
moderateComplaints handling: “Complaints were discussed with some people via WhatsApp message, instead of adhering to the provider's internal complaints policy.”
moderatePerson-centred care: “People or their relatives were not always supported to be involved in decisions about their care...care records did not always document if people were able to choose what they wanted to wear.”
moderateEnd-of-life care: “Care records did not always contain advance decisions about people's choices about how they wished to be supported at the end of their lives.”
moderateRecord keeping: “Care records were not always regularly reviewed. Support plans were not always signed either by people or their relatives consenting to their care.”
moderateConsent / capacity: “Support plans were not always signed either by people or their relatives consenting to their care. Staff had not always signed and/or dated support plans.”
moderateCommunication with families: “People or their relatives had little involvement in the planning or review of their care. One relative told us, 'I don't know if [family member] has a care plan.'”
minorCultural competency: “People's cultural needs had not always been explored and clearly documented in people's support plans.”

Strengths

· Staff were described as kind and caring by people and their relatives.
· Infection control was appropriately managed and staff wore PPE during care visits.
· Staff and the registered manager understood the principles of the Mental Capacity Act and sought consent before supporting people.
· A system was in place to record accidents and incidents.
· Care records showed that people's communication needs had been recorded in support plans.

Quality-Statement breakdown (20)

safe: Assessing risk, safety monitoring and managementInadequate
safe: Using medicines safelyInadequate
safe: Staffing and recruitmentInadequate
safe: Systems and processes to safeguard people from the risk of abuse; learning lessons when things go wrongInadequate
safe: Preventing and controlling infectionGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawInadequate
effective: Staff support: induction, training, skills and experienceInadequate
effective: Supporting people to eat and drink enough with choice in a balanced diet