13 October 2015
During an inspection looking at part of the service
We inspected this home on 13 October 2015. This was an unannounced inspection.
Brightlands is registered to provide accommodation and personal care for up to 13 people with a learning disability. Each person who lives in the service is provided with en-suite facilities for their own use. Accommodation is provided over three floors and there is a stair lift to the first floor only. People who lived in the home had learning disabilities, some with communication difficulties, physical disabilities and challenging behaviour. At this inspection we found that there were 10 people living in the home.
At our last inspection on 26 February 2015, we found that the provider was in breach of Regulation 14 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Staff had not followed specialist guidance on feeding one person. We requested the provider to submit an action plan on how and when they planned to improve the service. The provider submitted an action plan to show how they planned to improve the service by 06 July 2015.
We inspected the home against four of the five questions we ask about services: is the service safe, effective, responsive and well led.
Prior to this inspection we received information of concern in relation to care practices at the home. This included whistleblowing information that had not been investigated and poor staff practice. In addition, concerns had been raised about lack of consistency of records, incidents that were not reported to the local authority and notifications that had not been sent to the commission to tell us about incidents and accidents in the home.
There was a registered manager at the home. 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.
Medicines had not been properly managed. Not all staff were trained and allowed to give medicines, and people did not always receive their medicines in a timely manner, to meet their needs.
Brightlands had a safeguarding policy. They also had a copy of the local authorities safeguarding adult’s policy, protocols and guidance. However, the registered manager had not followed the local authorities safeguarding policy, protocol and procedure. The registered manager had not appropriately deployed staff to meet people’s needs.
Accidents and incidents in the home had not always been reported to the local authorities and other relevant agencies.
Although risk assessments were in place, risks to people’s safety and wellbeing were not always managed effectively to make sure they were protected from harm.
Areas of the home were visibly dirty and the provider failed to protect people from the risk of infection or to maintain a clean environment.
Appropriate action was not always taken in timely manner when people’s weights reduce; to ensure that their nutritional needs are met.
Effective systems were in place to enable the registered manager to assess, monitor and improve the quality and safety of the service. However, shortfalls had not been identified by the registered manager and actions had not been taken in a timely manner to improve the quality of the service.
Staff encouraged people to undertake activities. However, there were not enough resources to meet people’s chosen activities. People were not provided with sufficient, meaningful activities to promote their wellbeing. Staff spent time engaging people in conversations, and spoke to them politely and respectfully.
The complaints procedure did not provide information about all of the external authorities people could talk to if they were unhappy about the service. People told us they would speak to the manager if they wished to complain.
One person’s care plan did not correspond with the level of risk they had been assessed at. The home did not have all associated behavioural guidelines in place to identify and reduce risks. These risks involved when meeting people’s needs such as behaviours that challenge, and details of how the risks could be reduced. Staff were unable to take immediate action to minimise or prevent harm to people based on specified guidelines.
Staff had received training relevant to their roles such as epilepsy, safeguarding, Deprivation of Liberty Safeguards (DOLS) and challenging behaviour. However, staff training were lacking in some other essential areas. Regular supervision and appraisals were lacking.
The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager understood the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty safeguards.
Staff meetings and residents meetings took place in the home.
Safe medicines management processes were in place and people received their medicines as prescribed.
During this inspection, we found breaches of regulations relating to fundamental standards of care. You can see what action we told the provider to take at the back of the full version of this report.