Bradeney House Nursing & Care Home

Bradeney House is a large nursing home providing personal and nursing care to up to 101 people. The service primarily provides support to older people and those living with dementia. The service can also support younger adults with physical disabilities. At the time of our inspection there were 96 people using the service. This included people with learning disabilities whose primary need was nursing care.

The home is divided into smaller units and the majority of people have an en-suite bedroom. People have access to communal lounges and outside space. Two of the units offered same sex accommodation.

The service is also registered to provide domiciliary support however, no one was accessing that service at the time of our inspection.

People’s experience of the service and what we found

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

Right Support

People received the correct support however, the provider’s electronic care plan system required reviewing to ensure there was accurate record keeping and to ensure staff had access to essential information especially for people on short term placements.

People were supported by sufficient numbers of/suitable staff however, further monitoring of call bell response times was required. People did not always feel their feedback was sought around mealtime experiences.

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.

Right Care

People had care plans in place however, the provider was in the process of reviewing these to ensure they contained specific information in relation to certain health conditions .

The home was kept clean and areas in need of attention were scheduled for refurbishment work which had already commenced.

People’s end of life wishes had been considered.

Right Culture

The service had an open culture where concerns were discussed and investigated. People’s communication needs were understood, and people’s relatives had access to a family liaison worker who could assist them in raising any concerns.

People were able to receive visitors throughout the day.

Lessons were learnt when things went wrong although we did discuss the need to ensure there was effective recording of any outcomes.

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 Good published 2 April 2019.

Why we inspected

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

Follow Up

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

Bradeney House is a nursing home which can accommodate 101 people. It provides a service to older people, some of whom may be living with dementia. Bradeney House is also registered to provide personal care to people living in their own homes which are situated in the grounds of the home. At the time of this inspection there were 94 people living at the home. There was currently nobody receiving the regulated activity of personal care in their own home.

People’s experience of using this service:

•People and their relatives were very positive about the service and care provided. A person who lived at the home said, “The staff are very nice, very helpful and very friendly. They deserve every accolade you give them. They put themselves out to keep us happy. You can’t fault them.” A relative said, “I am here all day every day so I know my [relative] is safe and they are looking after them. It’s a lovely home.”

•Risks to people were monitored and procedures were in place to help keep people safe.

•People’s physical and mental health needs were monitored and understood by staff and referrals to healthcare professionals were made in a timely manner when required.

•There were safe systems for the management and administration of people's prescribed medicines.

•People were protected from the risk of harm or abuse.

•People were supported by adequate numbers of staff who were safe and competent to work with them.

•People were protected from the risks associated with the control and spread of infection.

•The environment and equipment used by people was well-maintained.

•The registered manager ensured people received a service which met their needs, aspirations and preferences.

•People’s views were encouraged and responded to.

•People benefited from a staff team who were motivated and supported to provide the best care possible.

•There were effective procedures to monitor the quality and safety of the care people received.

•There was an ethos openness and transparency and learning when things went wrong.

Rating at last inspection: In January 2019, the service was rated good.

Why we inspected: This focused inspection took place because we received information of concern about the care of people who exhibited behaviours which may challenge. We focused on the key questions is the service safe? And is the service well-led?

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

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

Bradeney House Nursing and Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Bradeney House Nursing and Care Home is registered to provide accommodation with nursing and personal care to a maximum of 101 people, most of whom are living with dementia. There were 93 people living at the home on the day of our inspection. The home consists of units, which are all connected to each other. People's rooms are situated over three floors with stairs and passenger lift access to each floor. People have access to communal areas inside and outside the home.

Bradeney House Nursing and Care Home is also a domiciliary care service. It provides personal care to people living in their own houses. This service provides care and support to people living in purpose-built bungalows within the home’s grounds and is the occupant’s own home. The accommodation is bought. CQC does not regulate premises used for extra care housing; this inspection looked at people’s personal care service.

Not everyone using Bradeney House domiciliary care service receives a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided. No one was receiving a personal care service at the time of our inspection.

No registered manager was in post. The previous registered manager had left in November 2018. We are aware the provider and home manager have applied to become registered managers and will be registered shortly. 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.

During our previous inspection on 12 and 14 July 2017, we found areas where the provider needed to make improvements, but had not breached any regulations. At this inspection, we found the provider had made all the required improvements.

The provider had made improvements in all areas of the service, since our previous inspection and continued to build on these. Quality systems were effective and were used to ensure the improvements were sustained.

Staff practice helped to keep people safe and systems and protocols helped to protect people from danger, harm and abuse. The provider and staff assessed and managed any potential risks to people from their medical conditions, equipment and the environment to help ensure they remained safe.

People received their prescribed medicines when they needed them and were supported safely by sufficient and experienced staff.

The provider followed safe recruitment practices and appropriate checks had been undertaken, which made sure only suitable staff were employed to care for people in the home.

Staff were aware of the need to gain people's consent to their care and support. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. The arrangements included processes and procedures to protect people from the risk of abuse.

People were supported to eat and drink enough to maintain their health and welfare. They made choices about their food and drink, and meals were prepared appropriately where people had dietary needs or associated risks.

People were supported by staff who knew them well and had good relationships with them. Staff made sure people were involved in their own care and encouraged to take part in decisions about their care and support. Staff respected people's individuality, privacy, dignity and independence.

People’s equality, diversity and human rights (EDHR) were promoted by staff. Where people had individual preferences, these were respected and supported.

Staff were responsive to people’s individual needs and care given was personal to each person. People could choose to take part in leisure activities which reflected their interests and provided mental and physical stimulation. Group and individual activities were available if people wished to take part.

People were encouraged to give their feedback and make complaints as necessary. The provider took complaints seriously and used them to learn from and improve the service.

People were happy with the care and support they received and gave positive comments about the staff, management and provider. There was a welcoming and friendly atmosphere at the home, where staff were confident in their roles and worked for the benefit of the people who lived there.

Bradeney House Nursing and Care Home is registered to provide accommodation with nursing and personal care to a maximum of 101 people, some of whom are living with dementia. There were 95 people living at the home on the day of our inspection. The home has five ‘units’ which are all connected to each other. There is one female only ‘unit’ and one ‘unit’ which supports people with their advanced dementia. The other units support people who have nursing or residential needs, both with or without dementia. People’s rooms are situated over three floors with stairs and passenger lift access to each floor. People have access to communal areas inside and outside the home.

A registered manager was in post, who was also the provider and was present during our inspection. The provider had recently appointed a manager who confirmed they had applied to register with us. 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.

The home was last inspected on 5 July 2016, where we gave the service an overall rating of requires improvement. At our last inspection, we found one breach of Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This breach related to the provider's failure to ensure their last inspection rating was conspicuously displayed at the home and on their website. We asked the provider to send us an action plan of how they intended to address this breach. At this inspection, we found their inspection rating was displayed conspicuously at the home and on their website.

The provider had made improvements since our last inspection in the processes they used to monitor the quality of the service provided. However, although the provider had these systems in place to ensure people were protected from the risk of harm, these were not always followed by staff. People also had a varied experience of the support they received at lunchtime and we had some concerns in practice in two units. The provider had already identified shortfalls in the leadership and staff supervision within two of the home’s ‘units’ and the provider was taking steps to address this.

People felt safe living at the home and with the support they received from staff. Staff were aware of the risks associated with most people’s care and understood how to keep them safe. However, there were isolated incidents in two units where staff practice needed improvement to support people safely and effectively with their eating and drinking. In addition, the assessment of risk for some people had not been completed or kept up to date by staff. This had led to staff practice not being consistent with what some people’s risk assessments stated, such as with their mobility. The provider took action to make improvements to this during our inspection.

People and relatives gave us a mixed response about the staffing levels at the home. Although there were enough staff to meet people’s needs, the deployment of staff at certain times of the day needed improving to make sure staff were always available to support people when they needed it.

People’s right to make their own decisions about their own care and treatment was supported by staff. However, at our last inspection we found staff did not always seek people’s consent before they placed clothes protectors on them prior to their meal. At this inspection, we found this was again the case in one unit.

People were supported to take their medicines when they needed them. Medicines were stored safely and only staff who had received training and been assessed as competent, were able to support people with their medicines.

People and relatives thought staff were well trained and understood how to support them. Staff had received training to give them the skills and knowledge needed to support people's individual needs. These skills were kept up to date through regular training and staff felt supported in their roles by managers and their colleagues.

Where people were unable to make their own decisions about the specific arrangements to keep them safe, these were made in their best interests by people who knew them and other relevant professionals.

People felt they had good relationships with staff and that staff respected their privacy. They were happy with the care and support they received and gave positive comments about the staff and management at the home.

Care that staff gave was personal to each person and people were supported to spend their time how they wanted to. Most people’s support needs were kept under review and staff responded when there were changes in these needs. Not everyone felt they were involved in the process of reviewing their care plans but the provider was taking action to address this.

People had opportunities to give feedback and where necessary, make complaints about the care and support they received. They also had opportunities to make suggestions for improvements at the home at meetings and through surveys. People and relatives felt involved in what happened at the home and felt staff and management listened to them.

Bradeney House is registered to provide accommodation with nursing care for up to a maximum of 97 people. There were 95 people living at the home on the day of our inspection. People were cared for in five units over three floors. Some people were living with dementia.

There was a registered manager in post who was present during the inspection. 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.

The checks the provider had in place to monitor the quality and safety of the care were not always completed. Therefore they had not identified inaccuracies in care records or the inconsistencies in the quality of care across the home.

The provider did not ensure that all staff had the necessary communication skills to support people effectively. Staff had mixed views on the quality of training provided but felt they could approach their seniors for support when needed.

People did not receive adequate support to eat their meals in a dignified manner. There were charts in place to monitor what people ate and drank but these charts were not always accurately completed. This placed people’s health and wellbeing at risk.

People were not always responded to appropriately or in a timely manner when they were distressed. People’s privacy was not always protected.

People’s preferences were not always known or respected. Although there was a range of activities on offer these were not always suited to people’s needs or preferences. On one unit staff were working with a new approach on how best to support people living with dementia to positive effect.

There was a complaints process in place but this was not always followed. Concerns were not always dealt with to the satisfaction of the complainant. People were asked for their views on the services but recommendations for change were not consistently applied by all staff.

People were supported by staff who were able to recognise the different signs of abuse and knew who to report concerns to. Staff were aware of the risks associated with people’s needs and how to minimise these risks. Staff demonstrated they would take appropriate action in the event of any accidents or incidents. The management analysed the information to identify any trends and action required to prevent reoccurrence.

People were supported to take their medicines as prescribed and accurate records were maintained. Staff received regular competency assessments to ensure the ongoing safe management of medicines. Staff monitored people’s health and arranged medical appointments as required to maintain good health.

People were involved in decisions about their care and treatment. Where people were unable to make decisions for themselves these were made in their best interest by people who knew them well.

People and their relatives found staff and management friendly and caring. Staff promoted people’s independence.

Staff found the management team approachable and supportive of them in their roles. Staff were asked their opinion on how the service could be improved and felt listened to.

You can see what action we told the provider to take and the end of the full report

Two inspectors carried out this inspection over two days. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

As part of this inspection we spoke with five people who used the service, six relatives, four staff, the registered manager, deputy manager and the provider.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

Prior to this inspection we had received information about low staffing levels and their lack of skills. The registered manager was confident that there were sufficient staffing levels to meet people's care and treatments needs. We saw that staff were nearby by to assist people when needed. One care staff and four relatives told us that there were insufficient staffing levels to meet people's needs. We found that records and systems relating to staffing levels provided conflicting information. This meant the provider was unable to demonstrate that there were sufficient staffing levels provided at all times.

We saw that wheelchairs were unclean and placed people at risk of cross infection. Concerns about the cleanliness of wheelchairs were also shared with us by relatives. Immediate action was taken by the provider to ensure all wheelchairs and hoists were cleaned.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found that mental capacity assessments had been carried out and where necessary DoLS were in place. The staff we spoke with were unable to tell us which people had a DoLS in place. This meant people were at risk of receiving inadequate support.

Is the service effective?

Prior to this inspection we had received information that people were not provided with sufficient drinks. We spoke with three people who used the service who confirmed that they had access to drinks at all times. We saw that people who required support to have a drink were assisted by staff.

The home provided a service for people living with dementia. We found that not all staff had received dementia awareness training. This meant that people living with dementia could not be confident that all staff would have the skills to support them. The registered manager said that arrangements were in place to provide dementia awareness training in the near future.

Is the service caring?

We observed that staff were attentive to people's needs. We spoke with two relatives who said they were happy with the care provided to their relative. However, we spoke with a further three relatives who were dissatisfied with the care and support provided to their relative. We shared these concerns with the registered manager who said that this would be investigated.

One person who used the service said they had to wait a long time to be assisted with their personal care needs and when staff arrived it was too late. The registered manager said that the support provided to this person would be reviewed.

Is the service responsive?

Prior to this inspection we received information relating to the lack of access to routine health screening. Discussions with one person who used the service confirmed that they did not have access to a dentist. The care record we looked at confirmed this. The registered manager said they had experienced difficulties in obtaining a dentist.

Is the service well-led?

The home was run by the registered manager, a deputy manager and a team of nursing staff to ensure people's assessed needs were met.

The registered manager told us that meetings were carried out with people who used the service and their relatives and this was confirmed by the people we spoke with. This gave people the opportunity to have a say in the way the home was run.

People told us that they attended reviews to ensure that the care they received continued to reflect their needs. People were supported to meet their individual needs in ways that promoted their health and wellbeing. This meant that the care was responsive to people's needs.

Staff were knowledgeable about people's individual needs. Staff told us they had attended a range of training courses to equip them with the knowledge and skills to carry out their duties effectively. The staff had the opportunity to regularly meet with their line manager to review their performance and address any induction, training and development needs.

The provider had a suitable system in place to monitor the quality of the service it was providing. This meant the service was effective and well led.