Old Rectory (Bramshall) Limited

Old Rectory (Bramshall) provides accommodation and nursing or personal care for up to 30 people. On the day of our inspection, 20 people were living there, some of whom were living with dementia.

People’s experience of using this service and what we found

People did not always receive safe care and support as staff members did not always follow the guidelines in place to safely support people with their mobility.

The physical environment was not always maintained to a standard which was safe for people to live in.

Despite staff members following infection prevention and control procedures the maintenance of some areas prevented this from being effective.

The provider could not demonstrate people received their prescribed topical creams as directed. This was because the recording charts were not completed as expected.

The provider’s quality checks were not always effective in identifying improvements which were needed to drive good and safe care.

The provider was not meeting the requirements of their registration as they did not have a registered manager in post. Although a manager had been appointed they had yet to complete the registration process.

Staff members had been provided with the training they needed to support people.

People’s care and support plans gave staff the necessary information to effectively respond to their needs and preferences.

People were protected from the risks of harm and abuse as the staff team had been trained to recognise potential signs and understood what to do to safely support people.

Staff members were aware of the necessary actions they should take in the event of an emergency.

Staff members had access to, and used, appropriate personal protection equipment.

The provider supported staff members through structured one-on-one supervision sessions.

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 at the Old Rectory (Bramshall) supported this practice.

People had access to additional healthcare services when required.

People were supported to maintain a healthy diet by a staff team which knew their individual preferences.

People received help and support from a kind and compassionate staff team with whom they had developed positive relationships.

People were supported by staff members who were aware of their individual protected characteristics like age, gender and disability.

The provider had systems in place to encourage and respond to any complaints or compliments from people or those close to them.

The provider, and management team, had good links with the local communities within which people lived.

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 23 June 2017).

Enforcement

We have identified one breach or regulations in relation to people not being safely supported.

Please see the action we have told the provider to take at the end of this report.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will request an action plan for 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.

This inspection visit took place on 23 May 2017 and was unannounced. At the last inspection on 6 July 2016, the service was rated as requires improvement overall with specific concerns about the management of people’s medicines and to ensure people who needed help with decision making were appropriately supported.. The provider sent us an action plan on 8 September 2016 which stated how and when they would make improvements to meet the legal requirements. At this inspection, we found that some improvements had been made but further action was still required.

The Old Rectory, Bramshall is registered to provide accommodation, personal and nursing care for up to 30 people some of whom are living with dementia. At the time of the inspection, 20 people were living at the home. There was a registered manager at the service. 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.

We found that improvements had been made and people’s medicines were administered, recorded and stored safely, in accordance with legislation and good practice.

We found that people’s capacity to make decisions was being considered. Staff sought people’s consent before providing care and supported people to make choices over their daily routine. Where people were being restricted to the home’s environment in their best interests to keep them safe, the appropriate approvals had been sought. However, the provider still needed to make improvements where people lacked the capacity to make certain decisions for themselves to fully demonstrate that their rights were being upheld. We have recommended the provider seeks advice on best practice in this area.

People felt safe living at the home and their relatives were confident they were well cared for. If they had any concerns, they felt able to raise them with the staff and registered manager. Risks to people’s health and wellbeing were assessed and managed and staff understood their responsibilities to protect people from the risk of abuse. People’s care was regularly reviewed to ensure it continued to meet their needs. There were sufficient, suitably recruited staff to keep people safe and promote their wellbeing. Staff received training so they had the skills and knowledge to provide the support people needed.

Staff knew people well and encouraged them to have choice over how they spent their day. Staff had caring relationships with people and promoted people’s privacy and dignity and encouraged them to maintain their independence. People were supported and encouraged to eat and drink enough to maintain a healthy diet. People were able to access the support of other health professionals to maintain their day to day health needs.

People received personalised care and were offered opportunities to join in social and leisure activities. People were supported to maintain important relationships with friends and family and staff kept them informed of any changes.

There was an open and inclusive atmosphere at the home. People and their relatives were asked for their views on the service and this was acted on where possible. Staff felt supported and valued by the registered manager.

The registered manager and provider carried out a range of checks and audits to continually assess monitor and improve the quality and safety of the service.

to make improvements to ensure that the rights of people who did not have the capacity to make their own decisions about their care were being protected. We also asked them to make improvements to the systems used to improve the quality and safety of the service. At this inspection, we found that some improvements had been made but further action was still required. We also found improvements were needed in relation to medicines management.

Old Rectory, Bramshall provides accommodation, personal and nursing care for up to 30 people some of whom are living with dementia. At the time of our inspection, 27 people were using the service. There was a registered manager at the service. 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. On the day of our inspection visit, the manager was not working at the service and we were only able to speak with them briefly. However, the provider was at the service for most of the day.

People’s medicines were not always managed safely. Further improvements were needed to the provider’s quality monitoring systems to ensure shortfalls were consistently identified and the necessary changes made.

The manager and staff understood the principles of the Mental Capacity Act 2005 (MCA) but further improvements were needed to ensure people were being assessed in line with the legislation as required. Where people were restricted of their liberty in their best interests, for example to keep them safe, applications had been made in accordance with the legal requirements. Staff gained people’s consent before providing care and support.

People felt safe living at the home and their relatives were confident they were well cared for. If they had any concerns, they felt able to raise them with the staff and management team. Risks to people’s health and wellbeing were assessed and managed and staff understood their responsibilities to protect people from the risk of abuse. People’s care was regularly reviewed to ensure it continued to meet their needs. There were sufficient, suitably recruited staff to keep people safe and promote their wellbeing. Staff received training so they had the skills and knowledge to provide the support people needed.

Staff knew people well and encouraged them to have choice over how they spent their day. Staff had caring relationships with people and promoted people’s privacy and dignity and encouraged them to maintain their independence. People were supported and encouraged to eat and drink enough to maintain a healthy diet. People were able to access the support of other health professionals to maintain their day to day health needs.

People received personalised care and were offered opportunities to join in social and leisure activities. People were supported to maintain important relationships with friends and family and staff kept them informed of any changes. People’s care was reviewed to ensure it remained relevant.

There was an open and inclusive atmosphere at the home. People and their relatives were asked for their views on the service and this was acted on where possible. Staff felt valued and supported by the manager.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

In this report the name of a registered manager, Ms Sarah Janet Galer appears, who was not in post at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time.

At the time of our inspection 26 people were using the service, although one of these people was in hospital. During our inspection we spoke with three people who used the service and two relatives. People and their relatives told us they were happy with the care and shared no concerns with us.

We also spoke with one nurse, five care staff and the new manager. The manager was in the process of applying to become a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

We looked at three people's care records and four staff records to see if they were accurate and up to date.

Below is a summary of what we found. The summary describes what we observed, the records we looked and what the staff told us.

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

Based on the information we received we asked if this service was safe?

Is the service safe?

The service was not consistently safe. Equipment to help people to move around the home was not consistently used correctly.

People's care records did not contain all the information the staff needed to protect people from harm.

The provider could not show us that people were consistently protected from the risks of receiving care from unsuitable staff.

People's personal and confidential information was not kept safe and secure. This meant there was a risk it could be lost, damaged or accessed without their consent.

We observed interactions and saw that people were relaxed with staff. Staff had a good knowledge of people's support needs and we saw the staff were respectful when providing this support. One person told us, 'The staff are wonderful, so polite and helpful.'

Where people were not able to make decisions, capacity assessments were completed and information about why others had made decisions on their behalf had been recorded. This meant people could be confident decisions had been made in their best interest.

People had care records which recorded how they wanted to be supported. The information we read in the care records matched the care, support and treatment we saw being delivered to people.

We saw people were dressed in their own style. People told us if they needed support the staff would help them to continue to take a pride in their appearance.

Family and friends we spoke with told us they could visit whenever they wanted to. People using the service told us family members were able to continue to provide care for them and were involved in providing support. One person told us. 'It's a home away from home, my family is always made to feel welcome.'

Where people were not able to make decisions, capacity assessments had been completed. Information about why others had made decisions on their behalf had been recorded to demonstrate why decisions had been made. This meant people could be confident these had been made in their best interest.

We saw the staff provided sensitive support to people, and people were treated with respect. Personal care issues were discussed discreetly and people using the service could choose who they wanted to help them with their personal care requirements.

The registered provider was upgrading the facilities in the building including the kitchen and bathroom areas. The registered person told us this would mean they improved facilities to meet people's on-going needs.

We saw that people were protected from the risks of abuse because the staff had received the necessary training to identify and report safety concerns.

We saw that there was now a system in place to regularly assess and monitor the service which focussed on service improvement and included the views of people using the service.

We spoke with four people using this service, four visitors and seven members of staff. People told us they were happy with the care provided and visitors reported that they were made to feel welcome. People said, 'The staff here are very caring and I have everything I need.' 'I'm very happy here.'

During our inspection, we observed staff treat people with care and respect. We found that care records were informative. We saw that some care practices were not always followed, as we saw care which placed people at risk of falling and choking.

We found that people's views were taken into consideration when planning their care; however the records were not always in place when people were unable to make decisions for themselves. This meant that we could not be sure that decisions were being made in peoples best interests.

We found that views of relatives about the quality of the service were gained, however people using the service or professionals were not consulted. The provider had not evaluated or developed the service from any information they had received. This meant that valuable feedback which could improve the service was potentially being missed, and people could not be confident their views were being listened to.