Background to this inspection
Updated
2 October 2018
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
Before our last inspection, the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We also reviewed information we held about the service, including notifications the provider had sent us. A notification is information about important events such as, accidents and incidents, which the provider is required to send us by law.
We also contacted the Bury and Rochdale local authorities, who commission services from Browfield and Healthwatch Bury. It was acknowledged that improvements had been made since out last inspection in January 2018.
This inspection took place on 14 and 16 August 2018 and was unannounced on the first day. The inspection was undertaken by one adult social care inspector and an Expert by Experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service.
During our inspection we spoke with six people who used the service, the registered manager and three members of the staff team.
We looked at the environment and the standard of accommodation offered to people. We also reviewed four care files, medication administration records (MARs), staff recruitment, training and development records as well as information about the management and conduct of the service.
Updated
2 October 2018
This inspection was unannounced and took place on the 29 and 30 August 2018.
We last carried out a comprehensive inspection of this service on 8 and 9 January 2018. At that inspection we found 13 breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014. The breaches related to the person-centred care, dignity and respect, need for consent, safe care and treatment in relation to risks within the environment, people’s health and well-being, management of medicines and infection control, safeguarding from abuse premises and staff training and development. We also issued a warning notice with regards to the lack of evidence to demonstrate Good Governance. Due to the breaches found the service was rated Inadequate in the Safe and Well-led domains and Requires Improvements in the Effective, Caring and Responsive domains. The service was given an overall rating of Inadequate and placed in Special Measures.
Following the inspection, we required the provider to complete an improvement action plan to show how they would improve all key questions; safe, effective, caring, responsive and well led to at least good.
Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.
Browfield is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided and both were looked at during this inspection.
Browfield provides accommodation for up to fourteen people with enduring mental health needs who require support with personal care. Accommodation is provided on three floors. There is no passenger lift. On street parking is available to the side of the home. The home is situated approximately one mile from Bury town centre and is close to all local amenities and public transport. At the time of our inspection there were 12 people living at the home.
The service had a registered manager, who is also the owner of the home. A registered manager is a person who has registered with the CQC 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. People said the registered manager was approachable and they could talk with them.
Audits and checks were completed to monitor and review the service provided. We recommend information gathered as part of the quality monitoring is consolidated and used to inform the development of the homes improvement plan. This will help to demonstrate sustained and ongoing improvement so the people receive a quality service which meets their needs.
Action had been taken to ensure the safety of building. Up to date risk assessments, maintenance records and fire safety checks were in place to help keep people safe. On-going redecoration was to be completed to enhance the appearance of the home.
Suitable arrangements were in place to protect people from abuse. The provider had worked in partnership with the local authority to address recent issues. Staff were provided with procedures to guide them and recent training had been completed. Staff spoken with knew what action should be taken so that people were protected.
A safe system for the management and administration of people’s medicines was in place.
Sufficient numbers of staff were available to support people living at Browfield. Relevant recruitment checks were completed prior to new staff commencing work at the home.
Suitable arrangements were in place to ensure people were protected against the risks of cross or spread of infection.
Consent had been sought from people about the care and support they wanted and needed. Where necessary people had access to independent advocates to help ensure their wishes and feeling were considered when important decisions needed to be made. Where people were being deprived of their liberty, lawful authorisations were in place.
On-going training and support was provided for staff. Further opportunities were being explored to help staff develop the knowledge and skills to meet people’s changing needs. Staff said the team worked well together and were supported in their role.
Suitable arrangements were in place with regards to the mealtime arrangements. People told us they were supported to access relevant health care professionals so that their health and well-being was maintained.
Care records contained good information about people’s individual needs and wishes. Plans were reviewed and updated and provided guidance for staff about how people wished to be supported. Where risks to people’s health and well-being had been identified these were assessed and planned for.
People told us they liked living at Browfield and had choice and control over their daily routines following activities of their own choosing. Staff were said to have a good understanding of their individual needs and wishes and treated them with dignity and respect.
Systems were in place for the reporting and responding to any complaints brought to the registered managers attention.