Bradbury House

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

The service had improved. Risk assessments and care plans now included enough information for care staff to provide safe care and manage any risks. Action had been taken to address risks from the environment and staff had completed a nighttime fire drill. People were protected from the risk of abuse. Staff knew how to identify and report concerns which were investigated and acted upon appropriately. People told us there was enough staff and we observed staff responded quickly to requests for assistance. However, feedback from relatives about staffing levels were mixed. Staff had the skills they needed to support people. However, there were areas where the service was not clearly able to demonstrate staff had undertaken training.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

There is a safeguarding policy in place and systems and processes to support staff to keep people safe. Staff had undertaken safeguarding training to ensure they knew how to identify and report concerns. The acting manager knew how to raise concerns with the local authority if concerns arose. When concerns had arisen, the acting manager had reported these as required to both the local authority and CQC and taken action to reduce the risk of further concerns. There was information for staff on how to whistleblow if they had concerns about poor practice at the service they felt were not being addressed. The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. People can only be deprived of their liberty when this is in their best interests and legally authorised under the Mental Capacity Act (MCA). In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). Where people were deprived of their liberty appropriate legal authorisations were in place.

The service was provided across two floors and both floors were calm and relaxed, warm, and well lit, with a fresh aroma. We saw that staff were busy but not rushed and there were kind interactions between staff and residents. Staff respected people and their choices, for example where people wanted to sit to eat. Staff were attentive to people and noticed if people were upset or needed support and reassurance. For example, one person became upset whilst eating lunch. Staff sat with the person to provide support and reassurance and comforted the person.

When asked if the service was safe the feedback from people and their relatives was positive. One person said, “I am very happy here. The staff are here if I need them.” Comments from relatives included, “Yes, I feel like they are safe, they are well looked after and if there are any issues they ring me straight away, for example Mum had a fall and they let me know straight away and what would happen next.”

Staff had the skills and knowledge they needed to protect people from the risk of abuse. Staff knew how to identify and report concerns. Staff told us, “Reporting concerns has always been transparent here and I know staff and residents can express themselves without fear or repercussion.” And, “When anyone raises a concern, maybe an unexplained bruise for example, this is escalated, if staff are worried about anything, they record their concern.”

Staff knew how to support people to manage the risks to their health. If staff identified concerns, they were supported by the nursing team who would follow up if staff raised any concerns about people’s health. One staff told us, “We know our residents so well that any little changes are noticed, and anything out of their normal send alarm bells, so you report to the nurse, and they follow up with observations and tests.”

Risk assessments were clear, comprehensive and up to date. They contained enough information for care staff to provide safe care and manage any risks, such as falls, skin damage or choking. Where people required monitoring charts such as weight, fluids or repositioning, these were in place and had been completed correctly. Where people required special pressure relieving mattresses, the required settings were documented and checked regularly. The provider had a robust system in place for regularly reviewing the care plans and risk assessments and these were up to date. Any changes in a persons’ needs were shared with staff during handover meetings which were documented.

People told us staff knew how to support them with their health and wellbeing. One person said, “They look after me well”. Feedback from relatives was also positive. When asked about how well people were supported one relative said, “Overall, very well.” Relatives also felt staff listened to them about their relatives’ care where this was appropriate. One relative told us, “They [staff] do, always listen very well.”

People received safe care and treatment by staff who knew them very well. During mealtimes staff were present to assist people and sat with people where needed. When people wanted support, such as to go to the lavatory, staff provided this when it was requested. People were supported to maintain their hydration and had drinks in reach. One person was assisting staff to ensure visitors signed in and out as needed and was enjoying this role. People were being supported by staff to move around the service as needed.

Staff were positive about the environment and the equipment at the service to enable them to provide safe care. One staff said, “We have enough equipment now…we have enough wheelchairs, and no one is left waiting for a chair or hoist…everyone has their individual slide sheet and sling…I see that that the equipment is well maintained and in good working order. The weighing chair is recalibrated every month.”

People and their relatives told us that the service was suitably maintained and had no concerns about the management of the environment. When we asked one person if they thought the service was well maintained they told us, “I think so, the gardens are lovely”. Relatives’ comments included, “When things do go wrong things get fixed quickly by the facilities team.” And, “It is good, we have had some issues with the door closure but the maintenance staff sort things out”.

Environmental checks had been completed to ensure the environment was managed safely. For example, checks were made to ensure the gas, electric and water systems were safe. Staff had completed a night-time fire drill and fire drills were scheduled to happen once a quarter. Some staff had not yet attended a fire drill but the new manager had a plan in place to address this.

The environment was clean and free from trip hazards or other risks. Where rooms contained chemicals or medicines the doors were locked to protect people from the risk of harm. The environment was clean, uncluttered and welcoming with a friendly atmosphere. Cleaning schedules were in place and were up to date. When maintenance issues arose staff had recorded these in a book which was completed by the maintenance team when issues were addressed.

Staff were positive about the number of staff on shift and how well they were supported by management. One staff said, “There is enough staff. Agency staff work with permanent staff. I get supervision and this is always supportive. There isn’t anything bad I can’t say.” Another said, “We do not keep people waiting and always try to accommodate personal preferences but within our staffing capacity.” The service had been focusing on recruiting new staff to reduce the use of agency staff and had had some recent success and the use of agency staff had reduced. Staff were confident in their skills and learning. Staff told us, “The training is good, and I can’t think of any other training I need to do this job.” Staff told us they felt well supported when they first joined the service to learn how to meet peoples needs. One staff said, “During my induction, I was supported by a very experienced carer, and it was so helpful, I could ask anything.”

There was mixed feedback about staffing levels, but views were mainly positive. When we asked people if staff responded quickly to requests for help one person told us, “Yes most of the time can take a bit longer during the night”. A relative said, “At times it feels like they could have more staff on but overall, they have been brilliant, can’t fault them.” Another relative said, “Not always enough staff but the staff they do have the right skills and nothing to suggest they don’t have the right skills.” And a third said, “Sometimes feels like there that could be more staff on but overall, very, very happy with the service.”

Staff responded to call bells quickly when people rang for support. There was positive engagement between staff and people with staff having enough time to speak with people and joke with them. This led to a positive atmosphere. Staff asked people their views on what was going on during the day such as when music was on and provided people with comfort when they needed it. When relatives arrived, they were equally welcomed by staff and included in the activities and offered a choice of drinks.

Staff had the skills they needed to support people and were supported by nursing staff. However, there were still some gaps in staff training. Staff were able to tell us what they needed to do to keep people safe. Staff told us, “This is a very supportive environment, and you shadow staff here who really know the residents, so you get to understand the particular nuances of care that each person needs.” The provider had focused on ensuring staff had completed mandatory training such as safeguarding, infection concern and administering medicines. Staff had also completed training in dementia awareness, learning disability and autism. However, some staff had not undertaken training in areas such as diabetes awareness and catheter care. This meant there was a potential risk that staff would not know when to raise concerns with nursing staff. However, we did not identify any areas where concerns had arisen. The new manager was planning to address this. Staff competency checks for medicine administration and manual handling were not up to date. However, the new manager had put in a new process and was in the process of updating these. The service used a dependency tool to calculate the number of staff needed to meet people’s needs. The rota reflected this assessed need. Staff supervisions were up to date to ensure staff were supported in their role. Appropriate checks were undertaken to ensure staff were recruited safety. For example, Disclosure and Barring service (DBS) checks were undertaken. DBS checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.