Bramcote Hills Care Home

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

Risks were assessed and managed, improvements had been seen since our last inspection, and records were more concise. Staffing levels were sufficient with the use of agency and bank staff to cover shortfalls. Medicines were administered in a safe way by competent staff. The service was following infection control guidance to ensure control measures were in place. People told us they felt safe living at the service and with staff who care for them.

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. People had enough to eat and drink to ensure they had good nutrition and were well hydrated. Staff received training that reflected their role and recruitment safety checks were completed to make sure staff were safe to work with vulnerable people.

People received consistent effective care. They had access to other healthcare professionals when needed.

Care plans contained detailed information to ensure staff could meet people’s needs. People had received positive outcomes that improved their wellbeing. Communication needs were considered to help people communicate effectively. People were supported to maintain relationships with family, friends and others at the service.

Regular audits had been completed to improve the quality of the service. We received positive feedback in regard to the managers and how the service had improved. The service planned and promoted person-centred care. They fulfilled their legal obligations to report incidents of concern and worked well with other professionals.

Rating at last inspection and update

The last rating for this service was requires improvement (published 06 December 2019) and there were breaches of regulation.

Why we inspected

We carried out an unannounced focused inspection of this service on 24 September 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve Regulation 12 Safe care and treatment and Regulation 17 Good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective, Responsive and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Bramcote Hills Care home on our website at www.cqc.org.uk.

We found the following examples of good practice.

The home was currently closed due to an outbreak of COVID-19. However, the provider ensured people still had access to an ‘essential care giver’. This is a named person who can still visit during a COVID-19 outbreak. This helped to reduce the risk of loneliness and improved people’s mental health and wellbeing. Alternative methods of seeing friends and family were also in place.

The provider ensured people visiting the home provided proof of a negative Lateral Flow Test result before being permitted access to the home.Visitors were provided with the required Protective Personal Equipment (PPE) for their visit and were confined to agreed parts of the home, reducing the risk of the spread of infection.

Professionals and other visitors to the home were required to provide proof of vaccination status, wear the required PPE and to adhere to the provider’s various infection control, COVID-19 and visitation policies.

People were supported to use and access their environment in a safe way. Social distancing was encouraged wherever possible. We observed staff supporting people with their meals whilst wearing the appropriate PPE. Efforts had been made to support people living with dementia to maintain social distancing. Rooms were well ventilated.

Safe isolation procedures were in place to protect others from the risk of infection. Where required barrier nursing took place and there were strict PPE criteria for staff to follow when providing personal care for people. Appropriate procedures were also in place to dispose of used PPE safely. We observed staff doing so.

Safe admission and re-admissions protocols were in place. People were required to provide negative LFT results upon entry. They were then required to isolate until further negative test results had been confirmed.

The provider showed us the high levels of PPE stock they held at the home. Staff had received training on how to ‘Don and Doff’ (put on and take off) their PPE to reduce the risk of cross-contamination. Staff helped support people to use PPE when needed.

A regular testing programme was in place. This testing was carried out in accordance with government guidelines. People were supported to receive their vaccinations and booster. Staff were all fully vaccinated. The layout of the premises ensured the risk of the spread of COVID-19 was reduced.

There were enough staff to support people safely and to cover any staff holidays, sickness and COVID-19 isolation. There had been some pressures on staff numbers. When needed in urgent situations, agency staff have been used. Occasionally, some non-care staff have carried out care staff duties where there had been a sudden shortage. We were assured by the provider that these staff were fully trained care staff.

The provider considered staff member’s wellbeing. A variety of initiatives were in place to support staff whose mental health and wellbeing may have been affected by the pandemic.

The provider had assessed the impact of potential ‘winter pressures’ and acted accordingly. Regular COVID-19, outbreak and other related audits were carried out to help identify any areas of concern. Action plans were in place and reviewed.

Bramcote Hills Care Home is a care home providing personal and nursing care to 53 people aged 65 and over at the time of the inspection. The service can support up to 63 people. The home is purpose built, split over five floors.

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

Risks to people’s health and safety were not always identified, thoroughly assessed or updated to reflect changes to people’s needs. Recruitment processes were safe and there were sufficient staff to meet people’s needs. The management of people’s medicines was safe. The premises and equipment were predominantly clean.

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. People were happy with the meals, although we found records relating to people’s food and fluid intake needed to be improved. Staff were supported but not all training was up to date.

Staff were caring and kind. People were treated with dignity and respect. Staff respected people’s right to privacy and personal information was stored confidentially.

Care records were individualised, but they were not always reflective of people’s current needs, some documents did not include people’s names and were not always dated. Information regarding people’s communication needs was limited. Improvements were needed to the quality of care records for people who were in the final stages of their lives. There was a range of activities provided for people to participate in. There was a system in place for people to complain in the event they were dissatisfied with the service.

Although regular audits were completed, they were not sufficiently robust as they had failed to identify or address the shortfalls we have identified throughout this report. The management team were professional throughout the inspection, taking on board our feedback, they understood their professional responsibilities. People were positive about the management team, staff felt supported.

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 28 March 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to safe care and treatment and good governance at this inspection.

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.

Accommodation for up to 63 people is provided in the service. The service is designed to meet the needs of older people living with or without dementia. There were 53 people using the service at the time of our inspection.

A registered manager was in post and was available throughout 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.

Staff knew how to keep people safe and understood their responsibilities to protect people from the risk of abuse. Risks were managed so that people were protected from avoidable harm and not unnecessarily restricted.

Sufficient staff were on duty to meet people’s needs and staff were recruited through safe recruitment practices. Medicines were safely managed.

Staff received appropriate induction, training and supervision. People’s rights were protected under the Mental Capacity Act 2005.

People received sufficient to eat and drink, though the mealtime experience in one dining area and the completion of fluid chart documentation could be improved. External professionals were involved in people’s care as appropriate.

Staff were kind and knew people well. People and their relatives were involved in decisions about their care, though documented evidence of this could be improved. Advocacy information was made available to people.

People received care that respected their privacy and dignity and promoted their independence.

People received personalised care that was responsive to their needs. Care records contained information to support staff to meet people’s individual needs, though activities could be further improved.

A complaints process was in place and staff knew how to respond to complaints.

People and their relatives were involved or had opportunities to be involved in the development of the service. Staff told us they would be confident in raising any concerns with the management team and that appropriate action would be taken.

The provider was meeting their regulatory responsibilities. There were effective systems in place to monitor and improve the quality of the service provided.

We looked at some of the records held in the service including the care files for five people. We observed the support people who used the service received from staff and carried out a brief tour of the building.

We carried out this inspection to answer five key questions; is the service safe, effective, caring, responsive and well-led. Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

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

Is the service safe?

We found people's care and support was not planned and delivered in a way that ensured their safety and welfare. Systems in place to ensure people received their medication safely were not always followed and medicines were not always safely administered.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The manager informed us after the inspection they had made one application and was waiting for the result of this and the required policies and procedures were in place for this. The manager said relevant staff will be trained to understand when an application should be made, and how to submit one.

Is the service effective?

We found the provider had effective systems to involve people in planning their care, and obtaining people's consent for this to be provided. A person who used the service told us, 'We talk about my care, they keep me happy.'

We found staff were not always effective at meeting the care and welfare needs of all the people who used the service. A relative told us they had some concerns about the night time care of their relation. The documentation completed did not make this clear so staff could not effectively answer the relative's concerns.

The number of staff employed and how they were deployed had been identified as reasons why staffing arrangements in the home were not effective and action was being taken to resolve this.

Is the service caring?

We found the care and welfare needs of people who used the service were met in a sensitive and caring manner. People who used the service told us staff made them feel safe and well cared for. A person who used the service told us, 'The care here is very good, they don't forget you. The food is very nice too.'

Is the service responsive?

We found care workers responded appropriately when people had the capacity to make decisions about their care and welfare. We saw people who used the service were asked for their views by staff over every day matters.

We found staff responded appropriately to the care and welfare needs of people who used the service. A person told us, 'Staff make sure I am alright, I feel safe here. They come and move me to stop me getting sore.'

Is the service well-led?

We found the provider did not protect the rights of people who did not have the capacity to consent as staff did not know how to complete an assessment to determine if a person had the capacity to make a decision.

The manager told us they were putting management systems, including quality assurance systems into place and these would be used to make improvements to the service. A person who used the service told us the new manager, 'Knows what she is doing, she gets things done.' A relative said, 'I have faith in her, she know what to do.'

We saw that people's individual needs and risks had been assessed and had been reviewed regularly since our last inspection. During our inspection we observed that staff interacted well with people who used the service.

We noted that nutrition care plans were in place with completed risk assessments which had been updated on a regular basis. We also noted that people's food and fluid intake charts had been completed regularly.

We saw policies were in place in relation to the prevention and control of infection. We saw improvements had been made by the service regarding the prevention, control and management of infection.

During our inspection we observed that maintenance work had been completed in line with the provider's action plan. One staff member told us, 'I use the maintenance book and jobs are dealt with as quickly as possible.'

We saw that regular supervision meetings and appraisals were held between the staff and the manager. We noted that the staff training matrix had not been fully updated at the time of our inspection.

We found that people's care plans were stored and secured appropriately. We saw that records were completed appropriately and information in people's care plans was updated regularly.

The expert by experience (ex by Ex) talked with three people using the service and one visitor. All of them were full of praise for the establishment. One person said, 'You can get up and go to bed when you want'. There is a good response to the bell if it's rung in the night.' Another person said, the staff were 'very good'.

We found there had been some improvement in respect of the organisation of the care files and more personalised information was available. However further improvement was still required to ensure all the necessary information was available for staff to follow. Improvement was also needed to ensure some staff supported people in line with their plan of care.

The Ex by Ex spoke with people in respect of the food on offer. One person told them the food was good and they said, 'I can choose what I have'. Another person told them there was no time limit for breakfast and they said, 'Every choice is on offer for breakfast.'

One person also told them that sandwiches and 'small bits' were served at teatime but then there was nothing else until breakfast.

We found staff had not always followed the instructions within plans of care for those people assessed as nutritionally being at risk.

One person told the Ex by EX they had experienced people walking into their room at times, and this made them feel unsafe. They also told them that the staff had listened to this and responded to their concerns and they now felt safe.

We found the home was mostly clean and tidy in all areas. However minor improvements were still needed to ensure people were cared for and supported in a clean environment at all times.

The provider had changed some communal areas and added additional bedrooms. An additional lounge area had been created to ensure there was still communal space for people to use. One person told us there have been improvements in respect of the environment and they particularly enjoyed sitting in the sun room. We found that minor improvements were still needed in respect of the environment; however the provider was acting upon these.

The people using the service who we spoke with did not raise any concerns about the competency of staff.

We saw staff had attended additional training sessions and some staff had undertaken a supervision. However improvement in this area was still needed.

We found improvements had been made in respect of the storage and completion of records but the provider was not fully compliant with this outcome area in that people's personal records were not always accurate and fit for purpose.

We spoke with seven people who were using the service and three visitors who told us about the improvements they had noticed in the quality of services provided in the weeks leading up to this inspection. We were told, They take good care of me," and "there's been a vast improvement."

We looked at care plans and other records, spoke with staff and observed care practice. Some of the care plans contained good person centred information about people, including their care needs, likes and dislikes. Other care plans were not well developed and lacked information for about how to support people's health and personal care needs.

People commented on the improvements they had noticed in staffing levels and said this had a positive effect on people who lived at the service. People were also provided with opportunities to share their views with the provider and manager.

We spoke with four people who were using the service on the day of our visit. Each of the people we spoke with told us staff were polite and treated them with dignity and respect. One person said, 'Yes they are very nice, I have no complaints in that respect.' Another person said, 'I receive all the care that I need and the staff are good at what they do. The only issue is that sometimes I have to wait a while to be seen.'

Each of the people we spoke with told us they felt safe and had no concerns about living at the service.

We saw there was a lack of structure and organisation and staff were extremely busy. We spoke with four people who were using the service during our visit and asked if they felt there were enough staff to care for people. One person said, 'I would say they could do with more staff. I sometimes have to wait a few minutes when I press the buzzer.'

We spoke with four people who were using the service and asked if they felt they could express their opinion on the quality of service provided. We were told, 'I've not been formally asked. I guess I would speak to the manager if I needed to.' None of the people we spoke with were aware of ways in which they could give their opinion on the quality of the service.