Archived: Bronte Park Residential Home

Bronte Park Residential Home is a large detached converted property. It provides accommodation and personal care to a maximum of 28 people. Accommodation is provided in double and single rooms on two floors. There is a lounge and dining room on the ground floor, car parking to the front and a garden.

At the time of the inspection there were 24 people using the service.

There was a registered manager in post. 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.

When we inspected the service in February 2016 we identified one breach of regulation in relation to staff training and the overall quality rating for the service was requires improvement. On this inspection found the service had declined significantly.

Staff were not being recruited safely and there were not enough care staff on duty to keep people safe or to meet their needs in a timely way. We saw staff had received training, however, some of the poor practices we saw regarding moving and handling and privacy and dignity made us question the quality of this training.

In their direct dealings with people we saw staff were kind and caring. However, we found practices in the home which showed a lack of respect for the people who lived there. People were not receiving person centred care which met their needs or preferences and there was a lack of activities to keep people occupied.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did not support this practice.

Although staff were able to describe how they would keep people safe, they were not always following their safeguarding policy and reporting incidents to CQC or the safeguarding team. The registered manager was holding money for safekeeping, however, the finance policy was not being followed which left people at risk of financial abuse.

People’s healthcare needs were mostly being met, however, there were some concerns about the management of people’s nutrition and hydration needs. Medicines were being managed safely.

People’s views about the meals were mixed and the meal time experience was very poor for some people.

Risks associated with the building were poorly managed, leaving people at risk. Repairs were not being completed in a timely way and information which would be required in an emergency was not readily available. We also saw not enough was being done to mitigate risks to people who used the service who were at risk of falling or had swallowing difficulties.

A complaints procedure was in place, however, concerns were not always fully investigated and no analysis was being done to look at any common themes or trends so further complaints of the same nature could be eliminated.

We did not find an open and honest culture at the service. Staff found it difficult to answer direct questions or were not honest in their answers.

We found there was a lack of effective management and leadership which coupled with ineffective quality assurance systems meant issues were not identified or resolved. We found shortfalls in the care and service provided to people.

We identified eight breaches in regulations – regulation 18 (staffing), regulation 19 (fit and proper persons employed), regulation 12 (safe care and treatment), regulation 13 (safeguarding), regulation 10 (dignity and respect), regulation 9 (person-centred care), regulation 11 (Need for consent), and regulation 17 (good governance). The Care Quality Commission is considering the appropriate regulatory response to resolve the problems we found. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Bronte Park Residential Home is a large detached converted property. It provides accommodation and care to a maximum of 28 people. Accommodation is provided in double and single rooms on two floors. There is a passenger lift. At the time of our inspection 26 people used the service.

The service had a registered manager in place. 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.

Following inspections of the service in July 2014 where we found four of breaches of Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. This inspection was a further comprehensive inspection where we also checked whether Bronte Park had made necessary improvements.

We found improvements had been made and the service was no longer in breach of regulation.

People told us t staff worked with them and supported them to continue to lead fulfilling lifestyles. Staff outlined how they supported people to continue to lead independent lives.

We found that a range of activities were provided at the home.

People we spoke with told us they felt safe in the home and that staff made sure they were kept safe. We saw there were systems and processes in place to protect people from the risk of harm.

People who used the service and the staff we spoke with told us there were enough staff on duty to meet people's needs. The registered provider and manager had closely considered people's needs and by using a dependency tool to determine the number of staff.

We reviewed the systems for the management of medicines and found people received their medicines safely.

Effective recruitment and selection procedures were in place and we saw that appropriate checks had been undertaken before staff began work. The checks included obtaining a criminal history of staff to show they were safe to work with vulnerable people.

Staff received a wide range of training, which covered mandatory courses such as fire safety as well as condition specific training such as dementia care. However on the first day of inspection, few staff were up to date with two of the mandatory training courses.

Where people had difficulty making decisions we saw staff worked with them to offer them choice. Staff understood the requirements of the Mental Capacity Act 2005 but had not always appropriately requested Deprivation of Liberty Safeguard (DoLS) authorisations.

We observed staff had developed very positive relationships with the people who used the service. The interactions between people and staff were positive and supportive.

Staff were kind and respectful; we saw that they were aware of how to respect people's privacy and dignity. Staff also sensitively supported people to deal with their personal care needs.

People told us they were offered plenty to eat and we observed staff assisted individuals to have sufficient healthy food and drinks to ensure their nutritional needs were met. We saw each individual's preference was catered for and people were supported to manage their weight and nutritional needs.

People were supported to maintain good health and had access to healthcare professionals and services. People were supported and encouraged to have regular health checks and were accompanied by staff or relatives to hospital appointments or by the use of video conferencing with health professionals.

People's needs were assessed and care and support was planned and delivered in line with their individual care needs. The care plans contained detailed information about how each person should be supported.

We found that risk assessments were detailed. However areas of identified risk had not always been assessed.

There was a system in place for dealing with people's concerns and complaints. People were supported to access an independent advocate when required.

Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety.

The provider had systems in place to oversee the performance of the home and to identify any areas that needed to be developed.

We found one breach of regulation; you can see the action we told the provider to take at the back of the full version of the report.

Our observations indicated to us that the provider was not ensuring that the premises were maintained to appropriate standards of cleanliness and hygiene. As a result we found that the provider was not taking adequate steps to protect vulnerable people from the risks associated with an unclean environment.

The provider was not protecting service users against the risks associated with the inappropriate and unsafe storage of medicines.

The provider had taken steps to provide care in an environment that was suitable and adequately maintained and they had appropriate security arrangements in place to protect people who lived at the service.

We sought comment from the relatives of service users and limited comment from service users themselves. We spoke with visiting health care professionals. We spoke with care staff, non-direct care staff and the management of the service. Our observations and interpretation of comments led us to the conclusion that the provider was not providing sufficient numbers of staff to safeguard the health, safety and welfare of service users.

Staff were not receiving formal, structured and regular supervision. Staff were not receiving a yearly appraisal. As a result we were unable to inspect any form of a learning and development plan for any of the staff