Background to this inspection
Updated
11 December 2015
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.
We undertook an unannounced inspection of this service on 16 and 17 July 2015. The inspection was undertaken by three inspectors.
We focused on speaking with people who lived in the home, speaking with staff and observing how people were cared for and interacted with by staff. We looked in detail at care plans and examined records which related to the running of the service. We looked at six care plans and seven staff files as well as staff training records and quality assurance documentation to support our findings. We looked at records that related to how the home was managed such as audits, policies and risk assessments. We also pathway tracked some people living at the home. This is when we look at care documentation in depth and obtain people’s views on their day to day lives at the home. It is an important part of our inspection, as it allowed us to capture information about a sample of people receiving care.
We looked around most areas of the home including bedrooms, bathrooms, the lounge and dining room/conservatory as well as the kitchen and laundry area. During our inspection we spoke with nine people who live at the home, four visitors, four care staff, the home’s cook and the deputy and registered managers as well as the provider. Mr & Mr Jaunky are the providers who work in the service and Mrs Jaunky is also the registered manager.
We reviewed the information we held about the service. We considered information which had been shared with us by the local authority, relatives and healthcare professionals such as a social worker. We reviewed notifications of incidents and safeguarding documentation that the provider had sent us since our last inspection. A notification is information about important events which the provider is required to tell us about by law.
Updated
11 December 2015
We undertook an unannounced inspection of this service on 16 and 17 July 2015. Bracknell House is registered to provide accommodation and support for up to 22 older people. There were 13 people living at the service during our inspection. Accommodation is provided over two floors with communal lounge, dining/conservatory areas.
Our previous inspection on 17 and 22 December 2014 found breaches of 10 regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. These now correspond with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which came into force on 1 April 2015.
We took enforcement action and required the provider to make improvements. We issued four warning notices in relation to care and welfare; management of medicines; records and quality assurance. We told the provider they needed to meet the terms of the warning notices by 30 January 2015.
At the previous inspection on 17 and 22 December 2014 we also found six further breaches of regulations. We asked the provider to take action in relation to safeguarding people from abuse, staff recruitment processes, staff training and induction, consent to care and treatment, nutrition and respecting and involving people. The provider gave us an action plan and told us the work needed to meet these requirements would be complete by the end of April 2015.
Mr & Mr Jaunky are the providers who work in the service and Mrs Jaunky is also the registered manager. We met with the provider on 23 January 2015 to make sure they understood their responsibilities and explained possible further action, should appropriate improvement not be made. The provider voluntarily agreed not to admit any more people to the service until they met the requirements of the regulations.
At this inspection we found that some improvements had been made, but the provider had not met all elements of each warning notice. Where the provider had sent us action plans telling us what they were doing to improve in other areas, all of the actions they told us they had completed were not completed. As a result, we found the service continued to breach regulations relating to fundamental standards of care.
People remained at risk of not receiving appropriate care and support because guidance about how people should be supported was not always in place where needed.
Risk assessments did not reflect people’s changing needs and reviews of incidents and accidents did not result in action for staff to take to try to prevent people being at risk again.
People suffered repeated falls. Insufficient and ineffective action to address the cause meant people were not safeguarded from abuse and improper treatment. The service failed to recognise their lack of activity to respond to the concerns appropriately represented neglect of the people to whom they should have provided care and support.
Medication was not safely managed and shortfalls previously pointed out had not all been addressed.
People’s safety was at risk because checks of fire detection and prevention equipment were not up to date. Equipment, enabling people to access some parts of the service, had not been maintained or certified as fit and safe to use.
Care plans were contradictory and not specific about the support people needed, including the number of staff required to safely support people.
Principles of previous enforcement action had not been adopted as best practice at the service where reasonable to do so; including ensuring personalised information was available to support different healthcare needs.
Mental capacity assessments did not always meet with the principles of the Mental Capacity Act 2005, as they are required to do so.
Training had not been delivered where identified as needed and administrative processes to support training, staff supervision and appraisal were inaccurate and incomplete.
Care plan records did not always reflect that people were involved or had agreed to decisions and changes made about the care and treatment they received.
Care plan reviews did not identify or address contradictory information or effectively cross reference people’s support needs from one area to another.
People and visitors felt activities were infrequent and those which took place could be improved.
A complaints policy was in place, but it did not provide all of the information it was required to and some of the information provided was contradictory.
Leadership at the service had not ensured that all enforcement and requirement actions issued following our last inspection were met. The service lacked an effective quality assurance framework and management action plan for ongoing improvement and development.
People and visitors felt the quality of food had improved at the service and there was a better choice.
Staff felt supported in their roles and that the service and moral had improved. People and visitors told us that staff were supportive and caring.
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.
As not enough improvement had been made within this timeframe so that there is still an overall rating of inadequate, we have taken action in line with our enforcement procedures, which has led to cancelling their registration.