Archived: The Brake Manor

Updated 24 January 2017

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.

This unannounced inspection took place on 24 November 2016. The inspection team consisted of two adult social care inspectors.

Before the inspection we reviewed information held about the service and notifications of incidents we had received. A notification is information about important events which the service is required to send us by law.

During the inspection we spoke with Moreligh’s operations manager, the manager on duty at The Brake Manor, five care staff, the cook and one member of the domestic staff team. Following the inspection we spoke with a health professional about the service.

Not everyone who was living at The Brake Manor was able to tell us their views about the care and support they received due to their health needs. We spoke with one relative and five people using the service. We also observed staff interactions with people.

We looked at care documentation for four people, medicines records, three staff files, training records, maintenance records and other records relating to the management of the service.

Updated 24 January 2017

We carried out this unannounced comprehensive inspection of The Brake Manor on 24 November 2016. At the previous comprehensive inspection on 3 November 2014 the service was meeting the requirements of regulations. Following concerns raised with the commission in March 2015 we carried out a focused inspection. The concerns related to people not having a choice as to when they got up and went to bed, a lack of access to snacks in the evening, male residents not being supported to shave and people’ not receiving adequate support with other aspects of personal care. The inspection found the allegations were unfounded.

We undertook this comprehensive inspection of the service as we had received concerns in respect of the care and welfare of people using the service. The concerns raised were that staff did not know what a person’s needs were when ambulance staff requested the information. Also, that where people were at risk from skin damage, staff were not supporting them as instructed in their care plan to minimise this risk.

The provider for this location is registered under the legal entity of Morleigh Limited which is responsible for a group of nursing and residential care homes.

The Brake Manor is a care home which provides accommodation for up to 26 people who require residential care. At the time of the inspection 25 people were living at the service. Some people were living with dementia. The Brake Manor is a three story house set in an elevated position in its own grounds. The service had a range of aids and adaptation in place to meet the needs of people living there.

The service is required to have a registered manager. 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. The Brake Manor had two registered managers in post until September 2016 when one left. The current registered manager had been managing the service on a part time basis three days a week. The registered manager was not available throughout the inspection although they had been made aware of our presence in the service and did visit the service on the day. At the time of this inspection a newly recruited full time manager had been in post for eight days.

Systems and processes to ensure good governance were not being effectively operated. Records relating to managing the health and care needs for people were not always being updated or completed by staff. People’s fluid intake was not being recorded as instructed in the care plan. There were gaps in records to demonstrate people had been repositioned regularly to prevent pressure sores.

Medicines were not being managed safely. There had been no audit of the medicines system since July 2016. The medicines trolley was dirty and disorganised. There was no evidence of stock rotation. Medicines were being used when the use by date had expired. There were gaps in the records of when creams had been applied and they were not consistently signed as given. Medicines were not being returned to the pharmacist as required. Medicines requiring stricter control were not being managed safely. The level of stock of these medicines did not reconcile with the records. We found one person was not receiving their medicine as prescribed. There were regular errors in recording medicines which required stricter controls.

Records to show when people had been repositioned due to the risk of pressure damage to their skin, were not always taking place or being recorded. One person who had been identified as requiring repositioning and had no record to show this had occurred throughout the day of the inspection. This person’s care records had not been updated since May 2016 and therefore staff did not have the accurate information to enable them to deliver safe and effective care. Staff were relying on daily information from the manager. Another person required regular re-positioning. The associated records were not clear. They did not record the time or frequency of change. They did not show what position the person had been in prior to the change and what position they were in when the staff had completed the change. This meant the information could not be relied upon and we were unable to establish if people were receiving the care and support required to protect them from identified risk.

Records relating to managing the health and care needs for people were not always being updated or completed by staff. People’s fluid intake was not being recorded as instructed in the care plan. One person’s health had been deteriorating for some time and a professional told us they had only recently been made aware of this person’s needs in order to carry out a health assessment. The person had experienced a weight loss of 10kgs in the period August 2016 to October 2016. A record of the person’s food and fluid had been put in place to allow staff to monitor if they were getting enough to eat and drink. Fluid records did not show the minimum daily amounts the person should be consuming. This meant staff would be unaware if the person’s intake was enough to maintain their well-being. Daily fluids recorded were not totalled or reviewed. Where people were at risk of losing weight due to a poor appetite or being unable to eat independently they had their weight recorded. However, these weight records were not being reviewed regularly to ensure that any loss of weight was identified and action was taken to address the concern. This meant care and support was not being monitored effectively.

Information in care plans was not always accurate because they had not been reviewed or updated. For example a person had recently been discharged from hospital back to the service and their needs had changed. Staff told us they had been updated about the person’s needs verbally by the manager. However the person’s care plan was last reviewed in May 2016 and did not reflect their current needs.

The service did not have robust recruitment procedures in place. We found staff were starting work in the service before the organisation had received satisfactory Disclose and Barring Service (DBS) checks. In one instance an employee had no record of the date they started working in the service or whether a satisfactory Disclosure and Barring Service (DBS) check was in place at the time the staff member started work. These are used to help ensure staff are suitable to work in the care sector. In two other instances recruitment files showed one person had started working at the service ten days before a completed DBS check had been received and another twenty-one days before a satisfactory DBS check had been received. The failure to complete necessary checks before allowing staff to provide care exposed people to unnecessary risk.

The environment was not being suitably maintained and there was a general air of neglect. There was evidence of some water damage to the ceiling of a bedroom on the third floor. This room also had the top drawer missing from a chest of drawers. A room on the first floor had been a bathroom. The bath had been removed although the toilet was still operational in this room. There was no floor covering for this room. Two hoists were also being stored in this room and there was a sliding door with no lock. The dignity of people using this toilet was therefore not maintained.

There was a lack of signage which would support people to move around the service independently and recognise bathroom, lounge and dining areas as well as their own rooms. This did not support the needs of people who were living with dementia, and needed prompts to help them to recognise their surroundings.

Systems for recording daily records were not robust. This was because staff removed all care plans from the office and completed the daily logs in the lounge area. However, there were occasions when staff needed to respond to call bells etc. This meant staff sometimes had limited time to complete the daily logs. In some instances staff told us they verbally passed on information to their colleagues about an event and relied on the staff member to record this.

Staff were not always being regularly supported in their role. Staff told us that, due to recent changes in managers, supervision had lapsed. Two staff files did not have any supervision records in place. Staff files were loose leaf resulting in information being difficult to find. There was a supervision matrix in place. It showed the previous manager and four of the care staff had not received supervision at all during 2016. This meant not all staff were receiving the level of support they needed to help them carry out their role and develop their learning.

Staff were caring but were not always available to people in lounge areas for any length of time to provide meaningful support. For example, two people without mobility in reclining lounge chairs spent most of the morning sleeping. They remained in the chairs when being supported with their lunch. There was little interaction seen between them and the staff members on duty. Staff were respectful and sensitive when speaking with them but there were periods of time when they were on their own without any environmental stimulation other than music playing or television. Neither seemed particularly interested in these pastimes.

People had mixed views about meals provided by the service. Some people told us they liked the food and others said it could be improved. In general we found that the quality of food was adequate though not of a high quality. Comments included, “It’s not been as good as usual today” and “I have changed my mind and had the alternative.” Other people told us they were not happy with the food in general. Comments included, “It’s