Archived: Brackenbridge House

Brackenbridge House is a residential home and is part of Gold Care Homes. It provides accommodation for up to 36 people in single rooms. The home is situated within a residential area of the London Borough of Hillingdon. At the time of the inspection there were 21 people using the service (of which two people were in hospital).

At the time of the inspection the service did not have a registered manager in post. Since the previous inspection the manager in post at that time had left. A new manager started at the home five weeks before the current inspection we carried out in September 2016 and was in the process of registering with the Care Quality Commission. A registered manager is a person who has registered with the CQC to manage the service and has the legal responsibility for meeting the requirements of the law, as does the provider.

At our last comprehensive inspection of this service on 31 January, 1, 3 and 4 February 2016, we found breaches relating to dignity and respect, meeting nutritional and hydration needs, fit and proper persons employed, safe care and treatment, safeguarding, good governance and staffing. As a result of these, our concerns were sufficiently serious for us to impose a condition on the provider's registration to restrict admissions to the service based on our concerns in relation to staffing issues. We rated the service as overall inadequate and consequently placed into special measures. At this inspection, we found some improvements had been made in these areas and we have informed the provider the condition would remain but they can now admit four people per calendar month to the home.

We also imposed a positive condition in relation to the provider providing us with regular updates on their progress in addressing the breaches we found with Regulations 12 (safe care and treatment) and Regulation 17 (good governance). At this inspection, we found there had been some improvement in relation to the breaches of Regulations 12 and 17 but sustained improvements had not been demonstrated so we therefore decided to continue with the positive condition. If the provider wishes to, they can apply to have this condition removed at a time they feel appropriate.

Some improvements had been made in relation to the number of care workers available, administration of medicines and information about the knowledge and skills of care workers provided by an agency.

The care workers now followed safe and suitable practices when they provided care and supported people.

A range of risk assessments were in place in relation to the care being provided. Processes were in place for the recording and investigation of incidents and accidents.

Some improvements had been made in relation to training and support for care workers to ensure they were providing appropriate and effective care for people using the service.

The provider had policies, procedures and training in relation to the Mental Capacity Act 2005 and care workers were aware of the importance of supporting people to make choices.

Some improvements had been made in the support provided to people to eat their meals and to make choices from the menu by providing photographs of each option available.

People we spoke with felt the care workers were caring and treated them with dignity and respect while providing care. Care plans identified the person’s cultural and religious needs.

Improvements had been made to the type and variety of activities offered at the home and people were encouraged to be involved in the decisions about the activities and outings organised. People told us they felt there were limited activities arranged during the weekend. The manager confirmed they were in the process of recruiting an additional activities coordinator to provide support at weekends.

Appropriate equipment including specialist wheelchairs and height adjustable side tables were now available to meet the needs of people using the service. Equipment was clean and well maintained.

Detailed assessments of the person’s needs were carried out before they moved into the home and each person had a care plan in place which described their support needs. Care workers completed a daily record of the care provided.

People using the service and their relatives had a range of ways to provide feedback on the way care was provided and the quality of the service.

The provider had recently introduced a range of new systems to monitor the quality of the service provided.

Some improvements had been made in the recording of people’s care needs and the support provided.

Following our last inspection, we placed the service in special measures. For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. As the provider has demonstrated improvements and the service is no longer rated as inadequate for any of the five questions, it is no longer in special measures.

Brackenbridge House is a residential home and is part of Gold Care Homes. It provides accommodation for up to 36 older people in single rooms. The home is situated within a residential area of the London borough of Hillingdon. At the time of our visit there were 31 people using the service.

We previously inspected Brackenbridge House on 6 and 8 July 2015 and we identified issues in relation to staff training and supervision, staffing levels, maintain accurate records of care, the support provided not reflecting people’s needs, sending notifications to the Care Quality Commission and care plans not including information on DoLS.

At this inspection we found the provider had made some made some improvement but there were still shortfalls with staffing levels, training and supervision, medicines management and activities.

The service had a new manager who started during January 2016. They were in the process of applying to be the new 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 number of care workers on shift at night had increased to three. However, there were not enough staff deployed during the day to meet people’s needs and there were delays in people receiving the support they needed. People told us they felt safe but they had concerns regarding the number of care workers available to provide support.

There were recruitment processes in place for care workers that were directly employed by the provider but records were not kept in relation to the care workers employed via an agency. Therefore the provider could not ensure these care workers had the appropriate knowledge and skills to provide safe care.

There was a procedure in place for the management of medicines but care workers were not recording the administration of medicines accurately. Stocks of prescribed medicines were not monitored appropriately which resulted in people running out of their medicines.

The care workers did not have access to appropriate hand washing facilities to support their infection control process. We observed people were being put at risk because some practices in relation to supporting people to eat were not safe.

The provider had processes and procedures in place for the recording and investigation of incidents and accidents. Each person using the service had an evacuation plan in place in case of an emergency.

Some staff had not completed training identified as mandatory by the provider. Staff had not had annual appraisals in line with the provider’s policy in relation to supporting staff.

We found the service had made appropriate applications to meet the requirements of the Deprivation of Liberty Safeguards (DoLS) and Mental Capacity Act 2005 (MCA) but these applications had not been monitored to ensure they were being processed.

We saw that in general people were treated with dignity and respect but on some occasions this did not happen when people were being moved using a hoist and being weighed.

The activities provided in the home were not meaningful, were not based on people’s interests and did not encourage engagement with other people.

The provider did not ensure equipment was kept clean and met the needs of people using the service.

Detailed assessments and care plans were in place identifying the care and support needs of the people using the service.

The provider had limited systems in place to monitor the quality of the care provided. These did not provide appropriate information to identify issues with the quality of the service.

Records relating to care and people using the service were not completed accurately to provide a current picture of the person’s needs and the support provided.

We found a number of breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We are taking action against the provider for the breach of the Regulations in relation to person-centred care (regulation 9), safeguarding (Regulation 13), the safe care and treatment of people using the service (Regulation 12), the good governance of the service (Regulation 17) and staffing (Regulation 18). You can see what action we told the provider to take at the back of the full version of this report.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains 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 the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will 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 we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with five people who were using the service, the staff supporting them and from looking at records. If you want to see the detailed evidence that supports our summary please read the full report.

Is the service safe?

People told us that they felt safe. Safeguarding procedures were in place and staff understood their role in safeguarding the people they supported. Staff told us that they had received training and they were able to demonstrate their knowledge of safeguarding procedures.

There were enough staff on duty to meet the needs of the people living at the home and a member of the management team was available on call in case of emergencies.

People told us that they felt their rights and dignity were respected.

We looked at the staff rotas and saw that the staffing levels and skill mix were tailored to meet the number of people who were using the service. The provider was able to demonstrate that the staff employed to work at the home were suitable and had the skills and experience needed to support people living in the home.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. Due to recent case law legislation in this area the manager had contacted the local authority and had been provided with advice regarding applications under the operation of the Deprivation of Liberty Safeguards. The manager confirmed that applications are currently being submitted.

Is the service effective?

People told us that they were happy with the care they received and felt their needs had been met. It was clear from what we saw and from speaking with staff that they understood people's care and support needs and that they knew them well. One person told us "The staff respond quickly if I request assistance."

People's health and care needs had been assessed and care plans were in place. We saw that care plans had been reviewed regularly.

Is the service caring?

Five people told us about the staff supporting them. They told us that "The staff are very attentive and support me in making choices as required", "I am very happy here and feel respected by the staff", "The staff are very approachable." We saw that staff were patient and supportive when supporting people.

The manager told us that various methods were used to monitor the quality of services, which included a formal survey, meetings for people who used the service and staff meetings. We saw that actions had been taken to address comments or concerns which had been raised.

Is the service responsive?

People's needs had been assessed before they moved into the home. People told us they met their key workers once a month to review their care plan and discuss any changes related to their specific needs. Records confirmed people's preferences, interests, dietary requirements and any specific needs for equipment and where possible had been signed by the person.

People said that they could make a complaint if they wanted to. Five people who used the service told us that they saw the manager regularly and they were approachable. On relative told us that "The care has been fantastic and I have no complaints at all."

Is the service well-led?

Staff had a good understanding of the ethos of the home and quality assurance processes were in place. All of the staff said that if they witnessed poor practice they would report their concerns. The manager told us that they had ben in post in excess of fifteen years and had a established team of staff in place.

People told us that were asked for feedback on the service they received and they had attended meetings where they could share their views. We saw a summary of surveys which had been completed by the relatives of people who were using the service and the manager confirmed that all comments were reviewed and changes made to improve the service if possible.

Staff told us that they were clear about their role and responsibilities. They said they attended regular staff meetings and said that the management had consulted with them before implementing changes to the management of the home and their views had been taken into consideration.

People told us that they were happy at the home. One person said 'I have been here five years and it is excellent' and 'the home is clean, very well run and the food is great'. Another person said 'all the staff and management are very nice'.

People's privacy, dignity and independence were respected. One person said "everyone is treated with dignity here", "I couldn't ask for better care for my relative".

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We viewed five care files of people who use the service. All contained a detailed assessment of a person's needs and their care plans had been developed to meet these.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

Staff received appropriate professional development, including Induction training, annual appraisals and regular supervision.

There was an effective complaints system available. Comments and complaints people made were responded to appropriately.