De Bruce Court

Updated 23 December 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

Two inspectors and a member of the CQC medicines team carried out the inspection.

Service and service type

De Bruce Court is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. De Bruce Court is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This 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. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was not a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

We spoke with nine people who used the service and four relatives about their experience of the care provided. Some people who used the service had difficulty communicating, however, we spent time observing people’s daily experiences of the care and support provided.

We spoke with 16 members of staff including the manager, deputy manager, two heads of care quality, administrator, maintenance person, kitchen assistant, two nurses, and seven support staff. We spoke with local authorities placing people at the service and four professionals who regularly visit the service.

We reviewed a range of records. This included five people’s care records and six medication records. We looked at four staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records. We were also provided with evidence requested during feedback and additional information supplied in light of our initial feedback.

Updated 23 December 2022

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

About the service

De Bruce Court is a residential care home providing personal and nursing care to 18 people at the time of the inspection. Care is provided to younger adults and older people, some of whom have a dementia, physical disabilities, learning disabilities or mental health needs. The service can support up to 46 people.

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

Right Support

The provider did not always support people to have the maximum possible choice, control and independence. Staff did not always act in accordance with the requirements of the Mental Capacity Act 2005 and associated code of practice. Staff did not always adhere to safe practices when wearing personal protective equipment (PPE).

Staff did not always support people to achieve their aspirations and goals. When goal care plans were in place, relatives told us these were not always followed, and records confirmed this.

Healthcare professionals worked in partnership with the provider when people moved to the home, professionals told us this was managed successfully.

Right Care

People were not receiving person-centred and safe care. The ability to provide person-centred care was compromised due to low staffing levels. People could not always take part in activities and interests that were tailored to them. Some people told us they were bored and had nothing to do or could not go out as no staff were available to support them in the community.

Healthcare professionals gave mixed comments regarding staff interventions with people. One healthcare professional complimented staff on following guidance. Whilst others described the lack of support offered.

Right Culture

People's quality of support was not always enhanced by the provider’s quality assurance systems. People did not always lead inclusive and empowered lives. People were not encouraged to be involved in the organisation of the home, including menu planning and recruitment. Staff did not always focus on people’s strengths or promote what they could do. People were not always supported in line with their cultural and religious needs.

For more details, please see the full report which is on the Care Quality Commission website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 27 July 2021).

Why we inspected

The inspection was prompted by concerns regarding how the service was applying the principles of right support, right care, right culture. We assessed the application of these principles during this inspection.

Initially the inspection was a targeted inspection focusing on Safe and Well-led. However, after some concerns were identified, we widened the scope of the inspection to include all five key questions.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment, staffing, consent, dignity and respect and good governance at this inspection.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from 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.