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Archived: Bretton Care Inadequate

Inspection Summary


Overall summary & rating

Inadequate

Updated 11 June 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 was 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. 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.

This inspection took place on 1 October 2014 and was unannounced. A further visit took place on 3 October 2014. The two people who lived at the service did not wish to speak with the inspection team about their experiences of living at the service. Each person was supported in a separate property and during the inspection we looked at the individual properties. We had spoken with one person who lived at the service during our inspection on 10 June 2014 and at that time they were positive about the care they received.

At our previous inspection on 10 June 2014 we identified a breach of regulation 11 safeguarding people who use services from abuse, regulation 23 supporting workers, and regulation 10 assessing and monitoring the quality of service provision of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. Following this inspection the provider sent us an action plan to tell us the improvements they were going to make. During this inspection we looked to see if those improvements had been made. We found continued breaches in regulation 23 supporting workers and regulation 10 assessing and monitoring the quality of service provision. You can see what action we told the provider to take at the back of the full version of the report.

Bretton Care provides accommodation and personal care for up to six people who are care leavers who have a range of learning disabilities including challenging behaviours. The service has not had a registered manager since 10 April 2014. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. A manager was employed at the service and had made an application to become the registered manager.

The service had not identified, assessed and managed risks relating to the health, welfare and safety of people and others who may be at risk from the carrying on of the regulated activity. For example, we identified risks to people associated with the environment such as fire, window openings and water temperatures. We also identified individual risks to the people living at the service presented in terms of their welfare and safety. You can see what action we told the provider to take at the back of the full version of the report.

People were supported to make choices and care staff had received training in safeguarding to provide them with the knowledge to protect people from potential abuse and they said they were aware of the procedures to follow to report abuse.

Two members of care staff were on duty at all times providing 24 hours support to the two people who lived at the service. This was not one to one support at all times meaning that people who lived at the service were not under constant control and supervision. This was to ensure that care staff were available to support people at all times.

The recruitment of care staff did not evidence that all the required pre-employment checks and documents as set out in the regulations were in place. You can see what action we told the provider to take at the back of the full version of the report.

Whilst the service were aware of people’s health and care needs, care staff did not always have the sufficient training, skills and experience to ensure they managed the risks people who used the service. External health and social care professionals were working closely with care staff to support them to develop these skills and provide a consistent approach to people living at Bretton Care.

The manager was conversant with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS), but care staff lacked understanding about how it might apply to people who used the service and in their role.

People who used the service were provided with a weekly allowance for shopping and encouraged to be independent with this and with aspects of their care such as preparing and eating meals of their choice.

People’s support plans were not reviewed when needed, resulting in support plans being out of date and not reflecting people’s current needs. This put people at risk of inconsistent and/or not receiving the support they need. You can see what action we told the provider to take at the back of the full version of the report.

Care staff knew people’s life history, likes, preferences and needs. Discussions with care staff evidenced they cared for the people who used the service. Care staff provided people with opportunities to express their views and listened and acted on this information.

People were encouraged to give their views and raise concerns or complaints. The matters they raised were dealt with in an open, transparent and honest way.

At the time of our inspection leadership of the service was reactive, and not proactive. The registered provider did not have the knowledge, skills or experience to carry on the regulated activity. There had been no registered manager since 9 April 2014. Legal obligations, including those placed on them by other external organisations were not always understood and met. Quality assurance systems were in place, but were not sufficiently robust to identify, assess and manage risks. You can see what action we told the provider to take at the back of the full version of the report.

Care staff told us they were happy in their work, motivated and confident in the way the service was managed. They said, “everything’s loads better since [manager] came” and “I feel safer now than I did. It’s better now because we have policies and procedures we can refer to. There’s been a big improvement with training”.

Inspection areas

Safe

Inadequate

Updated 11 June 2015

The service was not safe.

The service had not maintained a safe environment to safeguard people from risks associated with fire, window openings and water temperatures. The risks presented by people were not always managed well, which meant the safety of care staff and others was compromised.

Not all the specified documentation to confirm if all the pre-employment checks had been carried out for the recruitment of care staff was available in their files as required by the regulations.

People were supported to make choices and take risks and care staff had received training in safeguarding to protect vulnerable adults from potential abuse and said they were aware of the procedures to follow to report abuse.

Sufficient numbers of care staff were available to meet people’s needs.

Effective

Inadequate

Updated 11 June 2015

The service was not effective.

The service were aware of people’s health and care needs, but care staff did not always have the sufficient training, skills and experience to ensure they managed the risks associated with the care of people who used the service.

Deprivation of Liberty Safeguards (DoLS) and the key requirements of the Mental Capacity Act (MCA) 2005 were not fully understood by care staff, despite them attending training.

People who used the service were provided with a weekly allowance for shopping and encouraged to be independent with this and preparing and eating meals of their choice.

Caring

Good

Updated 11 June 2015

The service was caring.

Care staff knew people’s life history, likes, preferences and needs. Discussions with care staff evidenced they cared for the people who used the service. Care staff provided people with opportunities to express their views and listened and acted on this information.

Responsive

Inadequate

Updated 11 June 2015

The service was not responsive.

People’s support plans were not reviewed when needed, resulting in support plans being out of date and not reflecting people’s current needs. This put people at risk of inconsistent support and/or not receiving the support they needed.

People were encouraged to give their views and raise concerns or complaints. The matters they raised were dealt with in an open, transparent and honest way.

Well-led

Inadequate

Updated 11 June 2015

The service was not well led.

At the current time leadership was reactive, rather than proactive. The registered provider did not have the knowledge, skills or experience to carry on the regulated activity. There had been no registered manager since 9 April 2014. The service did not have a clear vision about the type of service they wished to provide. Legal obligations, including conditions of registration from CQC, and those placed on them by other external organisations were not always understood and met. Quality assurance systems were in place, but were not sufficiently robust to identify and manage risks.

Care staff told us that they were happy in their work, motivated and confident in the way the service was managed.