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Archived: Bretton Care Inadequate


Inspection carried out on 1 and 3 October 2014

During a routine inspection

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 carried out on 1 October 2014

During Reference: R6 not found

Inspection carried out on 10 June 2014

During a routine inspection

At the time of this inspection, two people were living at Bretton Care. We observed the care one person received and spoke with them. We also spoke with a social care professional, the nominated person who acts on behalf of the registered provider and four members of staff. A range of relevant documentation was reviewed during our inspection.

Two adult social care inspectors carried out this inspection. We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask: Is the service safe, effective, caring, responsive and well led?

Below is a summary of what we found.

Is the service safe?

People received safe and appropriate care that met their needs and supported their rights. Assessments of needs had been carried out, in order that a plan of care could be formulated. Where required there were risk assessments in place for people who used the service in relation to their support and care provision. This meant action could be taken to minimise any risks, whilst at the same time, taking the least restrictive option. Risk assessments were completed in consultation with people.

The systems and processes in place to safeguard people from harm and abuse were not sufficiently robust to protect people. This was because key local policies and procedures were not known about or reflected in the service�s own policy and procedure.

The home had policies and procedures in relation to the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). We found the manager had the necessary knowledge to apply for a DoLS if necessary, but staff knowledge was not sufficiently robust. This means there is a risk that staff could make decisions on behalf of people without following the correct legislative process.

There were sufficient numbers of staff on duty to meet the health, safety and welfare needs of people who used the service.

Systems were in place to make sure the manager and staff analysed and learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. Appropriate action was taken to minimise the risk of further events and help the service to continually improve.

Is the service effective?

People�s health and care needs were assessed with them and people and relevant others, such as social and health care professionals were involved in their care plan. The support people received promoted a good quality of life for people using the service.

The service had relied on the previous training of the staff they had appointed to ensure that people were supported safely and to an appropriate standard. There were gaps in this training and in staff knowledge. A number of staff had not received a robust induction to the service. This meant staff had not always received appropriate induction and training before they started working with people using the service.

Is the service caring?

When we spoke with the person who used the service they told us they had looked around the home with their social worker and mum and came to live there the following day. They said, �it�s not too bad, I quite like it, it�s a quiet area�. They told us staff were �fine� and commented, �they know me inside out now�. They also stated, �I don�t call them staff members, they�re like normal people�. They told us about the health appointments they had attended and were due to attend. They said that the staff supported them in keeping these appointments. They also said that health professionals were contacted when necessary to meet their needs.

We saw staff engaging with people who used the service. This demonstrated positive relationships had developed. Staff treated people in a respectful way when providing their day to day care and responded in a calm and appropriate manner when people showed behaviours which may challenge We saw that the staff responded in a timely way to try to reduce the risk of these behaviours escalating. Our observations of staff demonstrated they had a clear knowledge of people�s needs, individual likes and preferences and showed concern for people�s wellbeing.

Is the service responsive?

Services were organised so that they met people�s needs. People accessed a variety of social activities and community resources to meet their individual needs and interests. People were supported to maintain relationships with family members. Staff responded promptly to any changes in people�s needs and care plans were updated accordingly.

Is the service well-led?

A registered manager had not been in place since 9 April 2014. We found the provider could not demonstrate that they had always been well led. Until recently, the service had not had the systems and processes in place to effectively identify, assess and manage risks and maintain the quality of the service.

The service had formulated a quality assurance system, but this was not fully operational in practice. Where it was in operation, records seen by us showed that actions had been appropriately identified together with a timescale for them to be addressed by.

We found the nominated individual who acted on behalf of the company was not fully conversant with their responsibility in managing the regulated activity. For example, ensuring that notifications were submitted to CQC as required, by providing induction and training for staff to ensure they were competent before they started to working with people who used the service and having knowledge of local safeguarding policies and procedures.

If you want to see the evidence supporting our summary please read the full report.