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Bradfield Residential Home Requires improvement


Inspection carried out on 23 January 2019

During a routine inspection

The inspection was carried out on the 23 January 2019 and 29 January 2019. The inspection was unannounced on 23 January 2019 and announced on 29 January 2019.

Bradfield residential home is a ‘care home.' People in care home services receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The accommodation was provided over three floors. A lift was available to take people between floors. Residential accommodation and personal care were provided for up to 37 older people. Double rooms were offered for couples. There were 33 people living in the service when we inspected. Some people had memory loss or health issues associated with ageing or were living with dementia.

We carried out our last comprehensive inspection of this service on 22 October 2015 and we gave the service an overall rating of ‘Outstanding.’ At this inspection, we found the service Requires Improvement.

Since our last comprehensive inspection in 2015, two new registered managers had registered and shared the responsibility for the management of the service. A registered manager is a person who has registered with CQC 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 design, decoration and signage in the service did not meet current standards for individual people living with dementia or with a visual impairment. We made a recommendation about meeting best practice in the design of the premises.

The premises were well maintained, clean and odour free. Risk assessments were in place with actions to minimise risks, to people, staff and visitors. Safe systems of work were used by staff to manage infection control. For example, good hand hygiene, the use of disposable gloves and the use of planned cleaning schedules. However, the registered managers had not properly minimised the risk from waterborne infections, for example legionella. We made a recommendation about meeting health and safety guidance.

Systems were in place to enable the provider to assess, monitor and improve the quality and safety of the service. These systems were not fully robust as they had not identified the areas for improvement we found during the inspection.

Safeguarding procedures were in place and staff understood their individual responsibility to protect people from harm and report concerns to the registered managers or if required externally in line with the providers whistle blowing policy. Incidents and accidents were reported and appropriately investigated.

Emergency response contingency plans were in place to maintain the levels of care. For example, if the premises had to be evacuated. Fire systems were tested and staff practised the fire evacuation procedures to maintain their skills. Equipment such as hoist, lifts, gas appliances and electrical systems and equipment were regularly tested.

Comprehensive needs assessments were carried out with people and or with relatives so that the service staff could meet their needs. A care plan was in place based on people’s current needs. The care plans provided personalised information, including people’s life stories. Likes and dislikes, medical needs and lifestyle choices.

Staff understood the risks to people’s individual health and wellbeing and risks were clearly recorded in their care plans. This included hydration and nutrition and health care management. People were supported to eat and drink according to their needs, staff supported people to maintain a balanced diet. Referrals were made to external health care professionals when required. For example, GP’s.

We observed that staff were friendly and caring. There were appropriate systems

Inspection carried out on 22 October 2015

During a routine inspection

The inspection visit was carried out on 22 October 2015 and was unannounced.

Bradfield Residential Home is a large detached property in a quiet residential area of Walmer near Deal. It is a privately owned family run service and provides care and support for up to 32 older people, some of whom are living with dementia. There were 29 people living at the service when we visited. Extensive communal spaces are available in the service for people to meet with friends or family or carry out activities. A passenger lift is available for access to the two upper floors. All but two of the rooms have en-suite toilet and shower facilities. A secure garden is available for people to use throughout the year; some bedrooms have their own access to the garden.

There was a registered manager working at the service. 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 registered manager was also one of the owners/providers. The registered manager was in the process of handing over the responsibility of managing the service to their daughter and her partner. At the time of the inspection the provider’s daughter and her partner were both managing the service together and were going to apply to the Care Quality Commission (CQC) to become the joint registered managers. The managers did not work from an office so were available around the service to everyone, they chatted with people and opened the door and chatted to relatives and other visitors.

People and their visitors told us that this was ‘by far the best service they had visited’ when looking for somewhere new to live and they had to wait for a vacancy. Some people had gone to stay at other services in the interim period. One person said, “It was worth the wait. The other home I was in was alright but when I came here the difference was unbelievable. They can’t do enough for you. It doesn’t matter what time of the day or night it is”. The managers made sure peoples’ bedrooms were how they wanted them. They made them comfortable and familiar and this helped people settle in. People chose the colour schemes and furnishings for their bedrooms.

There was a strong and visible person centred culture in the service. (Person centred means that care is tailored to meet the needs and aspirations of each individual.) The registered manager/provider, the two managers and all the staff were passionate about providing a service that placed people and their families at the very heart of the service. They provided support that was based on mutual respect and equality. As a result, people felt really cared for and that they mattered. This was confirmed by three health care professionals who visited the service regularly.

The management team demonstrated strong values and a desire to learn about and implement best practice throughout the service. The management team made sure the staff were supported and guided to provide outstanding care and support to people enabling them to live fulfilled and meaningful lives. The ethos of the service was to support people to be as independent as possible. Staff were positive about the support they received from their managers. They were encouraged to strive to improve. Staff were very motivated and proud of the service.

People, relatives and visiting professionals could not speak highly enough about the support and care that was given. They said the dedication and attitude of the managers and staff was ‘over and beyond the call of duty’. People told us they received care that was personal to them. They felt staff understood their specific needs well and had good relationships with them. People were settled, happy and contented. Relatives visiting the service told us they only had positive experiences and praise. Staff treated people as individuals with dignity and respect. Staff were familiar with peoples life stories and were very knowledgeable about people’s likes, dislikes, preferences and care needs. They approached people using a calm, friendly manner which people responded to positively. This continuity of support had resulted in the building of people’s confidence to enable them to make more choices and decisions themselves and become more independent.

When people were moving towards the end of their life, the management and staff made sure their dignity was maintained and they received the specific care to meet their needs. The managers and staff had a strong commitment to providing support to people and to their family to ensure a person’s end of life was as peaceful and pain free as possible.

People had varied communication needs and abilities. Staff knew people very well and knew how to respond and talk to each person to give them the support and care that they needed and wanted. Staff listened to what people had to say, they gave them time to express themselves. Staff were intuitive and if there was a problem communicating they were able to anticipate what people wanted and responded appropriately to them. Some people were able to express themselves verbally; others used body language to communicate their needs. Some of the people’s behaviour presented challenges and was responded to and supported by one to one support from staff.

People were supported to make choices and to take ‘risks’ in their daily lives. Potential risks to people were identified and assessed and kept to a minimum and people were not restricted from doing what they wanted to do. There was guidance in place for staff on how to care for people effectively and safely and without restricting their activities or their lifestyles. Staff were able to tell us what they would do if an incident did occur. Risks were kept to a minimum

Some people were able to make decisions about their care and support. Staff had received training in the Mental Capacity Act 2005 and they were able to explain current guidance to support people to make decisions. They told us about the importance that everyone should be deemed to have capacity to make decisions about their lives. The Mental Capacity Act 2005 provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. The managers told us about occasions when people had been referred to health and social care professionals to make big decisions about their care and support. Best interest meeting had been held to collectively decide what action should be taken to act in the person’s best interest.

There was a high level of understanding of the need to make sure people were safe. People and staff told us they were actively encouraged to raise their concerns no matter how small. They said this was part of day to day practice. People felt comfortable in complaining if they had to. They said if they did complain they knew their complaint would be taken seriously and looked into and action taken to resolve them. The manager’s actively sought people’s views and opinions. People told us the managers always asked if everything was alright and if there was anything they needed or were not happy about.

Safeguarding procedures were in place to keep people safe from harm. People felt safe living at the service; and if they had any concerns, they were confident these would be addressed quickly by the management team. One person said “There is always someone around, I feel quite safe.”

The staff understood their responsibility to recognise and report safeguarding concerns and to use the whistle blowing procedures. They demonstrated a good understanding of what constituted abuse and how to report any concerns.

People were protected by robust recruitment procedures and people were involved in choosing suitable staff so they had a say about who might support them. New staff had induction training which included shadowing experienced staff, until they were competent to work on their own. Staff had core training and more specialist training, so they had the skills and knowledge to meet people’s specific needs. Staff fully understood their roles and responsibilities as well as the values of the service. They said that they knew and trusted the managers to do a good job. They said the managers were ‘always there’ if there were any problems. The managers were fully involved with the care and support people received. Staff were listened to and were given the support and help that they needed on a daily basis. Staff had regular one to one meetings with the managers and a yearly appraisal.

There was sufficient numbers of staff deployed at the service to make sure people received the care, support and time that they needed. The staffing levels were flexible and were increased if a person needed extra support or for events and activities. Many of the staff had worked at the service for long time. They said they would not want to work anywhere else.

A wide range of activities were available, based on people’s suggestions and requests, which people’s family and friends were invited to take part in. Spontaneous activities took place and entertainment was provided. On the day of our inspection people were entertained by a musician. People joined in the songs and they enjoyed the event. People were supported to do what they wanted when they wanted. People led a fulfilled and meaningful life. Staff spent quality time with people to give them emotional support and comfort. Staff reminisced with people about their life and discussed what was happening in the world.

The chefs provided good quality food and catered for people’s individual preferences. This included people’s specific health and dietary requirements. Food and drink was available to people throughout a 24 hour period. Staff gave excellent and discreet support to those who required extra help in eating and drinking. One person said, “We have lovely dinners, if you don’t like something they get you something else.”

Medicines were stored, administered, recorded and disposed of safely. Staff were trained in the safe administration of medicines and kept records that were accurate. People were encouraged and supported to take their medicines themselves if they wanted to.

Audits and health and safety checks were regularly carried out. The managers had sought formal feedback from people and relatives about what the service did well and what they could do better. There was strong leadership at Bradfield Residential Home. Standards were high, and staff responded to this well. The management culture of the service was open, dedicated to providing excellent care to people, and equipping staff to provide excellent care. The managers communicated a strong ethos focusing on person centred care and ensuring a good quality of life for people. The managers led by example and staff followed the high standards they had set for managing the service. Staff told us they felt valued and appreciated for the work they did by the management team. The service had made sustained improvements over time.

There was a strong emphasis on continually striving to improve. The managers recognised, promoted and regularly implement innovative systems in order to provide a high-quality service.They looked into new and creative ways to include everyone in developing and improving the service.

Emergency plans were in place so if an emergency happened, like a fire the staff knew what to do. Safety checks were done regularly throughout the building and there were regular fire drills so people knew how to leave the building safely.

Everyone we spoke with which included, people who lived at the service, staff, relatives and healthcare professionals involved with people, told us Bradfield Residential Home provided very good or excellent care to people who lived there.

Inspection carried out on 25 October 2013

During a routine inspection

We looked at paperwork and found that people had the right support to give consent. People had a full assessment and a care plan, which were reviewed regularly. We saw that the service responded quickly when people's needs changed.

Medicines were managed in a safe way, and the environment was safe, helping people to retain as much independence as possible.

People had fresh, home cooked food. We found meals to be well thought out and people's preferences and allergies were known by the cook. Visitors were welcomed and supported to spend time with their friend or relative. The house had a friendly, happy, calm atmosphere.

We spoke with at least eight people, three whom we spoke with in detail. One person told us that �There is always something going on, it�s a good place to live, so warm and safe. The food is very good'. Another said �I am not sure how they know what I like, but I always get the right things�. A third said �I was not keen to come to a residential home, but this is the best thing. I hope I am around another ten years, I enjoy my life here'.

We saw that staff were busy, but they didn't rush. They responded in a person focused way that helped people, if they were confused, to be calm and confident. We spoke with a relative; they said their relative was happy, that they were always made to feel welcome. Staff told us they liked working here, that they enjoyed getting to know the people they support and were proud of giving quality service.

Inspection carried out on 22 October 2012

During a routine inspection

We made an unannounced visit to the service and spoke to people who use the service, the Registered Manager and to staff members.

Not all the people at Bradfield Residential Home were able to talk with us directly to tell us about their experiences. We spent time with the people and observed interactions between the people and the staff.

Other people were able to talk with us and tell us about their experiences at the home. The four people we spoke with gave us positive feedback about the service.

They said: "There is always someone around to help me if I need it but they let me be myself.� �They always ask me if I want to go to bed, but if I say no that is respected.� �I have no complaints, not one. The food is marvellous.� �The staff don�t have much time to sit and chat but they always ask me if I am alright and if there is anything I need�.

People told us that they were treated with respect by the staff that supported them and that their privacy was maintained. They felt listened to and supported to make decisions about their care. They said that they received the health and personal care they needed and that they were comfortable. They said that their likes and dislikes were taken into consideration.

Reports under our old system of regulation (including those from before CQC was created)