Bradwell Hall Nursing Home

Bradwell Hall is a care home providing personal and nursing care for up to 127 people aged 65 and over some of whom are living with dementia, mental health conditions, sensory impairments and physical disabilities. Bradwell Hall accommodates people across five different units, each which have their own adapted facilities. At the time of the inspection 64 people were living at the service.

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

People told us the care they received had significantly improved. The home had reduced in size which meant management had a greater oversight about the needs of people living at the service. The policies and practices in place had been redeveloped to support the new mission statement of the service.

People were supported by a well-trained staff team who understood people’s needs and knew how to keep people safe. Staff were recruited safely and there was a positive culture shift amongst the staff across the home. People received their medicine in a safe way and practices which had previously deemed to be unsafe were no longer supported. Staff understood the importance of choice and cared for people in a dignified way.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Care plan documentation had improved. Records were detailed and gave staff the information they needed about people they were supporting. The governance systems had been redeveloped which evidenced care and support people received was monitored and reviewed to continue to drive improvement.

There was a new registered manager in place. The clinical operations director had continued to work with the providers, staff and people at the home to continue to improve practices, embed and sustain improvements and continue to enhance the quality of the service.

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

Rating at last inspection (and update)

The last rating for this service was inadequate (published 10 February 2021).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since September 2020. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an unannounced inspection of this service on 29 and 30 September 2020. Breaches of legal requirements were found in regulation 12 (Safe Care and Treatment), regulation 13 (Safeguarding Service Users from Abuse and Improper Treatment) and regulation 17 (Governance). The provider completed an action plan after the last inspection to show what they would do and by when to improve.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Caring, Responsive and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from inadequate to good. This is based on the findings at this inspection.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Bradwell hall Nursing Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Bradwell Hall Nursing Home is a residential care home providing nursing care to 116 people aged 65 and over at the time of the inspection. The service can support up to 187 people.

Bradwell Home Nursing Home has seven units, each with their own communal areas. During this inspection, we visited three of the units. People living in the home are living with dementia, mental health conditions, physical disabilities and sensory impairment.

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

People were not always protected against the risk of abuse. Before and during our inspection we had safeguarding concerns and three safeguarding referrals were made during and after this inspection.

People’s care and treatment was not always provided in a safe way. Staff did not always follow people's care plans, which increased the risk to their health and safety.

People’s medicines were not always safely managed. Staff did not always follow the provider's infection prevention and control systems and this placed people at risk of cross infection.

The registered persons had not ensured all staff supported people safely with their care. Staff did not always report concerns about people’s health needs.

We found widespread shortfalls in the way the service was managed and there was a risk of people receiving inappropriate care.

The provider had quality systems, including clear plans for improvement, in place. However, these were not always used effectively to help identify concerns to people’s health, safety and wellbeing.

The provider ensured people lived in a safe building. Safety checks and on-going monitoring helped to ensure the environment and equipment were in a good state of repair.

At the time of our inspection, no one at the home had a positive test result for COVID-19. The provider ensured people and staff were tested in line with government guidance.

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

Rating at last inspection

The last rating for this service was requires improvement (published 20 March 2020) and there were breaches of regulation.

Why we inspected

Since our previous inspection, the provider had improved on their reporting processes for safeguarding concerns. However, there had been a significant increase in safeguarding concerns of a specific nature to warrant further inspection. These concerns included allegations of abuse, altercations between people and how these were managed. This had resulted in the local safeguarding authority monitoring the home more closely. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. We did not inspect the key questions of effective, caring and responsive which are rated requires improvement. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Bradwell Hall Nursing Home on our website at www.cqc.org.uk.

Enforcement

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safeguarding people, the safe care and treatment of people and the management systems in place for the home at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Bradwell Hall is a nursing home that provides personal and nursing care for up to 187 people. Bradwell Hall accommodates people in seven units across five different wings, each of which has separate adapted facilities. At the time of the inspection, 160 people were using the service.

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

People were not always protected from the risk of harm and abuse because some staff were not always confident in identifying what may constitute abuse and the mechanisms in place for staff to report concerns were not fully understood. Safeguarding concerns were not always reported in a timely and safe way.

Some systems had been introduced to improve the governance of the service. However, these had not yet been imbedded into practice and we were unable to determine the impact of the effectiveness of the changes.

There had been some changes to the management at the home to try and improve the day-to day running of the units and provide the registered manager with a full oversight of the service. This was newly implemented, and it was not yet possible to review the success of the practice.

There were mechanisms in place to learn lessons when things went wrong; however, some errors were still occurring, and these had not been reviewed to ensure the risk of reoccurrence was mitigated. Some regulatory requirements had not been met.

There was a high number of agency care staff working at the home, but this was balanced against the improvements made to the number of permanent nursing staff now employed at the service.

Since the last inspection, people’s individual risks had been reviewed and care records amended to reflect people’s specific needs.

Medicine management had improved, and the risks associated with infection prevention and control had been reduced.

The home was working well with other professionals to try and improve outcomes for people.

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

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 15 November 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found some improvements had been made and the provider was no longer in breach of some of the regulations. However, we found one further breach of regulation and we noted further improvements were required in some areas and the provider was still in breach of some regulations.

Why we inspected

We received information in relation to how safeguarding allegations were managed. As a result, we undertook a focused inspection to review the Key Questions of Safe and Well-led only.

The overall rating for the service has not changed. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvement. Please see the Safe and Well-Led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Bradwell Hall Nursing Home on our website at www.cqc.org.uk.

Enforcement

The provider had failed to notify us, without delay of incidents related to abuse or an allegation of abuse in relation to a service user. This was a breach of Regulation 18 (Notification of other incidents) Care Quality Commission (Registrations) Regulations 2009.

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 continue to monitor information we receive about the service. We will continue to request an action plan for 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.

Bradwell Hall is a nursing home that provides personal and nursing care for up to 187 people. Bradwell Hall accommodates people in seven units across five different wings, each of which has separate adapted facilities. At the time of our inspection, there were 167 people using the service.

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

People were not always protected from the risk of harm as staff did not always have or follow the correct guidance to help them manage people’s risks and health conditions. Environmental risks were not always assessed and managed. The provider did not consistently ensure that infection control and prevention measures were in place.

There was a lack of governance because the provider and the registered manager did not consistently have a clear oversight of the day-to-day running of the service. The systems that were in place to assess the quality and safety of the service were not always effective.

Staff were not always deployed effectively around the home which meant people did not always receive person-centred care.

Staff knew how to identify and report safeguarding concerns and the policies and systems in the service largely supported the principles of the Mental Capacity Act. The provider supported people’s end of life wishes and these were recorded in line with people’s preferences. We observed some caring interactions between staff and the people they were supporting.

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

Rating at last inspection

The last rating for this service was Requires Improvement (published 19 October 2018). At this inspection enough improvements had not been made and the provider was in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

The inspection was prompted in part due to our continual monitoring of the service and concerns we received, and we needed to ensure that improvements had been made following our focussed inspection in August 2018. We have found evidence that the provider needs to make further improvements. You can see what action we have asked the provider to take at the end of this full report.

Enforcement

At this inspection, we have identified breaches in relation to Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Person centred care), Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Safe Care and Treatment), Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Good Governance) and Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Staffing).

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 meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. 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.

Bradwell Hall Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Bradwell Hall Nursing Home is registered to provide personal care and accommodate up to 187 people, based in one building. There were six ‘units’. The units were called, Keele & Breward, Tunstall, Chatterley, Chester, Sneyd and Audley & Little Audley. There were 176 people using the service at the time of our inspection.

There was a registered manager in post. 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.

Quality assurance systems in place were not always effective in identifying when improvements were required. Lessons had not been fully learned following the identification of a risk regarding peoples’ continence care.

Improvements were required about how people were supported to have their prescribed medicines. There was mixed feedback about staffing, but overall staff were not effectively deployed to ensure people did not have to wait for support. Staff were recruited safely and they had their character checked before supporting people.

People felt safe but there was a delay in making a referral to the necessary organisation following two incidents occurring. People were protected as infection control measures were in place and the building was appropriately maintained and checks took place.

People, relatives and staff felt the management team were approachable and were able to give feedback about their care. The registered manager and provider were receptive to feedback and wanted to improve the service.

Notifications were made as required and the previous CQC rating was being displayed as required.

Bradwell Hall is registered to provide accommodation and nursing care for up to 187 people. People who use the service have physical health and/or mental health needs, such as dementia. Bradwell Hall provided accommodation and nursing care over seven separate units. We inspected all of the units within the service. At the time of our inspection there were 170 people using the service.

The service had a registered manager in post. 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. Each unit also had a unit manager who reported to the registered manager.

Some improvements were needed to ensure that some medicines were recorded and administered safely.

People told us they felt safe and we saw that staff carried out support in a safe way. People were supported to be as independent as possible whilst taking account of any risks to their safety.

We saw that there were enough staff available to meet people’s assessed needs. The provider had an effective system in place to monitor the staffing levels and the provider had a recruitment procedure in place, which ensured people were supported by suitable staff.

Staff listened to people and encouraged them to make decisions about their care and where able people consented to their care. Where people were unable to consent to their care people were supported to have the maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff received regular training which ensured they had the knowledge and skills required to meet people’s needs effectively.

People told us that the food was good and improvements had been made to ensure that people received positive mealtime experiences on all of the units.

People were supported with their health needs and advice was sought from health professionals when required, which was followed by staff to maintain people’s health and wellbeing.

People who used the service and their relatives told us the staff treated them with compassion, dignity and staff listened to and respected their care choices people made.

People had access to interests and hobbies that were important to them. There were dedicated members of staff available to provide these activities alongside care staff and people were supported to meet their emotional and social needs.

People’s preferences were sought and staff understood how people liked their care to be carried out. People’s care needs were regularly reviewed and updated.

People and their relatives understood how to complain and were happy with how complaints were handled. We saw that complaints were managed in line with the provider’s complaints policy.

People and their relatives were encouraged to provide feedback about their care, which was acted upon by the registered manager and changes were made in response to the feedback received.

Effective systems were in place to monitor the quality of the service and actions had been taken to make improvements to people’s care.

People told us that the management team promoted a friendly atmosphere across the service. We saw that the provider promoted an open culture and people and staff told us that the management was approachable and that they listened to them.

Bradwell Hall is registered to provide accommodation and nursing care for up to 187 people. People who use the service have physical health and/or mental health needs, such as dementia.

Bradwell Hall provided accommodation and nursing care over seven separate units. We inspected the Audley, Breward, Chester, Chatterley, Keele and Sneyd units. The provider had recently registered the Tunstall unit and at the time of the inspection this unit was not providing a service. At the time of our inspection there were 141 people who used the service.

The service had a registered manager in post. 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.

Systems were not always in place to ensure people received their medicines safely. Improvements were needed to ensure that some medicines were stored and administered safely.

Some improvements were needed to peoples’ mealtime experiences to ensure that people on all of the units experienced their meals in a calm and organised environment.

People had access to some interests and hobbies within the service. However, improvements were needed to ensure that when the dedicated member of staff was unavailable to provide these activities, people were still supported to meet their emotional and social needs.

Some improvements were needed to ensure that the systems in place to monitor the quality of the service provided were monitored effectively.

People told us they felt safe and we saw that staff carried out support in a safe way. People were supported to be as independent as possible whilst taking account of any risks to their safety.

We saw that there were enough staff available to meet people’s assessed needs. The provider had an effective system in place to monitor the staffing levels and the provider had a recruitment procedure in place, which ensured people were supported by suitable staff.

Staff listened to people and encouraged them to make decisions about their care. We found that the provider followed the legal requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). The Mental Capacity Act 2005 and the DoLS set out the requirements that ensure where appropriate; decisions are made in people’s best interests when they are unable to do this for themselves.

Staff received regular training which ensured they had the knowledge and skills required to meet people’s needs effectively.

People were supported with their health needs and were able to access other health professionals when required.

People who used the service and their relatives told us the staff treated them with compassion, dignity and respect and staff listened to their choices in the care they wanted.

People told us that the management team showed them care and they promoted a friendly atmosphere across the service.

People’s preferences were sought and staff understood how people liked their care to be carried out. People’s care needs were regularly reviewed and updated.

People understood how to complain and complaints were managed in line with the provider’s complaints policy.

People and their relatives were encouraged to provide feedback about their care, which were acted upon by the registered manager.

The provider promoted an open culture. People and staff told us that the management were approachable and that they listened to them.

Bradwell Hall was divided into five separate units providing nursing and personal care for people with a diverse range of needs. During this inspection we inspected four of the five units and our focus was on the care of people with dementia care needs.

Relatives we spoke with told us, "X has been here for two years, we came to look around and preferred this home to any of the others we had seen. We visit at least every other day and have no concerns. We are told if there are any changes to X's condition and get to talk to the staff or manager if we need to".

During this inspection we observed interactions between staff and people who used the service and noted when interactions were positive or not, to determine what people's experience of care were like. We saw that some people had positive experiences and we were provided with some positive comments about the support provided, but we also saw that the service could make improvements to ensure that quality standards were maintained throughout the service.