Archived: Braceborough Hall Retirement Home

Braceborough Hall Retirement Home is a care home providing personal and nursing care to 14 people aged 65 and over at the time of the inspection. The service can support up to 25 people. The service design is set out over two floors, with multiple communal areas and some shared room facilities.

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

The registered providers representative was unable to demonstrate formal systems and process to continually monitor and provide oversight to the service.

We recommended the provider representative follows through with plans to implement a formal quality assurance process to enable them to continually monitor and maintain oversight of the service.

The registered manager had effective processes in place to enable them to monitor quality, identify shortfalls in the service and address these in a timely way. People had care plans in place which were personalised to them. The service worked with health care professionals, who spoke highly of the care staff provide.

Risks associated with people’s care had been identified, assessed and were being monitored. Environmental risks had been mitigated to prevent harm to people. Staff received safeguarding training and understood their responsibilities to keep people safe. There were safe recruitment practices in place. Medicines were managed well. Action had been taken following accidents and incidents to reduce reoccurrence. Infection prevention and control had improved and there were clear processes to manage restrictions relating to the Covid-19 pandemic.

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 24 December 2019)

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 regulation 9 (person centred care), regulation 12 (safe care and treatment) and regulation 17 (good governance).

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 4 November 2019. Breaches of legal requirements were found. The registered manager completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, person centred care and good governance.

We undertook this focused inspection to check they had followed their action plan and to gain assurance around improvements in the service. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

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 coronavirus and other infection outbreaks effectively.

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

Follow up

We will 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.

Braceborough Hall retirement home is a residential care home providing personal and nursing care. 19 people aged 65 and over at the time of the inspection were receiving care. The service can support up to 25 people.

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

The risks to people’s safety were not always assessed, and measures to reduce risks were not implemented. People were not always protected from the risk of abuse as not all staff had received safeguarding training to support their knowledge of safeguarding issues. The investigations into safeguarding issues did not show learning from events. People’s medicines were not always managed effectively. People were not always protected from the risks of infection, as there was a lack of personal protective equipment in some communal areas, and there was a lack of cleaning schedules to show how areas were being cleaned.

People were supported by adequate numbers of staff, however due to staff shortages the registered manager had been required to undertake duties extra to their role. This had impacted on their ability to retain effective oversight of the service. Quality assessment processes were not robust, and this had impacted on the quality of information in people’s care plans to provide staff with clear information on their care. There was a lack of analysis of falls and environmental risks had not been properly assessed.

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; however the policies and systems in the service did not support this practice. The mental capacity assessments in place for people lacked clarity and consistency and were not completed in line with the mental capacity act.

People were supported by staff who were kind and caring. People and relatives told us the staff communicated well with them. Staff told us they felt supported by the registered manager

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 Good (published 28 April 2019)

Why we inspected

This was a planned inspection based on the previous rating.

We have identified breaches in relation to safe care and treatment, person centred care, recruitment processes, and governance at this inspection.

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

Follow up

We will 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.

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 home is run.

People and their relatives told us that they felt safe at the home. Staff were trained in adult safeguarding procedures and knew what to do if they considered someone was at risk of harm, or if they needed to report concerns.

There were systems in place to identify risks and protect people from harm. Risk assessments were in place and carried out by staff that were competent to do so. The risk assessments recorded what action staff should take if someone was at risk. Referrals were made to appropriate health care professionals to minimise risks and meet people’s health needs.

There were sufficient staff to keep people safe and meet their needs. The registered manager had followed safe recruitment procedures. Medicines were given to people on time and as prescribed.

Policies and procedures were in place to guide staff in relation to the Mental Capacity Act 2005. Staff understood the processes in place for ensuring decisions were made in people’s best interests. Staff and the registered manager were ensuring these steps were taken for people living at the home. Staff sought people’s consent and recorded this.

Staff were caring, they knew people well, and they supported people in a dignified and respectful way. Staff acknowledged and promoted people’s privacy. People felt that staff were understanding of their needs and they had positive working relationships with them.

People and their relatives were involved in the assessment and reviews of their needs. Staff had knowledge of people’s changing needs and they supported people to make decisions or changes to the way their planned care was delivered. Staff offered choices to people regarding all aspects of their care and support, and upheld these choices. People told us that they had access to activities and hobbies.

People and staff knew how to raise concerns and these were dealt with appropriately. The views of people and relatives were sought as part of the service’s quality assurance process. Quality assurance systems were in place to regularly review the quality of the service that was provided.

After our inspection on 1 October 2015 the registered persons wrote to us to say what they would do to meet legal requirements in relation to the breaches. The said that all of the necessary improvements would be made by 1 January 2016.

We completed the present inspection on 26 May 2016 to check that the improvements had been made so that people could safely and reliably receive all of the care they needed.

This report only covers our findings in relation to the breaches. You can read the report from our last comprehensive inspection and focused inspection, by selecting the 'all reports' link for Braceborough Hall Retirement Home on our website at www.cqc.org.uk

Braceborough Hall Retirement Home is registered to provide accommodation and personal care for up to 25 older people. The service is in a rural location that is approximately six miles from Stamford.

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.

During the present inspection we found that the registered persons had made the necessary improvements to address the shortfalls we had previously identified. There were arrangements in place to support people when they were at risk of not eating and drinking enough to stay well. People were being offered sufficient opportunities to express their autonomy by following their hobbies and interests. In addition, the registered persons had strengthened the way in which quality checks were completed in relation to the assessment and delivery of care, the recruitment and training of staff and the maintenance of the accommodation.

At our inspection on 17 July 2014 we found that improvements needed to be made to make sure that people reliably received safe care. This was because the arrangements to support people who had a particular medical condition were not robust. In addition, staff were not carefully monitoring some people who were at risk of not eating enough.

We also found that the provider had not given staff all of the induction and on-going training they said was needed. The provider said that the training was necessary to contribute to staff having the competencies they needed to care for people in the right way. We found that some staff did not have all of the knowledge and skills they needed to care for people in an effective and responsive way.

Our inspection noted that the provider had not completed rigorous quality checks. This had resulted in some fire safety checks not being completed. Also, the provider had not identified and resolved the problems we noted in relation to the delivery of care and supporting staff. These problems had reduced the provider's ability to ensure that people consistently received the assistance they needed in a safe setting.

After our inspection the provider wrote to us and said that they had made the improvements that were necessary to address our concerns.

Our inspection on 15 December 2014 examined the way in which people who had a particular health care condition or who were at risk of not eating enough were assisted to stay well. We also checked the knowledge and skills staff had and the training they had received. In addition, we looked at the quality checks completed by the provider. We found that the provider had introduced all of the improvements that were necessary to ensure that people's care needs were reliably met.

We considered our inspection's findings to answer questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? This is a summary of what we found:

Is the service caring?

We found that the service was caring. This was because people said that staff were respectful, kind and attentive. They considered staff to be genuinely committed to helping them. Relatives were confident that staff were polite and courteous to people who used the service.

Is the service responsive?

We found that the service was responsive. This was because staff knew about each person's choices and preferences about the care they wanted to receive. People said that their care needs were met in a flexible way with staff being happy to adjust the assistance they provided according to the person's changing needs and wishes.

However, we have said that the provider may find it useful to make some improvements to further develop the service. These included increasing the opportunities people have to participate in social activities. In addition, we noted that people considering using the service need more information about the terms and conditions that apply. This is necessary so that people can reach an informed decision about whether the service is right for them.

Is the service safe?

We found that the service was safe. This was because staff understood their roles and responsibilities to ensure that people were protected from the risk of abuse including physical and financial abuse.

However, we have said that the provider may find it useful to make some improvements to further develop the service. These involved strengthening the systems used to guide staff in the correct application of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. These measures are designed to support people to make decisions that are in their best interests. In addition, they safeguard people when they need to have their liberty restricted to keep them safe from harm.

Is the service effective?

We found that the service was not effective. This was because some people's individual needs for care had not been properly assessed and met. We looked at the care four people had received. We found that there were inadequate arrangements to assist people to maintain a healthy body weight. In addition, staff had not been given the support they needed to effectively care for two people who lived with a particular medical condition. Although the shortfalls had not resulted in people experiencing actual harm, they foreseeably increased the risk of this happening. This was because staff were not consistently using the correct systems to identify and respond to some people's care needs.

In addition, we found that staff had not received all of the training the provider said they needed in order to effectively care for people.

We have told the provider that they must make improvements to resolve these shortfalls.

Is the service well led?

We found that the service was not well led. This was because some quality checks had not been completed in an effective way. This had resulted in shortfalls in the delivery of care, staff training and health and safety not being quickly identified and resolved. These problems reduced the provider's ability to ensure that people consistently received the assistance they needed in a safe setting.

We have told the provider that they must make improvements to resolve these shortfalls.

People told us they enjoyed living and receiving care at Braceborough Hall. One person said 'The staff and food are wonderful.' Another said they had never heard staff say 'I can't be bothered or I don't have time.' Visiting friends and relatives compared the service favourably with others they had knowledge of'

People told us they felt safe, trusted care staff and felt confident in raising concerns or complaints. One person said 'If there is anything wrong I tell them.'

We observed positive respectful and warm interaction between staff and people who received a service, their friends and relatives. We noted staff knocking before entering people's rooms, and asking people's views and opinions in relation to the care and support they received.

Assessments and care plans we looked at included the views of people receiving a service, close relatives and health and social care professionals. Records included consideration of circumstances where people may need help to make decisions due to memory and awareness problems associated with ageing.

Staff told us that they enjoyed working at the service and felt generally well supported by the provider. We saw staff had not within the past year been offered 1:1 supervision or annual job appraisal. The manager was unable to provide clear information regarding the provision and planning of essential staff training.

We saw that the provider had sought the views of people who used the service. We saw that the collection of information required to assess and manage risk was limited in areas including fire safety, water safety and accidents/incidents.

We saw people were treated with dignity and supported to make decisions about their care.

People told us they liked living at the home.

People said the food was good and were given a choice at mealtimes.

One person told us if they needed help staff come very quickly.

We observed staff being supportive and reassuring people.

During our visit we looked at infection control issues. We found people were protected from the risk of infections as procedures and training were in place to support staff with this issue. Overall the home was clean and well furbished.