• Care Home
  • Care home

Archived: Brightlands

Overall: Requires improvement read more about inspection ratings

77 Main Road, Hoo, Rochester, Kent, ME3 9AA (01634) 250592

Provided and run by:
Clearwater Care (Hackney) Limited

All Inspections

13 October 2015

During an inspection looking at part of the service

We inspected this home on 13 October 2015. This was an unannounced inspection.

Brightlands is registered to provide accommodation and personal care for up to 13 people with a learning disability. Each person who lives in the service is provided with en-suite facilities for their own use. Accommodation is provided over three floors and there is a stair lift to the first floor only. People who lived in the home had learning disabilities, some with communication difficulties, physical disabilities and challenging behaviour. At this inspection we found that there were 10 people living in the home.

At our last inspection on 26 February 2015, we found that the provider was in breach of Regulation 14 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Staff had not followed specialist guidance on feeding one person. We requested the provider to submit an action plan on how and when they planned to improve the service. The provider submitted an action plan to show how they planned to improve the service by 06 July 2015.

We inspected the home against four of the five questions we ask about services: is the service safe, effective, responsive and well led.

Prior to this inspection we received information of concern in relation to care practices at the home. This included whistleblowing information that had not been investigated and poor staff practice. In addition, concerns had been raised about lack of consistency of records, incidents that were not reported to the local authority and notifications that had not been sent to the commission to tell us about incidents and accidents in the home.

There was a registered manager at the home. 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.

Medicines had not been properly managed. Not all staff were trained and allowed to give medicines, and people did not always receive their medicines in a timely manner, to meet their needs.

Brightlands had a safeguarding policy. They also had a copy of the local authorities safeguarding adult’s policy, protocols and guidance. However, the registered manager had not followed the local authorities safeguarding policy, protocol and procedure. The registered manager had not appropriately deployed staff to meet people’s needs.

Accidents and incidents in the home had not always been reported to the local authorities and other relevant agencies.

Although risk assessments were in place, risks to people’s safety and wellbeing were not always managed effectively to make sure they were protected from harm.

Areas of the home were visibly dirty and the provider failed to protect people from the risk of infection or to maintain a clean environment.

Appropriate action was not always taken in timely manner when people’s weights reduce; to ensure that their nutritional needs are met.

Effective systems were in place to enable the registered manager to assess, monitor and improve the quality and safety of the service. However, shortfalls had not been identified by the registered manager and actions had not been taken in a timely manner to improve the quality of the service.

Staff encouraged people to undertake activities. However, there were not enough resources to meet people’s chosen activities. People were not provided with sufficient, meaningful activities to promote their wellbeing. Staff spent time engaging people in conversations, and spoke to them politely and respectfully.

The complaints procedure did not provide information about all of the external authorities people could talk to if they were unhappy about the service. People told us they would speak to the manager if they wished to complain.

One person’s care plan did not correspond with the level of risk they had been assessed at. The home did not have all associated behavioural guidelines in place to identify and reduce risks. These risks involved when meeting people’s needs such as behaviours that challenge, and details of how the risks could be reduced. Staff were unable to take immediate action to minimise or prevent harm to people based on specified guidelines.

Staff had received training relevant to their roles such as epilepsy, safeguarding, Deprivation of Liberty Safeguards (DOLS) and challenging behaviour. However, staff training were lacking in some other essential areas. Regular supervision and appraisals were lacking.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager understood the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty safeguards.

Staff meetings and residents meetings took place in the home.

Safe medicines management processes were in place and people received their medicines as prescribed.

During this inspection, we found breaches of regulations relating to fundamental standards of care. You can see what action we told the provider to take at the back of the full version of this report.

26 February 2015

During an inspection looking at part of the service

The inspection took place on 26 February 2015 and it was unannounced.

Brightlands is registered to provide accommodation and personal care for up to 13 people with a learning disability. Each person who lives in the service is provided with en-suite facilities for their own use. Accommodation is provided over three floors and there is a stair lift to the first floor only.

At our last inspection on 08 July 2014, we found that the provider was in breach of regulations relating to cleanliness and infection control, management of medicines, safety and suitability of premises, supporting workers and assessing and monitoring the quality of service provision. We requested the provider submit an action plan on how and when they planned to improve the service. The provider submitted an action plan to show how they planned to improve the service by November 2014.

There was a registered manager 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.

Risk assessments failed to tell staff what action to take when people removed their catheter bag bag, and could lead to cross infection. Local infection control procedures were not available for staff to comply with. We have made a recommendation about this.

Staffing levels were too low to meet people’s needs. The shift times were varied and not consistent. The staff roster did not evidence how people received their support hours and did not detail which staff was allocated to which person in order to fulfil the additional support. We have made a recommendation about this.

Medicines were administered covertly, hidden in food. There was no covert medicine administration protocol in place. The correct process for covert administration of medicine had not been followed. We have made a recommendation about this.

Staff had completed training in a range of areas that reflected their job roles. Staff had received one to one supervision however, they had not received regular annual appraisals to identify any additional training and skills that maybe required to support people.

People told us they enjoyed the food, had plenty to eat and drink. However, where people needed help with eating, we saw that they were rushed, which made them were unhappy.

While some people were encouraged to take part in activities and leisure pursuits of their choice, and to go out into the community as they wished, some other people were not encouraged and supported to be actively engaged in activities inside and outside of the home. We have made a recommendation about this.

The staff we spoke with were able to tell us the action they would take to ensure that people were protected from abuse. All staff had received training about safeguarding.

Thorough recruitment checks were carried out prior to staff working in the service. This ensured staff were suitable to work with people.

The provider had a clear set of visions and values. Our observations and what we were told by staff showed us that these values had not been successfully implemented by the staff who worked at the service.

There were systems in place to protect people from abuse. The staff were aware of their roles and responsibilities in relation to protecting people from abuse. Relatives felt people were safe in the service and indicated that if they had any concerns they were confident these would be quickly addressed by the registered manager.

Where people lacked the mental capacity to make decisions the registered manager and staff were guided by the principles of the Mental Capacity Act 2005 (MCA) to ensure any decisions were made in the person’s best interests.

People were supported to attend health care appointments and visits from health care professionals such as district nurses.

People’s needs were fully assessed with them before they moved to the service to make sure that they could meet their needs. Assessments were reviewed with the person concerned and their relatives and care plans had been updated as people’s needs changed.

Staff demonstrated respect for people’s dignity during our visit, they were discreet in their conversations with one another and with people who were in communal areas of the service. People knew how to make a complaint if they were unhappy about any aspect of the service.

People spoke positively about the way the service was run. Members of staff told us that the registered manager was very approachable and understanding. They said they were encouraged to raise issues or make suggestions and felt they were listened to.

During this inspection we found a breach of Regulation 14 of the Health and Social Care Act

2008 (Regulated Activities) Regulations 2010, which corresponds to regulations 14 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Staff failed to adhere to professional’s guidance on people’s food intake.

You can see what action we told the provider to take at the back of the full version of this report.

8 July 2014

During an inspection in response to concerns

We visited the home on Tuesday 08 July 2014. Two inspectors visited to undertake a responsive inspection following on from information received from a whistle-blower with safeguarding concerns. We looked at records including care plans, staff files, policies and procedures. We spoke to people who lived at the home and staff. We looked around the home including people's rooms with people's permission. We used all the information we gathered to answer the following five questions.

Is the service safe?

People we spoke with told us they felt safe, they told us that if they were concerned about anything they would speak to the manager or the staff. Safeguarding procedures were available, and staff we spoke with were clear on what constituted abuse or when they should be reporting suspicions to the manager. We saw a supervision meeting record which documented that one member of staff had told the person supervising them that a member of staff had shouted at some people who lived in the home. However, this had not been brought to the attention of the manager or followed up. This was followed by the manager at our request. This meant that failure to report suspected abuse by staff could increase the risk of harm to people who lived in the home.

The service did not have robust infection control procedures in place, for example we saw that hand wash soap and hand gels were not available in all toilets, en-suite shower rooms and main bathrooms. Some people's bedrooms had carpets that were badly stained and smelt of urine. This showed that people could be put at risk of harm.

People's health and care needs were assessed at the time of admission to the home; however these had not been repeated to ensure any changes were documented. Where possible people and/or families had been involved in writing their care plans. The care plans had details of people's care and support needs. We saw risk assessments with the management strategy of how to reduce people's risks. Care plans were therefore able to give staff enough information to provide consistent care and support to safely meet people's needs.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to assessing and meeting people's needs people's needs

Is the service caring?

People were supported by kind and attentive staff. We saw that care staff showed patience and sensitivity when supporting people. People commented, "I like it here' ; 'Got my jobs I can get on with' and 'Staff treat me OK'. Other people told us 'If I am unhappy I talk to X (the manager)", Staff help me a lot, they talk to me when I am worried".

Staff understood people's individual needs and preferences and interests as well as their care and support needs. We saw that they knew how best to communicate with individuals, and told us how they knew when people were not happy and what to do to prevent possible changing behaviour.

Is the service responsive?

Staff explained that they have a number of health professionals they can speak with if they have concerns about individuals. They included, the person's GP, district nurse, and psychologists.

We found that there were some areas of the home, where maintenance issues had been identified and reported. However, repairs had not been actioned in a timely manner. This had left the home unsecure and unsafe.

Is the service well-led?

We found that the views of people who lived in the home were sought, their families and some health professionals. For example, a survey had been given out to people who lived in the home, their families and health professionals who visited on a regular basis. Staff undertook a keyworker review of teach person's care plan with individuals every month and also reviewed care plans with the person, their families and care manager twice a year.

The service did not have effective and robust quality audit systems in place; we found there were either no auditing systems or the manager had not completed them regularly.

We found the home's decoration and fittings had been allowed to deteriorate, with parts of the home looking tired, items needed to be replaced and some areas were in need of maintenance. This meant that the home was not a clean, safe and homely environment for people to live in.

3 October 2013

During a routine inspection

People’s dignity and privacy was respected and cultural differences were recognised and included in their support plans.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

We spoke with two people who used the service about their experience of living in the home. They told us that they liked their home. They commented, "I like it here” and “I am happy here, it’s fine”.

The staff were trained, skilled and experienced to meet people's needs.

People who used the service, their representatives and staff were asked for their views about their care and treatment and they were acted on.

People were made aware of the complaints system. This was provided in a format that met their needs. Staff supported people and they had their comments and complaints listened to.

27 February 2013

During a routine inspection

We used a number of different methods to help us understand the experiences of people using the service, because some people were not able to tell us their experiences. This included the use of the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand people's experiences.

We observed that staff communicated with people who live in the home in an individual way and respected their dignity.

Care plans were written from the point of view of the person who was receiving care and gave guidance to staff about how to support people to meet their individual needs. “My key worker looks after my care plan”, one person told us.

Staff were aware of people’s dietary needs and specific guidance was in place to support people who were at risk of poor fluid and food intake.

Plans were in place to refurbish parts of the home that had not been adequately maintained and that did not present a dignified environment to the people who live at the home. This work was to the downstairs areas of the home.

The home had assessed the quality of service that it provided and had put a plan of action in place to address the areas of the service where shortfalls had been identified. People who use the service and their representatives had been asked for their views of the quality of the service and a plan of action was in place to address the shortfalls highlighted in this survey.

5 October 2011

During an inspection looking at part of the service

At our visit to the service on 18 March we judged that the service was not compliant with four of the Essential Standards of Quality and Safety. After this visit and at our request, the service sent us a report detailing what action they were going to take to achieve compliance in these areas. The aim of this visit was to assess if the service had put this plan into practice and that it was now respecting and involving the people, obtaining people's consent, meeting people's health and welfare needs and providing adequate levels of staffing.

People told us that they enjoyed going out into the community and that they knew the care staff team well.

We used a specific way of observing care to help to understand the experience of people who could not talk with us.

18 March 2011

During a routine inspection

People told us that they like to do lots of different things. They said that they like to chat with people at college, to go shopping or to a caf'. One person said, "My key worker does all sorts of things with me. You name it, he does it!"

People told us that staff were helpful and that they could talk to them if they had any concerns. They said that staff were usually around if they needed help from them.

Not all staff treated people who lived in the home with dignity and respect. One person who lived in the home responded angrily to a member of staff when they went to wipe their mouth without their consent. "I am not a baby. I'm a grown man", was their justified response..

People told us that they had their own room and that no one had to share.

People said that a new person was going to be the home manager and that they had met them.