Archived: Brecklands Nursing Home

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with six people who lived at the home, the provider, a representative of the provider, a nurse, a domestic and two care staff. We also reviewed records that related to the management of the home. These included four people's care and health records, policies and procedures, accident records and audit reports. At the time of our inspection there were 14 people living at the home.

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

Is the service safe?

We found that action had been taken by the provider to ensure people who were at risk of malnutrition, dehydration and developing pressure areas received care that was appropriate and met their needs.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. On the day of our inspection we were told that no one who lived at the home was subject to a DoLS application. However, the provider did not understand people's rights not to be deprived of their liberty. We saw that one person could not leave the home without requesting staff to escort them. The provider had not assessed this practice or if the person had capacity to make decisions for themselves. This meant that the person's rights were not being promoted and respected. This is being followed up and we will report on any action when it is complete.

Is the service effective?

The majority of people told us that they were happy with the support they received. For example, one person told us, 'I'm very happy and comfortable thank you. My daughter comes every day. We sometimes sit out in the garden when it's hot. It's very well maintained'. Another person told us, 'Care is good'. A third person told us, 'It's lovely here; you get your hair done. It makes you feel better'.

Two people told us that they felt that at times there were insufficient staff on duty. One person told us that at times, they felt the care they received was rushed when being bathed and dressed. Another person told us at times lunch was served late and that, 'I've gone past it by then'.

Is the service caring?

People told us that they were happy with the staff. One person told us, 'We have a very good gardener. The girls are very nice here, very caring'. Another person told us, 'The proprietor is a charming lady. Her policy is that staff should treat residents as their own family and I believe it to be true. There is a good feeling about the place'.

Is the service responsive?

At this inspection we found that care planning systems had improved but that very little action had been taken in response to clinical oversight and robust management. This is being followed up and we will report on any action when it is complete.

Is the service well-led?

At previous inspections we raised concerns regarding the management of the home and how this impacted on the quality of service that people received. In particular this related to the provider's lack of clinical governance and management oversight in relation to nursing knowledge and practices. At this inspection we found that issues remained. As a result, people were at risk of unsafe or inappropriate care because the quality of care and service provision was not being monitored by a responsible individual with clinical oversight. This is being followed up and we will report on any action when it is complete.

In response to our previous inspection the provider sent us an action plan that detailed steps that would be taken make improvements at the home. We found that steps had been taken to improve care planning as per the contents of the providers action plan but that the provider had not ensured the action points that related to clinical governance and management had been acted upon.

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with five people who lived at the home, three relatives, and a representative of the provider, two nurses, a cook and two care staff. We also reviewed records relating to the management of the home which included three people's care and health records, policies and procedures, accident records, complaints and audit reports. At the time of our inspection there were 17 people living at the home. We were informed everyone who lived at the home had high level nursing and care needs. Some people also had reduced memory or dementia. As some people could not talk to us about their experiences of living at the home we spent time observing how they were cared for and treated by staff. We observed interactions between staff and people who lived at the home for two hours during the morning and afternoon.

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

Is the service safe?

We found that some people were at risk of receiving inappropriate care because their needs were not planned for, or managed safely. This included people who were at risk of malnutrition and dehydration and for people at risk of developing pressure areas. This is being followed up and we will report on any action when it is complete.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. On the day of our inspection we were told that no one who lived at the home was subject to a DoLS application. Relevant staff had not been trained to understand when an application should be made to deprive someone of their liberty and staff did not demonstrate knowledge and understanding in this area.

As a result of an inspection we completed in October 2013 a compliance action was set in relation to recruitment processes. At this inspection we found that the compliance action had been met. Staff records now evidenced that the provider had completed a number of checks that ensured staff were safe to care for people who lived at the home.

Is the service effective?

Monitoring of people's needs was not taking place in line with the contents of their care plans and assessments. Staff confirmed that without this they could not be sure that people's needs were being met. We found that staff did not provide care in line with people's needs and that this placed them at risk. This is being followed up and we will report on any action when it is complete.

The majority of people told us that they were happy with the support they received to access health care services. For example, one person told us, 'I need glasses for reading. I have had them tested here because I could not get out. I've been to the dentist. One of the girls went with me in a taxi.'

Is the service caring?

The majority of people that we spoke with told us that they were happy and well. For example, one person said, "I am very happy with the care thank you." Another person told us, "They (referring to staff) look after me. They are very kind." We observed that staff were patient with people and treated them warmly.

We observed the lunchtime routine in the dining room. The mealtime was well paced and allowed people the time they needed to eat their meal. We observed good interactions between people and staff. Staff who assisted people to eat their meal ensured the pace was dictated by the person. Encouragement was given where needed in a manner which enabled people to maintain their dignity and independence.

Is the service responsive?

A recent safeguarding investigation substantiated neglect at the home. Concerns related to nurses who did not have the knowledge and competencies to care for people safely, a lack of robust care planning and risk management and a lack of management oversight at the home impacting on service delivery to people. Our evidence found that concerns identified during the investigation were still apparent at the home on the day of our inspection. This is being followed up and we will report on any action when it is complete.

The home had a system in place that ensured information was shared if people needed to visit a hospital. We were also informed that if a person needed to visit a hospital and they had no family or representatives a member of staff from the home always accompanied the person to speak on their behalf if needed. This meant that the home had a system in place when more than one provider was involved in people's care and treatment.

Is the service well-led?

The home had not been able to sustain compliance since October 2012. Previous inspections found that the provider did not have effective systems in place to manage the risks to the health, safety and welfare of people who used the service and others. At this inspection we found that again, the provider had not ensured people received safe, consistent, quality care. We identified new concerns in relation to nursing practices for management of people's skin integrity, vital sign monitoring and observations and nutritional needs. These areas of concern had not been identified by the provider within the home's quality monitoring systems. This is being followed up and we will report on any action when it is complete.

At previous inspections we raised concerns regarding the management of the home and how this impacted on the quality of service that people received. In particular this related to the providers lack of clinical governance and management oversight in relation to nursing knowledge and practices. At this inspection we found that issues remained. As a result, people were at risk of unsafe or inappropriate care because the quality of care and service provision was not being monitored by a responsible individual with clinical oversight. This is being followed up and we will report on any action when it is complete.

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with eight people who lived at the home, the provider, the clinical lead, a nurse, a representative of the provider and two care staff. We also spoke with an external healthcare professional who was visiting the home at the time of our inspection. We reviewed records that related to the management of the home. These included five people's care and health records, accident records, staff training and supervision records and quality assurance reports. At the time of our inspection there were 14 people living at the home, 12 of whom required nursing care.

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

Is the service safe?

We found that action had been taken by the provider to ensure people received safe and appropriate nursing care that met their needs.

Is the service caring?

People told us that they were happy with the staff. Staff were kind and compassionate. They made eye contact with people and spoke clearly to explain what was support was being given. People responded positively to staff. The home had a warm and friendly atmosphere.

Is the service effective?

People told us that their needs were met by staff who knew them well.

Is the service responsive?

Records that gave staff information about people's care and nursing needs had been improved, along with clinical oversight and checks of nursing practice. As a result, changes to people's needs were identified and acted upon promptly.

Is the service well-led?

Changes to the management structure had taken place that included a clinical lead having been employed. The quality of care and service provision had started to be monitored by a responsible individual with clinical oversight to ensure people received a safe and consistent service. One person who lived at the home told us, "Things have certainly improved here lately".

People told us that they were happy with the quality of service provided. One person said, "I'm perfectly happy, thank you".

Everyone that we spoke with in the main, expressed satisfaction with the care they received. One person told us, "It's like a hotel here. They help with everything". Another person said, "I'm very happy".

At our previous two inspections compliance actions were set for areas that included consent, staff support, recruitment procedures and quality monitoring of the service. At this inspection we found that consent and staff support had improved. However, we found that robust recruitment procedures had not been followed. Also, that the provider had still not ensured effective systems for assessing and evaluating the quality of service were in place.

Since our last inspection the manager has resigned and the provider has taken on the day to day management of the service. At this inspection we found that the provider was unable to demonstrate that they had a clear oversight and understanding of the role of manager and the responsibilities that this entails.

At our previous inspection warning notices were issued for areas that included staff support and quality assurance. At this inspection we found that record keeping and training provided to staff had improved. We found sufficient steps had been taken for us to not take enforcement action at this time. The warning notices had not been met in full and the provider remained non-compliant, however the impact on people who received a service had changed from moderate to minor.

The majority of people that we spoke with expressed satisfaction with the care they received. One person told us, 'The optician visits here and I have my feet done. I have my hair washed and I have a bath". Another said, 'It's perfectly alright here'. Although people told us they were happy with the care they received we found that people were at risk of unsafe care and treatment because of a lack of robust assessment and care planning.

Four people said that they were happy with the staff that supported them. One said, 'Staff are lovely and kind'. Despite people expressing satisfaction with staff we found that people were cared for by staff who were not supported to deliver care and treatment safely, and to an appropriate standard. This included staff not receiving supervision or training in areas specific to people's needs.

We found that people's rights with regard to consent were not being met by the service and staff were not provided with training relating to consent if people lacked capacity.

There were no effective systems to regularly assess and monitor the quality of service that people received.