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Archived: Bradley House Residential Care Home Requires improvement

Reports


Inspection carried out on 2 August 2016

During a routine inspection

We carried out this unannounced inspection of Bradley House Residential Care Home on 2 August 2016. During our last inspection on 17 March 2015, we identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breaches related to hazards in the environment, cleanliness, storage of records and quality assurance systems. The provider wrote to us with an action plan of improvements that would be made. During this inspection we found most of the improvements had been made.

You can read the report from our last inspection by selecting the ‘All reports’ link for Bradley House Residential Care Home on our website at www.cqc.org.uk.

Bradley House Residential Care Home is a 10 bedded home that provides accommodation for persons who require personal care. At the time of our inspection there were nine people living in the care home.

There was a registered manager in place at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. The registered manager was also the registered provider. Registered providers and registered managers 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.

At our inspection on 2 August 2016, we found that sufficient action had been taken in relation to the requirement actions we had issued following the previous inspection. Overall, although we found improvements had been made, further improvements were still needed.

We identified a breach of regulation with regard to medicine management. People’s medicines were not managed safely. There were shortfalls in the recording and administering of some medicines. The recording of medicines, including those that require additional security was not sufficient. Topical medicines were not always recorded to confirm they had been applied.

People who lived in the home felt safe. Staff had a clear understanding of how to safeguard people from avoidable harm and abuse. Sufficient numbers of staff were deployed to meet the needs of people living in the care home.

People were supported to eat and drink and their nutrition and hydration needs were being met. We found people’s specific and assessed needs were not always recorded for the use of fluid thickening agents. We have recommended that current NHS guidance is followed.

People told us they enjoyed living in the home and felt cared for by staff. They told us staff knew their needs well. Staff were kind and caring. We found people were being treated with dignity and respect and we found people’s privacy was maintained.

Staff had an understanding of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). This meant people’s rights were protected.

There were some improvements in the systems and audits in place to assess and monitor the quality of the home. Further improvements were needed and we found shortfalls in relation to systematic completion of audits and identification of shortfalls. For example, in relation to management of medicines and the health and safety risks of scalds from baths. We have recommended that the provider completes a thorough scalding risk assessment in accordance with current Health and Safety Executive guidance.

We found one breach of the regulations at this inspection. You can see what action we told the provider to take at the back of the full version of the report.

Inspection carried out on 17 March 2015

During a routine inspection

The inspection took place on 17 March 2015 and was an unannounced inspection. Our last inspection took place in August 2014 and at this time we found one breach of regulation in relation to meeting people’s nutritional needs. We looked at the action taken in response to this breach as part of our inspection and found the actions had been completed.

Bradley House provides accommodation and personal care for 10 older people.

There was a registered manager in place 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.

People were not protected from risks associated with the environment. There were hazards such as broken panes of glass in the greenhouse, a garden hose lying across a paved area causing a trip hazard and clutter in various areas of the outside space. We observed one person use the outside area, however we told that most people would not use this area until the warmer weather. There was no risk assessment or action plan in place to address these risks.

We also found that risks associated with people’s care and support had not all been identified and assessed. We found that the laundry area of the home was used as an area for people to smoke; however this had not been risk assessed.

Inside the home we saw that people weren’t fully protected from the risks associated with cleanliness and infection control. Difficult to reach areas on the kitchen flooring, such as along the edges were not effectively cleaned. We also noted a number of fabric chairs and cushions that were stained and had dirty marks on them.

The registered manager had some systems in place to monitor quality and safety in the home; however these were not fully effective in identifying risks. For example, we saw that a maintenance audit had been carried out; however this had not identified any of the concerns that we found at our inspection, or generated an action plan to address them. Records relating to people’s care and support were not stored securely.

People were positive about the care they received and we saw staff interacting pleasantly with people. Staff had a good understanding of people’s individual needs and preferences. For example, we saw that one person in the home did not use English as their first language; staff used gesture to support their communication. The person’s keyworker had learnt to speak some of the person’s first language in order support them more effectively.

There was an open and transparent culture within the home. Staff reported that they felt able to raise concerns and issues and that the registered manager was approachable and visible in the home. Staff were positive about the training and support they received in their roles and felt able to seek advice from senior staff at any time.

Supervision sessions were held with staff on a regular basis as a means of reviewing staff performance and development needs. Staff were confident in identifying potential signs of abuse and knew how they should be reported. Staff were familiar with the term whistle blowing and knew which organisations they could approach if they felt that their concerns were not being addressed within the organisation.

Staff had an understanding of the Mental Capacity Act 2005 and Deprivation of liberty safeguards, which meant that people’s rights were protected.

We found four breaches of regulation at this inspection. You can see the action that we have asked the provider to take at the end of the full version of this report.

Inspection carried out on 13 August 2014

During a routine inspection

The inspection was carried out by an Adult Social Care Inspector and helped answer our five questions: 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, speaking with staff, speaking with people in the home and reviewing records.

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

Is the service caring?

We received positive feedback from people during our inspection and this was also reflected in the home's own satisfaction survey. We made observations during our inspection that showed people benefitted from positive relationships with staff. People enjoyed interactions with staff, demonstrating this by laughing and sharing jokes.

Staff understood the needs of people living in the home. People's individual routines and preferences were set out in support plans.

Is the service responsive?

People's needs were reviewed regularly so that staff could respond to any changes in the support that they required. Any changes to a person's support were recorded so that all staff were aware of them. However, we did find one occasion when a person's health need had not been responded to promptly and this meant that there was a potential risk that this person had not received the support that they required from another health professional.

Is the service safe?

There were appropriate systems in place for the storage and administration of medications. Medicines were stored in locked cupboards with extra security for controlled drugs. Staff signed MAR (Medicine Administration Record) sheets as a record of administering medication. When controlled drugs or antibiotics were given, two members of staff signed the record. Stock levels were checked on a regular basis.

People were weighed regularly to identify anyone at risk nutritionally. People told us that they had enough to eat and drink. On the day of our inspection we saw that people enjoyed their midday meal. We observed people being provided with drinks and snacks throughout the day as required.

There were systems in place to ensure that recruitment procedures were safe. This included gathering references and carrying out checks on the person's suitability.

Is the service effective?

People had clear support plans in place and these were reviewed regularly to ensure that they were reflective of people's needs. Key workers wrote weekly summaries as a further means of reviewing the support that people received.

A programme of audit was in place to help identify any shortcomings in the service.

Is the service well led?

The owner of the home was also the person in day to day charge. We found that there were systems in place to monitor the quality and safety of the home. This included undertaking annual satisfaction surveys with people in the home and their relatives. There were records to show that the safety of people was monitored. This included a fire risk assessment.

Inspection carried out on 4 September 2013

During a routine inspection

People told us that they felt safe and well looked after. One person told us “they treat me with respect”. We spoke with five people who use the service, examples of comments people told us included “I can do what I want to do” and “I could not wish for a nicer place”.

We found that the staff knew how to respect people as individuals and encouraged people to make decisions about their care and how their needs were met.

We found that care plans were sufficiently detailed and gave staff guidance about how to support people in the home in a person centred way. These were regularly updated to reflect peoples current needs.

Staff told us that they felt supported and attended training courses to enable them to deliver the care needed.

There were systems in place to monitor the quality of the service and this included gaining feedback from people who used the service.

Inspection carried out on 3 February 2013

During a routine inspection

People that we spoke with on the day of our visit told us "they look after me" and "I like it here". One relative of a person being cared for told us that they were happy with the care provided by Bradley House and that the staff were approachable should there be any problems or concerns.

We found that care plans were detailed and reviewed regularly. They contained information that would allow staff to care for people in a person centred way. We made observations on the day of our visit that showed people's individual day time routines were followed.

We saw that people were cared for in a clean and hygienic environment and there were sufficient staffing levels to meet people's needs.

We found that there was a complaints system in place to support people in raising concerns if they wished. They were also able to do this through surveys and resident meetings.

Inspection carried out on 6 October 2011

During a routine inspection

The six people we spoke with who use the service were positive about how they were supported by staff.

People felt they lived in a home that was as near as it could be to being their own home. Examples of comments people made included, “it is lovely here, I think it’s a marvellous place, we’re one big happy family”, “this is not just a care home, it’s a home", and “it’s the little things that matter here, it’s the extra touches”. “The staff are kind and I feel very safe”.

We found that staff were approachable and people were encouraged and supported to make their views known to the registered provider/manager and staff. We saw there were varied and thoughtful ways being used to seek people’s views about the quality of service and care they received.

People we spoke with told us they had access to a range of health professionals including GP, dentist, chiropodist and opticians. We saw the optician visiting the home and conducting sight tests during our visit. It was arranged in such a way that people’s dignity and confidentiality was respected.

We saw people being supported by staff to meet their needs in a caring and person centred manner, which was both timely and effective. We observed staff sitting and listening to people attentively. The responses seen were warm and respectful and showed staff had a good knowledge of the individual’s personality, history and preferences. We saw medication being given at a specific time, to an individual to ensure their condition was kept controlled for their health and well being.

Care plans we saw were person centred and contained clear and comprehensive information about individuals and their needs, to guide and enable staff to provide the support and care they needed. Information was current and seen to have been reviewed and updated regularly with the individual person using the service.

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