Archived: St Anne's Community Services - The Brambles

There is a registered manager in place who had been registered since September 2016. 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.

The Brambles is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service was previously inspected in August 2017 and was rated requires improvement. We found there was one breach of the regulations. These referred to care records, risk management plans, capacity assessments and best interest decisions. We asked the provider to complete an improvement plan to show what they would do and by when, to improve the key questions of Safe, Effective, Responsive and Well-Led.

At this inspection, we found sufficient improvements to meet the previously breached regulation for good governance and have rated The Brambles as ‘good.’

People using the service appeared to feel safe and were comfortable in the presence of staff. Staff had received training to enable them to recognise signs of abuse and they felt confident in how to report any concerns. People had risk assessments in place to enable them to be as independent as possible whilst also remaining safe. Staff knew how to manage risks to promote people's safety, and balanced these with people's rights to take risks and remain independent. There were sufficient numbers of skilled staff on duty to support people to have their needs met safely. Effective recruitment processes were in place to ensure only suitable staff were employed.

Medicines were given to people as prescribed and disposed of safely by properly trained staff. Auditing processes were effective in identifying and addressing any medicines shortfalls. The storage, recording and stock control was robust and in line with guidance.

New staff were required to complete an induction and initial training. Training was regularly refreshed. Supervisions, annual appraisals and staff meetings enabled staff to raise any issues or suggestions.

There were enough staff deployed with the right experience and skills mix, to provide effective care and support to meet people's needs, although relatives did not always think staff deployment was effective. Staff were enabled to develop and maintain the necessary skills to meet people's needs.

Staff applied the principles of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards in their day to day care practice. For example, people were involved in best interest decisions about their care, to ensure their human and legal rights were protected.

People's needs were assessed before they moved into the service. These needs were met by staff who had the skills and knowledge to deliver effective support. People were supported to eat and drink enough to have a balanced diet, including those with associated health needs. People were supported to have healthier lives by having timely access to healthcare services. People lived in an environment which was suitable for their needs.

People received a service which was caring, they were treated with dignity and respect. Staff were compassionate and caring. Staff treated people's private information confidentially. People, where possible, made decisions about how their care was provided and were involved in reviews of their care together with people important to them.

Care was personalised to people's individual needs and preferences. Activities were available for people to participate in if they wished and people enjoyed spending time with staff, although one relative believed activities were not regular. Staff knew people's interests and needs well. There was a complaints policy available to people. Staff were open to any complaints and understood that responding to people's concerns was a part of good care. One relative found responses to complaints could be slow.

Staff were positive about the culture of the service and people felt the staff team were approachable and polite. The staff team worked with other organisations to make sure they followed current good practice. Maintenance records for equipment and the environment were up to date. Policies and procedures were up to date and available for staff to refer to. Staff said they were encouraged to suggest improvements to the service.

The provider had sent CQC notifications in a timely manner. Notifications are changes, events or incidents that the service must inform us about.

Quality monitoring systems were in place. A variety of audits were carried out and used to drive continuous improvement and ensure shortfalls in service delivery were identified and rectified.

The Brambles provides respite for adults with a learning disability and/or physical disability, in the South Yorkshire area. There were three people using the service during our inspection. There is a registered manager in place who had been registered since September 2016. 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.

There were some improvements which could be made about the recording of risk and how this is managed. For example, we did not see an assessment for all the assistive equipment in use and more detail was required in some of the moving and handling care plans. However, in some files we looked at we found extremely detailed guidance for staff to follow, with the use of photographs and step by step plans. Risk assessments had been undertaken such as the risk of dehydration, malnutrition and pressure ulcers, and measures had been taken to reduce the risk of harm.

Accidents and incidents were monitored for trends and themes and actions implemented to prevent further harm.

Medicines management had improved since our last inspection. Staff were trained and assessed as competent to manage medicines and regular audits were undertaken. Where issues had been raised, we saw these were dealt with by the registered manager.

We found the necessary recruitment checks had been made to ensure staff suitability to work at the service. There were sufficient numbers of staff on duty during our inspection to provide person-centred care.

Staff received an induction to ensure they developed into their role and were able to shadow shifts with more experienced staff to ensure they felt confident to take on the caring role. Staff received supervision, appraisal and training to ensure they developed the skills to care for people at The Brambles.

People were supported to have 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. The registered manager was in the process of completing all the required capacity assessments and best interest decision making in consultation with family members. Deprivation of Liberty Safeguards authorisations had been completed where required.

Food was freshly prepared. Choice was offered at mealtimes and meals were varied depending on the preference of each person who stayed. We observed staff supporting people with their meals. Nursing staff monitored people at risk of dehydration to ensure they had adequate hydration, although the recommended fluid intake target was not always realistic.

We found staff to be compassionate and caring when supporting people who were staying at The Brambles. We observed staff protecting people’s privacy and dignity and ensuring their needs in relation to equality and diversity were appropriately met.

People were provided with care which met their choices and preferences, such as what time they got up, went to bed, what they ate and how they liked to spend their day. Staff we spoke with demonstrated they were aware of the needs of the people they were supporting and their individual personalities and preferences.

People and their families were encouraged to share their views on how they wanted the service to be run.

Care records we looked at during our inspection contained out of date information which had the potential to result in inappropriate care delivery; this was a concern raised at the last inspection in January 2017. However, the service had clear directions where improvements were required and those files which had been updated we saw were completed to a high standard.

Audits had improved since our last inspection and actions were completed where issues had been identified. The registered provider completed their own quality checks at the service and there was an improvement plan in place. Outcomes were monitored by the area manager

We found one breach of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014 in relation to records. You can see what action we told the provider to take at the back of the full version of the report.

The Brambles is a respite unit for adults with profound learning disability, some of whom also have physical disabilities .The unit offers accommodation for up to five people, each with their own bedroom, and the service provides 24 hour nursing care. A sixth bedroom can be used for emergency placements. On the first day of our inspection there were two people using the respite service and on the second day there were three people using the respite service. It was difficult to gain the views of people who used the service due to their conditions therefore we spoke with six relatives of people who accessed the service, the registered manager and three staff members. We also observed the interactions between staff and people using the service throughout our inspection.

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. 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 this inspection we found five breaches in the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulation 2014. You can see what action we have told the provider to take at the back of the full version of the report.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

People and their relatives gave us conflicting feedback about the service. Some people felt their relatives were safe whilst other people said that they were not treated with dignity.

Systems which were in place for the management of medicines were unsafe and did not protect people using the service or ensure they received their medicines as prescribed. On admission to the service people did not always have the required medicines for their stay. We recommend the service reviews its pre-admission process to ensure people receive safe care and treatment.

Medicines were not always administered and stored as per manufacturer’s instructions. Some of the medicine records had only one signature, when they should for safety have been signed by two members of staff.

Care plans were not always up to date or accurate and risk assessments that were in place were not reviewed to ensure they were still appropriate. Care records lacked the necessary information to ensure the health and welfare of the person was protected.

The service did not always follow the principles of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Two people who did not have the mental capacity to make their own decisions had accessed the service however no mental capacity assessment had been completed or best interest meetings had been held.

New staff had induction training which included shadowing experienced staff, until they were competent to work on their own. However other had not received the up to date training to make sure they had the competencies, skills and knowledge to do their jobs effectively and safely.

There were systems in place to prevent the spread of infection. Staff were trained in infection control however recommendations made from the local authority infection control audit had not been acted upon. For example there were no hand hygiene facilities in the launderette or the sluice area.

Gas appliances were serviced regularly, however portable electrical equipment had not been tested to ensure they were safe to use. Each person had a personal emergency evacuation plan (PEEP) and there was a business plan for any unforeseen emergencies.

During our inspection we saw there were staff in sufficient numbers to keep people safe and the use of staff was effective. Staffing was determined by people’s needs. Staff and relatives we spoke with confirmed that there was enough staff on duty.

Robust recruitment processes and systems were in place to ensure staff members were safe to work with vulnerable people. Checks had been carried out with the Disclosure and Barring Service (DBS).The DBS identifies people who are barred from working with children and vulnerable adults and informs the service provider of any criminal convictions noted against the applicant.

We saw there was adequate equipment throughout the service to meet the physical needs of people who used the service such as specialist baths, hoists (including ceiling track hoists), moveable sinks and shower trolleys.

The service had a sensory room which provided a relaxing and therapeutic atmosphere for people who used the service.

People who complained received a satisfactory answer. However the comments people made about the service were not always logged and used to make service improvements.

There were policies and procedures available for staff to follow good practice.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

People's views and experiences were taken into account in the way the service was provided and delivered in relation to their care. People told us, 'The staff are dead right, second to none' and 'It's up to me when and what I eat, what I do, they [staff] ask me.'

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. People said, 'I think it's brilliant, I'm happy, second to none' and 'I prefer it to anywhere else, good set up.'

People who used the service, staff and visitors were protected against the risks of unsafe or unsuitable premises.

There were enough qualified, skilled and experienced staff to meet people's needs. Staff undertook training so they could provide appropriate care and support.

There was an effective complaints system available. Everyone we spoke with told us they would feel comfortable speaking with the staff and/or manager if they had any issues.

People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

We consulted two visiting relatives and spoke with one person on the phone. We also requested the staff to give out some questionnaires which we prepared to the guests and their representatives to complete so that we were able to find out their views.

We received the following feed back from six guests.

Guest's views and experiences were taken into account in the way the service was provided and delivered in relation to their care. One of the guests said 'Everything explained by staff brilliantly and all good.' Another guest said,' Everything I need to know they tell me and they include me in the plans.' A third person commented that the staff always listened to their requests and accommodated them.

Before starting care guests were asked for their consent and the provider acted in accordance with their wishes. A relative said, 'Nothing happens here without the guests having given permission.' Two guests made positive comments about them being involved in decisions.

Guests said they knew how to make a complaint; but they would rather tell staff and sort out any misunderstanding.