Archived: Browns Field House

Browns Field House is a residential care home providing personal care to 15 adults at the time of the inspection. The service can support up to 29 people. Browns Field House accommodates people in one building over two floors. The provider was in a consultation period to close the service.

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

Risks to people were not always identified, managed or reviewed to ensure people were safe and

protected from harm. We could not be confident that staff always took the necessary action to ensure people received the care and support they required. People were not always protected from the risk of cross infection due to some poor infection prevention and control practices. Incidents and accidents were not always reported in a timely way to the manager. Analysis of incidents to identify patterns to learn lessons and prevent reoccurrence had not always taken place at a service level.

Staff had not always received the support they needed to carry out their role effectively. Not all staff had received/ completed inductions, supervisions and appraisals as expected. Senior staff told us they had not completed training to write and review care plans out their role. There was a high dependency on agency staff however where possible the same agency staff were used.

Oversight and audits had not been effective in identifying some areas for improvement and ensuring they were completed in a timely manner. Processes to monitor people's standards of care were not clear and we found gaps in recording and/or monitoring that had not been addressed. Lack of provider oversight had meant that it had not been identified that their policies and procedures were not always being followed.

Information about people was not always up to date and did not reflect their current needs. Care plans had not been regularly reviewed and updated as people’s needs changed. Information about how people wanted to be supported at the end of their life was not always in place in a timely manner.

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; the policies and systems in the service supported this practice.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence had good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and/or who are autistic.

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 (report published 06 August 2021).

Why we inspected

We received concerns in relation to the staffing levels and management of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We inspected and found there was a concern with reducing risks to people’s safety and identifying areas for improvement and taking prompt action, so we widened the scope of the inspection to become a comprehensive inspection which included all of the key questions of safe, effective, caring, responsive and well-led.

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 COVID-19 and other infection outbreaks effectively.

You can see what action we have asked the provider to take at the end of this full report.

The provider has taken action to mitigate the immediate risks to people’s health and safety.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Browns Field house on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to reducing risks to people, identifying areas for improvement and taking action in a timely manner, ensuring people records are reviewed and updated and that staff receive the support they need to carry out their roles effectively

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Browns Field House is a residential care home providing personal care to 15 adults at the time of the inspection. The service can support up to 29 people. Browns Field House accommodates people in one building over two floors.

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

Staff knew the people they supported well and demonstrated how they would use this knowledge when assisting people and when alleviating people’s anxiety. There were enough suitably trained and knowledgeable staff to help support people’s care and support requirements in a timely manner. Potential new staff to the service had a series of checks carried out on them to help ensure they were suitable to work with the people they supported.

People told us the support from staff made them feel safe. Staff demonstrated a good understanding of how to keep people safe from harm or abuse. They also confirmed that they would report any concerns they may have had to senior staff.

Staff had documented people’s end of life wishes and worked with external health professionals to try to make sure people had as dignified a death as possible.

Information in people’s care plans and risk assessments had improved since the last inspection. This individualised information helped guide staff to care and support people safely. Staff supported people to take their prescribed medicines safely. Infection control practices in line with government guidance were in place to reduce the risk of cross contamination. Lessons were learnt and shared with staff when things went wrong or there was a risk of this.

The registered manager and staff worked with external health and social care professionals. This helped make sure people received joined up care and support. Complaints received about the service were logged and investigated. People, their relatives and staff were asked to complete surveys to feedback on the service. Staff made sure people had information in different formats such as large print to help aid their understanding.

Audits were undertaken to monitor the quality of the service provided. There provider also promoted organisational oversight of the service. Improvements found were added to a service improvement plan and this document was regularly monitored.

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 12 March 2020) and there was a breach of regulation. The provider completed an action plan after the last inspection to show what they would do to improve information in people’s care records regarding risk and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulation.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 6 February 2020. A breach of legal requirements was found.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. We also received concerns prior to the inspection in relation to the safe management of medicines. This report only covers our findings in relation to the Key Questions Safe, Responsive and Well-led which contain those requirements.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Browns Field House on our website at www.cqc.org.uk

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We found the following examples of good practice.

In line with government guidelines external health and social care visitors had a series of checks completed before entering the service.

The service was not allowing any visiting at the time of this inspection, unless for exceptional circumstances for example, if a person was receiving end of life care.

Video and telephone calls to family and friends were available to promote people’s social well-being. Information for relatives was sent via email or by telephone to provide updates on COVID-19 restrictions and the vaccination programme for the service.

The registered manager told us that the building has been zoned into different areas during the recent outbreak, and this had worked well. They had sought advice from Public Health England (PHE) and their infection control lead with the clinical commission group (CCG).

Staff changed into their uniform and put on and off their personal protective equipment (PPE) before starting work.

The building was clean and free from clutter. The registered manager told us that staff were undertaking cleaning of frequently touched areas such as handrails, chairs, tabletops, handles and furniture. This cleaning was observed during the inspection.

Whole home testing was in place for people, visitors and staff.

Browns Field House is a residential care home providing personal care to 24 people aged 65 and over at the time of the inspection. The service can support up to 29 people.

Browns Field House accommodates people in one adapted building over two floors.

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

People’s health, welfare and safety were placed at risk because risk assessments were not in place to ensure staff knew how to keep people as safe as possible.

The service had a quality audit it in place however this was not effective as the service had not improved its rating from requires improvement to good.

Care plans were not all in place and therefore did not provide enough guidance to ensure staff had the detail on how to provide care and support to people in line with their needs and choices.

There was limited signage to help people find their way around the home. We have made a recommendation that the provider looks at best practice guidance for developing an environment for people living with dementia

Staff had clear guidance in place that detailed what medicines people were prescribed and to ensure they were administered in line with the prescriber’s instructions. There were systems in place that ensured lessons were learned.

Staff we spoke with had a good understanding about how to respond if they had concerns about a person being harmed in some way. Various safety checks were taking place to promote people's safety when they were in the building and using any equipment.

Staff received appropriate support and training to undertake their roles,

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; the policies and systems in the service supported this practice.

People told us they felt safe and were happy living at Browns Field House. Relatives were complimentary about the care people received. Activities were organised, and people told us they had enough to do. New staff were recruited in line with the regulations.

Staff were aware of their responsibilities to protect people from the spread of infection.

Relatives spoke about how the registered manager was out and about in the service and how they responded to any concerns.

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 requires improvement (published 13 February 2019). This service has been rated requires improvement for the last two consecutive inspections.

At this inspection enough improvement had not been made and the provider was now in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the safe, responsive and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified one breach in the regulations in relation to risk assessments at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

Browns Field House is registered to accommodate up to 29 older people, younger adults and people living with dementia. The home is located on the edge of the city of Cambridge. The home is on two floors accessible by stairs or lift. Shops and other amenities are a short walk from the home.

At our last inspection in June 2016 we rated the home ‘good’. During this inspection, we found the home is now Requires Improvement.

This unannounced inspection was completed by one inspector on 10 and 16 January 2019 and there were 27 people living in the home at the time of the inspection.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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. The registered manager understood their responsibilities in relation to notifying CQC of certain events that happened at the home.

People did not receive a service that was well led. Staff did not feel supported by management during the day or out of hours. People, relatives and staff meetings were not held regularly to enable concerns or issues to be discussed.

People were supported to have choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the home support this practice. However, people were not always provided or supported with choices about their food or drinks. People’s nutritional needs were however met because of staff who knew each person's needs well. People’s health and wellbeing was maintained and they had access to a range of health and social care professionals.

People continued to be kept as safe as possible because staff understood their roles and responsibilities in relation to keeping people safe from harm and abuse. Potential risks to people had been recognised and information on how to minimise risks had been recorded as guidance for staff to follow. People received their prescribed medicines, which were managed safely. There were enough staff on duty with the right mix of skills to meet people’s support needs.

People continued to receive good care because staff treated people with kindness, compassion, dignity and respect. People and their relatives were involved in decisions about their care and thought staff were caring. Staff knew people well and understood their care needs.

People continued to receive a service that was responsive. People and their relatives were involved in their personalised support plans and reviews. The information about them in relation to their care needs was up to date. People were encouraged to take part in a range of activities that they enjoyed and were the choice of the person at that time. This helped promote social inclusion. Information was in place to support people with end of life care.

Further information is in the detailed findings below.

This unannounced inspection took place on 17 June 2016.

There was a registered manager in place during this 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.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and report on what we find. Where people had been assessed as lacking capacity to make day-to-day decisions, decisions were made in their best interest. Applications had been made to the local authorising agencies to lawfully restrict people’s liberty where appropriate. Staff demonstrated to us that they respected people’s choices about how they wished to be supported. Staff were able to demonstrate a sufficient understanding of the MCA and DoLS to ensure that people would not have their freedom restricted in an unlawful manner.

Plans were in place to minimise people’s identified risks, to assist people to live as safe and independent a life as possible. Records were in place for staff to monitor people’s assessed risks, and their care and support needs.

Arrangements were in place to ensure that people were supported with their prescribed medicines safely. People’s medicines were managed, stored and disposed of appropriately. People’s nutritional and hydration needs were met.

When needed, people were referred and assisted to access a range of external healthcare professionals. People were supported to maintain their health and well-being. Staff supported people with their interests and promoted social inclusion. People’s friends and families were encouraged to visit the home and staff made them feel welcome.

People were supported by staff in a kind and respectful manner. People’s care and support plans gave guidance to staff on any individual assistance a person may have required. This included how person wished to be supported and what was important to them.

Staff were trained to provide care and support which met people’s individual needs. The standard of staff members’ work performance was reviewed during supervisions, competency checks and appraisals. This was to make sure that staff were deemed competent and confident by the management team to deliver people’s support and care needs.

Staff understood their responsibility to report any poor care practice or suspicions of harm. There were pre-employment safety checks in place to ensure that all new staff were deemed suitable and safe to work with the people they supported. There was a sufficient number of staff to provide people with safe care and support.

The registered manager sought feedback about the quality of the service provided from people, their relatives and visiting stakeholders. People who used the service and their relatives were able to raise any suggestions or concerns that they had with the registered manager and staff and they felt listened to.

Staff meetings took place and staff were encouraged to raise any suggestions or concerns that they may have had. Quality monitoring processes to identify areas of improvement required within the home were in place and formally documented any action required.

Is the service safe?

Risk assessments regarding people's individual needs and activities were carried out and arrangements were in place to minimise any potential dangers as much as possible. Staff understood their roles and responsibilities in making sure people were protected from the risk of abuse and were up to date with safeguarding training and accompanying reporting procedures. There were effective infection control procedures in the home to ensure that people were protected from the risk of infection as much as possible. The premises were well maintained and the communal areas and private bedroom space met the personal preferences and needs of people living in the home.

Is the service effective?

The care staff we met were knowledgeable about people's individual care and support needs and especially the needs of those people living with dementia. Observations we made during our inspection confirmed that the care staff provided friendly and attentive support when assisting people during the day. People were assisted to make choices regarding how they wished to spend time during the day either at home, or going to local facilities in the community. Staff had also received training in the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS), and we saw that appropriate assessments were in place so that people who could not make decisions for themselves were protected.

Is the service caring?

Observations made during our inspection showed that people received warm, consistent and respectful support from care staff and that they were enabled to make choices and decisions when required. One person told us that, 'I am happy living here and I have no concerns.' Staff told us that they were well supported and supervised by the manager and senior staff so that they could provide safe care and support to people.

Is the service responsive?

We saw that people's personal care and social support needs were assessed and met by staff. This also included people's individual choices and preferences as to how they liked to be supported. We observed and saw that people could make changes to their support and were treated in a very 'person centred' way by staff at all times. People and, or, their relatives had been involved in the reviews of their support plans as much as possible.

Is the service well led?

The home was effectively managed and staff told us that they felt supported and were regularly trained to safely provide support to people. Observations made during our inspection showed that staff were keen and enthusiastic about their work and provided friendly and attentive support to people living in the home. Health and safety checks were in place to monitor the services provided. The service gathered opinions from people who used the service, healthcare professionals and staff to identify any improvements that could be made to the service.

People that we met with during our inspection visit on 23 April 2013, were not able to tell us about the care and support they received whilst living in the home, due to their complex needs. However, observations made during our visit showed that people were satisfied and happy with the care and the attention they received from care staff. One relative told us that 'It's lovely here and feels like one big family'.

Care and support was being regularly reviewed and updated to ensure that peoples' care and support needs were being met. There was evidence that people's relatives had been involved in the planning of the person's care and support and had supplied background information which enhanced the staff's understanding of the person.

Staff were trained in the safe administration of medication and records of administration were accurately completed.

Ongoing training sessions were in place that ensured staff delivered safe care and support to people. Staff told us that they felt supported by the management in the home. However, it was noted that improvements were needed to the frequency of formal recorded supervision sessions that staff received.

The home had an effective system to regularly assess and monitor the quality of the service that was provided to people.