Archived: Braintree Nursing Home

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

People’s experience of using this service:

Staff understood the risks to people and the measures in place to keep them safe. Systems were in place to manage people’s medicines safely and to reduce the risks associated with the spread of infection.

Sufficient numbers of staff were employed to meet people’s needs. Staff received training that gave them the necessary skills and knowledge to carry out their roles and meet the specific needs of people using the service. Champions were promoted in the service. These are staff that have shown a specific interest in areas, such as promoting dignity and are essential in promoting best practice, by sharing their learning, acting as a role model for other staff. This ensured people received good quality care.

People were provided with the care, support and equipment they needed to stay independent. Staff were kind and caring and had developed good relationships with people using the service.

People were supported to maintain their health and had access food and drink based on their individual choice and preferences. People had access to a wide range of activities in the community and within the service, that reflected their specific needs and interests.

People’s communication needs had been assessed and were meeting the requirements of the Accessible Information Standards. This set of standards sets out the specific, approach for providers of health and social care to identify, record, share and meet the communication needs of people with a disability, impairment or sensory loss.

People's privacy, dignity and rights were respected and upheld. People were supported to have maximum choice and control over their lives and staff supported them in the least restrictive way possible.

The provider had clear and effective systems in place to identify and manage risks to the service and drive improvement. There was an open culture of learning from mistakes, concerns, incidents and accidents. The registered manager and staff worked well with other agencies to ensure people received high quality joined up care.

Rating at last inspection: Requires improvement (Report published 21 February 2018)

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up:

Our previous inspection in October 2017 (Published February 2018) identified improvements were needed in relation to recruitment practices, cleanliness and hygiene. There had been a lack of oversight of the service by the provider and the registered manager to ensure the service delivered was of a good quality, and safe.

During this inspection we found the required improvements had been made. We will continue to monitor all intelligence received about this service to ensure that the next planned inspection is scheduled accordingly.

Braintree Nursing Home provides nursing and personal care for up to 51 older people, some of whom have a diagnosis of dementia. There were 48 people living in the service at the time of our inspection. The service consists of two separate buildings referred to as the White House and main house. Both of which are spread across two floors and have communal lounge areas. The two buildings have access to a secure courtyard area with seating and flower beds.

At our previous inspections in May 2015 and June / July 2016 we found that the provider was not meeting the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because there was a lack of management oversight by the provider. At this inspection we found improvements are still required in relation to the implementation of governance systems to ensure the service is well led and records relating to people's care are accurate.

The service has a registered manager in post. 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.

Before the inspection we received information of concern about poor cleanliness and poor hygiene in the service. Although we found people’s rooms and communal parts of the service were generally clean and tidy, the standard of cleanliness and hygiene in toilets and bathrooms needed to improve. Cleaning schedules, including a deep clean rota are in place; however the last recorded deep clean of toilets and bathrooms was signed for on 16 August 2017. A senior member of staff has recently taken over responsibility for monitoring infection control and has implemented an audit which they are now checking to ensure the service is kept clean.

We received mixed feedback from people, their relatives and staff in relation to staffing levels. People’s relatives felt there should be more staff in the White House, however we saw and staff confirmed there are enough staff available to meet people’s needs. The registered manager has calculated staffing levels to ensure they are sufficient to meet people’s assessed needs and this is kept under review.

Recruitment practices are not carried out robustly to ensure potential employees are suitable to work at the service. Two out of the three staff files did not have references from their previous employer to check their previous conduct and suitability for their new role. We recommend that regular checks of recruitment files are undertaken to ensure all the information needed to demonstrate the fitness of the prospective employee has been obtained.

Overall people’s medicines are well managed; however nursing staff are not always adhering to the provider’s policies and procedures when administering medicines with expiry dates and for the disposal of unused medicines. We recommend that additional competency assessments are carried out by the registered manager to check that staff are reading and adhering to the medicines policy and procedures. This will ensure all medicines are administered correctly, in date and disposed of appropriately.

Systems are in place to identify and reduce risks to people using the service. Staff demonstrated a good awareness of safeguarding procedures and knew who to inform if they witness or have an allegation of abuse reported to them.

Staff receive training to meet the specific needs of people using the service and relevant to their roles. New staff are mentored by an experienced member of staff until assessed as competent to work unsupervised.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible, the policies and systems in the service support this practice.

People are supported to maintain their health and have access to appropriate healthcare services. The service is committed to a local authority scheme, known as Prosper aimed at promoting new ways of reducing preventable harm from falls, urinary tract infections and pressure ulcers. A review of people’s care records reflect that the implementation of the Prosper programme has clearly had an impact on reducing the number of falls, urinary infections and pressure ulcers. Although people are receiving sufficient food and drink, recording on people’s fluid charts is inconsistent. We recommend that additional training is provided to ensure staff complete records correctly to reflect the actual care provided. Additionally, the language used by staff when completing records about people’s behaviours is not always written in a dignified way.

People are provided with the care support and equipment they need to stay independent. Staff are kind and caring and have developed good relationships with people using the service. Relatives confirmed staff are caring and looked after people well.

People and their relatives were positive about the social engagement for people using the service. Although there is a timetable of activities as a guide people are asked on the day what they want to do. The service has established good relationships and links with the local community.

Concerns or complaints are taken seriously, explored and responded to. Quality assurance surveys completed by people, relatives and health professionals showed they have been asked for their feedback on the quality of the service. People’s feedback has been reviewed and action taken to address areas they identified as requiring improvement.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was in relation to there not being effective systems in place to monitor the quality of the service. You can see what action we told the provider to take at the back of the full version of this report.

Overall we found that the provider had implemented their action plan, however this was still a work in progress. At the previous inspection in May 2015, we found people were not supported in line with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). During this inspection we found that significant improvements had been made. The registered manager and staff understood their responsibilities in relation to the MCA and DoLS. People's best interests had been considered when decisions that affected them were made and applications for DoLS authorisations had been submitted to the Local Authority where restrictions were imposed upon people to keep them safe. However, we also found that there was a lack of management oversight by the provider and that further improvements were still required in relation to the implementation of governance systems to ensure the service was well led and that records relating to people's care were accurate.

Braintree Nursing Home provides nursing and personal care for up to 51 older people, some of whom have a diagnosis of dementia. On the first day of the inspection, there were 51 people living in the service. The service consists of two separate buildings both of which are spread across two floors and have communal lounge areas. The two buildings have access to a secure courtyard area with seating and flower beds.

The service had a registered manager in post. 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 told us that they felt safe living in the service. People were supported by sufficient numbers of staff who had undergone recruitment checks to ensure they were safe to work. Staff understood how to protect people from the risk of abuse and knew what action they needed to take to report any concerns in order to keep people safe. Staff were confident to whistle-blow to the registered manager if they had any concerns and were confident that appropriate action would be taken. Staff also knew how to report concerns to external agencies such as the police or social services if any concerns arose.

Care plans provided information for staff that identified people's support needs and associated risks. However, some care plans and risk assessments required information to be updated to ensure staff provided consistent support that met people's changing needs.

Checks on the environment were carried out and emergency plans were in place so that staff knew how to support people in an emergency situation. However, there were no procedures were in place to effectively monitor and maintain clinical equipment such as suction machines and nebulizers and quality assurance systems were not always effective at identifying areas of concern.

Medicines were administered safely. However there were areas where more attention to detail in recording would improve the overall management of medication.

New staff received induction training and a training programme was in place to ensure that staff had the skills and knowledge to perform their roles.

Where appropriate, staff supported and encouraged people at meal times. People were weighed regularly and when necessary referred to healthcare professionals for additional advice and support.

Staff understood people's individual needs and received updated information at shift handovers. People looked settled, happy and contented and staff were attentive and responsive when people called for them or indicated that they needed some help. We saw staff treated people with dignity and respect.

Staff were familiar with people's life stories and were knowledgeable about people's likes, dislikes, preferences and care needs. They approached people using a calm, friendly manner which people responded to positively. Staff asked people if they were happy to do something before they took any action. They explained to people what they were going to do and waited for them to respond before providing care.

An effective system was in place for investigating and responding to people’s complaints and concerns. People knew how to raise any concerns and relatives were confident that the registered manager would take appropriate action to resolve their issues.

Staff said they felt well supported by the registered manager and were clear about their role and what was expected of them.

Services that provide health and social care to people are required to inform the Care Quality Commission, (the CQC), of important events that happen in the service. This is so we could check that appropriate action had been taken. The registered manager was aware that they had to inform CQC of significant events in a timely way.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was in relation to there not being effective systems in place to monitor the quality of care. You can see what action we told the provider to take at the back of the full version of this report.

We considered our inspection findings to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

This is a summary of what we found;

Is the service safe?

When we arrived at the service a member of staff checked our identification. This meant that the appropriate actions were taken to ensure that the people who used the service were protected from others who did not have the right to access their home.

Two people told us they felt safe living in the service and enjoyed the enclosed garden. They also told us that they would feel able to speak to the manager and staff if they had concerns. We saw that all staff had received training in safeguarding of vulnerable adults from abuse as part of their induction and on-going training refreshers. This meant that staff were provided with the information that they needed to recognise signs of abuse and knew how to respond to any suspected abuse.

We reviewed staffing records regarding The Mental Capacity Act (MCA) 2005 in relation to Deprivation of Liberty Safeguards (DoLS) and saw this training was up to date and further training was planned for June and October 2014. The CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. Three staff spoken with were able to demonstrate a knowledge and understanding of MCA and DoLS. The registered manager informed us that no DoLS were in operation at the time of our inspection. While no applications have needed to be submitted, correct policies and procedures were in place.

Is the service effective?

People who used the service received regular support and access from a variety of health and social care services and professionals as their conditions and circumstances required.

People who used the service had a care plan in place detailing their specific care needs and the support to be provided by staff. The plans were updated as required and reviews were held each month.

Is the service caring?

One person said. 'They look after me so very well, can't find fault.'

Our observations showed that people who used the service were respected and treated with dignity by staff.

Is the service responsive?

There were appropriate arrangements in place for reporting of complaints and responding to concerns. People's preferences and diverse needs had been recorded in accordance with people's wishes. There were no restrictions upon visiting times and the service co-operated with other providers to meet people's assessed needs.

Is the service well-led?

There were systems in place to assess and monitor the quality of the service provided. The views of the people who used the service and staff had been sought. The registered manager and deputy operated an open door style of management so they were available to people who used the service and staff to support and resolve issues.

Observations of the staff providing care throughout the inspection demonstrated that the staff cared for the people they supported. We spoke with eight people who used the service who all told us that they felt cared for by staff. One person told us, 'The staff are so lovely, really caring.' Another told us, 'They always make time for me. Nothing is too much for them.'

We spoke with three relatives of people using the service. All told us that they felt listened to and could talk to the management team about anything. One relative told us, 'I don't need to make an appointment if I want to talk about something they make themselves available. They always sort things out and support us.'

Our inspection was conducted on Saturday. We saw that there was effective leadership on duty on the day of our inspection. This ensured that all people's needs were met.

We found that the records were not always accurate, up to date or fit for purpose. Documents required for the purpose of the inspection could not be located when required.

People told us how satisfied they were with this service because it had a homely atmosphere and they were treated with dignity and respect at all times. A typical comment was 'My daughter found this place for me, and I am so glad. It is kept so nice and clean, and nothing is too much trouble for the staff. In the evening I like to go into my room, and I spend time sitting in bed watching TV. I'm normally in bed by about 7.00pm. I could stay up until 10.00pm if I wanted, but I always feel quite spoilt sitting in bed watching the television ' how fortunate am I?'

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. People were getting sufficient nutrition and hydration and nursing interventions were making a real difference because wounds were healing.

We concluded there were enough qualified, skilled and experienced staff to meet people's needs. We examined rosters, spoke to staff and people at the service, and observed practice. Staff had undertaken several recent training courses and this included, wound management, medication and manual handling.