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Brampton View Care Home Requires improvement

Reports


Inspection carried out on 20 January 2021

During an inspection looking at part of the service

About the service

Brampton View Care Home is a care home providing personal and nursing care to 60 people aged 65 and over at the time of the inspection. The service can support up to 88 people.

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

People had individual risk's assessed with strategies in place to mitigate risks. However, staff did not always follow the strategies.

Checks were in place to ensure the environment was safe. We identified that some people's bedrooms doors required repair.

We were assured that infection control was managed appropriately but we found some gaps in recording on cleaning records.

Auditing and oversight of some care records required improvement.

Medicines were administered, stored and disposed of safely.

Systems and processes were in place to protect people from abuse and people told us they felt safe

There were enough staff on shift to meet people’s needs and staff were recruited safely.

People and relatives spoke positively about the care provided and people were supported to stay in contact with their loved ones.

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 1 April 2020). The service remains rated requires improvement.

Why we inspected

The inspection was prompted in part due to concerns received about staffing levels and oversight. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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 coronavirus and other infection outbreaks effectively.

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.

We have found evidence that the provider needs to make improvements. Please see the safe 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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Brampton View Care Home on our website at www.cqc.org.uk.

Enforcement

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified a breach in relation to the governance and oversight of the service.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.

Inspection carried out on 25 February 2020

During a routine inspection

About the service

Brampton View Care Home accommodates up to 88 older people in one purpose-built building. At the time of the inspection, 53 people were using the service. The care home accommodates 88 people in three separate areas, each of which has separate adapted facilities. One area specialises in providing care to people living with dementia, one for people with complex nursing needs and one for people who are semi-independent.

People’s experience of using this service

The quality and safety of the service was being closely monitored by the manager and new provider. New systems and processes were in place to ensure people received safe and person-centred care. However, this required time to be embedded into the service to ensure they were sustained, and improvements continued.

Risks to people’s care were identified and plans put in place to mitigate the risk. There was some inconsistency in recording information which could impact on the ability of staff to support people safely.

People were supported by a consistent staff team but at times staff were stretched to meet people’s needs in a timely way. Staff understood how to protect people from harm and followed good hygiene practices to prevent and control infection. Medicines were safely administered and stored.

People’s needs were assessed, and care plans guided staff how to meet those needs. Further improvements were needed to care plans to ensure they detailed the support people required for their social and emotional well-being. People had access to activities but wanted more opportunities to undertake activities geared towards their interests.

People’s dietary needs were met, and healthy eating was promoted. Staff ensured people's healthcare needs were met. Staff were alert and responsive to any changes in people's needs and liaised with health care professionals.

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 were cared for by staff who were kind and considerate and knew them. They had developed positive relationships with staff and were treated with respect. Their dignity was protected, and staff listened to their wishes and took account of their preferences when delivering care.

People, relatives and staff shared confidence in the manager to respond to and act on any concerns or complaints they may have.

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 inadequate (5 September 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since September 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Since this rating was awarded the registered provider of the service has changed. We have used the previous rating and enforcement action taken to inform our planning and decisions about the rating at this inspection.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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.

Inspection carried out on 26 June 2019

During a routine inspection

About the service

Brampton View Care Home is a care home providing personal and nursing care to 76 people aged 65 and over at the time of the inspection. The service can support up to 88 people.

The care home accommodates 88 people in three separate areas, each of which has separate adapted facilities. One area specialises in providing care to people living with dementia, one for people with complex nursing needs and one for people who are semi-independent.

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

The quality of care had deteriorated since the last inspection. People’s safety was at risk as there was a lack of oversight of people’s care needs. Staff were not always following the instructions given to them to ensure that they were providing the care and support people needed. Risks to people had not always been assessed and plans in place to reduce risks were not always followed. Some people had not received their medicines at the times prescribed. There was insufficient staff to meet people’s needs.

The lack of consistent management had impacted on the ability of the provider to drive the necessary improvements. The systems in place to monitor the quality of the service and audit systems were not adequate and shortfalls were not being picked up. Lessons were not always learnt from incidents and information from complaints were not sufficiently analysed for trends to help improve the service.

Some people’s nutritional and hydration needs were not met, despite assessments being undertaken and advice given. The quality of the food varied, and people’s experience of meals differed. People needing specialist diets were not always given the snacks and drinks they required to help them maintain and improve their weight. People were not always supported with their meals in a timely way and specially prepared food was not appetising and not always at a consistency people could eat safely.

Staff had not all received the training and supervision they required to provide consistent and effective care. Staff from outside agencies did not always have the induction they required to provide the care needed.

People’s dignity and privacy was sometimes compromised. Staff had no time outside delivering basic care needs to spend with people. We observed some good interactions with people but also some poor ones. Comments made by people and relatives included, ‘Staff are a pretty good bunch here, they just need some organising.’

People's needs, and preferences were not always known by staff and there was limited opportunities for people to undertake individual or group activities. We have recommend that the Provider seeks guidance around the Accessible Information Standard.

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.

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

The last rating for this service was Good (published 26 June 2018)

Why we inspected

The inspection was prompted in part due to concerns received about lack of staff, people being left for long periods of time without support, poor monitoring of people’s nutrition and hydration needs, and a notification of a specific incident. Following which a person using the service sustained an injury.

The information CQC received about the incident indicated concerns about the management of percutaneous endoscopic gastrostomy (PEG) feeding.

We have found evidence that the provider needs to make improvements. Please see the safe and effective sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Brampton View Care Home on our website at www.cqc.org.uk.

Enforcement

We have

Inspection carried out on 10 April 2018

During a routine inspection

Brampton View Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Brampton View Care Home is registered to accommodate up to 88 people; at the time of our inspection, there were 72 people using the service. The service provides nursing care and support to older people, including people living with dementia and people with physical disabilities.

At the last inspection in February 2016, the service was rated Good. At this inspection, we found the service remained Good. However, the rating under the key questions Safe, has deteriorated to Requires Improvement, as further work is needed to improve medicines administration.

This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Medicines were not always safely administered. Staff did not consistently administer medicines following the administration guidelines, which placed some people at risk of having their medicines given outside of the prescribed frequency / times. The actions put in place to learn from medication errors had not been effective in improving the medicines administration practice. Anticipatory medicines, designed to ease the symptoms of pain, anxiety and distress during palliative / end of life care, were not always arranged in advance for people receiving end of life care. This meant people receiving palliative / end of life care may have been at risk of not having medication readily available to provide effective symptom control.

Staff had a good understanding of what abuse was and of the safeguarding procedures to follow in reporting any concerns of abuse. People had risk assessments in place to cover any risks that were present within their lives, but also enable them to be as independent as possible. Staffing levels were sufficient to meet people's current needs. The staff recruitment procedures ensured that appropriate pre-employment checks were completed to ensure only suitable staff worked at the service.

Infection control procedures were followed to prevent the risks of illness due to poor hygiene practices. Staff were trained in infection control and used appropriate personal protective equipment to perform their roles safely.

People’s needs and choices were assessed and their care provided in line with up to date guidance and best practice. They received care from staff that had received training and support to carry out their roles effectively.

People were supported to access advice and support from other health and social care professionals and to attend appointments with healthcare professionals. The service worked with other organisations to ensure that people received coordinated and person-centred care and support.

People were supported to eat and drink enough to maintain a balanced diet. Their needs were met by the adaptation, design and decoration of premises and bedrooms were decorated and furnished to reflect people’s individuality.

People's consent was gained before any care was provided and the requirements of the Mental Capacity Act (MCA) 2005 were met. 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 support this practice.

Staff treated people with kindness, dignity and respect and spent time getting to know people and their specific needs and preferences. People were happy with the way that staff provided their care and support. People were encouraged to make decisions about how their care was provided.

People views were acknowledged and acted upon and their care and support was delivered in the way that people chose and preferred. Care plans were person centred and reflected how pe

Inspection carried out on 23 February 2016

During a routine inspection

This inspection took place on the 23 and 24 February 2016 and was unannounced. The service is registered to provide accommodation for people who require nursing and personal care for up to 88 people. The service caters for people with physical disability, degenerative conditions and people living with dementia. At the time of our inspection there were 79 people living there.

There was a registered manager in post 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.

Systems were in place to ensure people were protected from abuse; staff had received training and were aware of their responsibilities in raising any concerns about people’s welfare. There were formal systems in place to assess people’s capacity for decision making under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).

The provider had robust recruitment systems in place; which included appropriate checks on the suitability of new staff to work in the home. Staff received a thorough induction training to ensure they had the skills to fulfil their roles and responsibilities. There were enough suitably skilled staff deployed to meet people’s needs.

People’s care was planned to ensure they received the individual support that they required to maintain their health, safety, independence, mobility and nutrition. People received support that maintained their privacy and dignity and systems were in place to ensure people received their medicines as they were prescribed. People had opportunities to participate in the organised activities that were taking place in the home and were able to be involved in making decisions about their care.

There was a stable management team and effective systems in place to assess the quality of service provided.

At our inspection in November 2014, we concluded that the overall rating for the service was ‘Requires improvement’. This was because the provider was in breach of Regulation 22, of the Health and social care act 2008 (regulated activities) Regulations 2010: Staffing. This was because there were insufficient numbers of suitably qualified, skilled and experienced staff employed for the process of carrying on the regulated activities. This deficit impacted on all aspects of the service that people received. We asked the provider to send us an action plan setting out the action that they would take to stabilise staffing levels within an appropriate time frame. During this inspection we found that there were sufficient numbers of suitable qualified and skilled staff employed and that people received of a good level of care and support from staff that they knew and understood their needs.

Also during our inspection November 2014 we also found the provider was in breach of regulation 10 of the Health and social care act 2008 (regulated activities) Regulations 2010 Assessing and monitoring the quality of the service provision because quality assurance systems were not robust. The provider had not identified, assessed and managed the risks relating to the health; welfare and safety of the people who used the service and others who may have been at risk. We asked the provider to send us an action plan setting out the action they would take to strengthen quality assurance systems and the management of the home; within an appropriate time frame. During this inspection we found that quality assurance systems had been improved and that the management of the home had been strengthened. All of the people we spoke with told us they had confidence in the management and recognised the improvements that had been made.

Inspection carried out on 3 November 2014

During a routine inspection

This was an unannounced inspection which was conducted on the 3 November 2014.

Brampton View Care Home provides nursing and personal care for up to 88 people for people with physical disability, dementia and care for adults over 65 yrs. At the time of our inspection there were 86 people living at the home.

There was a registered manager in post at the time of our inspection, however they resigned shortly afterwards and an interim manager was appointed. 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 not always enough staff on duty to ensure people received the individual support that they required in maintaining their safety, independence, mobility and appropriate assistance with eating their meals.

The provider had a robust recruitment system in place which included appropriate checks on their suitability to work in the home and new staff received a thorough induction training to ensure they had the skills to fulfil their roles and responsibilities.

The provider had appropriate systems in place to ensure people received their medicines as and when they required them.

There was a lack of formal systems in place to assess people’s capacity for decision making under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).

People did not always experience care and support to maintain personal routines because staffing levels were unstable. The support they received was chaotic and did not always maintain their dignity. The people who used the service lacked confidence in the management of the home because they viewed the staffing arrangements as chaotic.

Because staff did not have time people spent significant periods of time with little interaction or stimulation from the staff. No organised activities were taking place on either of the dementia units because the activities staff were working as carers because of staff shortages.

There were systems in place to assess the quality of service provided; however it was not always clear what action the management had taken to address people’s concerns, particularly in relation to the staffing levels and the management had not formally assessed the number of staff required to meet peoples’ needs.

Records were not always fully completed therefore management could not assure themselves that people received the care and support that had been specified.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. 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 2 December 2013

During a routine inspection

We spoke with 10 people during our inspection at Brampton View. All of the people we spoke with told us they were well cared for and the staff knew the care they needed and how they wished to be supported. One person said �The care is excellent, I have never had a problem, the staff are very nice�.

People told us they were supported to be able to eat and drink sufficient amounts to meet their needs. One person told us �We get drinks regularly, morning and afternoon; I get offered biscuits, cakes and fruit and my water jug is there on the table within my reach�.

Six out of the 10 people we spoke with told us their enjoyment of the food at Brampton View was variable. One person said �I have a mixed opinion about the food, it�s of variable quality. I told the chef who comes in to see me every day. We also have tasting sessions to try out new recipes. There is a choice of options; it�s usually hot food and the plate is hot�.

People told us the environment was clean and hygienic. One person said �It�s a very pleasant environment and there is a good standard of care�. All the people we spoke with told us that they thought the staff had the skills they needed, to care for them and that they were well looked after by the staff at Brampton View. One person said �The personal attention is great, the staff always stop and chat, a lot of them have been here for some time�.

Inspection carried out on 25 February 2013

During a routine inspection

We spoke with four people during our inspection at Brampton View, two of the people that we spoke with provided specific feedback in relation to consent. They told us that the staff involved them in decisions about their care and explained their care needs to them before carrying out any procedures. This meant that people were provided with information, were able to make informed decisions and provide informed consent to the care and treatment that was offered.

All the people we spoke with told us that they were well looked after at Brampton View and that the staff knew how they needed and wished to be supported. One person commented �the care is excellent here and I am very satisfied with the way that I am treated�. Another person also told us �the staff know how I need to be cared for, they are very good here�.

People told us that they thought that the staff had the right skills to care for them safely. One person said �the staff are excellent; I have no concerns at all�. Another person commented �the staff are very good; they know how I need to be cared for�. People also told us that the staff were respectful towards them and that they felt safe living at Brampton View. People also told us that they knew how to complain should they need to do so.

Inspection carried out on 21 November 2011

During an inspection in response to concerns

Most of the people we spoke to told us that they were very happy with the quality of the service provided at Brampton View. People felt that they were well cared for and most felt that there were enough staff on duty to care for their needs. People told us that there were activities that they could either organise themselves or join in with.

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