Archived: Bracken Ridge Manor

Bracken Ridge Manor is a care home for up to 17 people with mental health needs. The service provides assistance with personal and nursing care. At the time of inspection 12 people were using the service. Bracken Ridge Manor accommodates people in one adapted building.

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

Staff were not responsive to risk. Where risk was in place, staff did not recognise or take appropriate action to reduce the risks. The safety of the building had not been maintained. Records for ‘when required’ medicines needed to be improved. There were enough staff on duty at all times. We made a recommendation about infection prevention and control.

People’s general needs were met because staff knew people so well. No effective action had been taken to address the inaccurate care records. This increased the risk of harm to new staff and students on placement. Activities needed to be improved. People knew how to make a complaint and felt confident they would be listened to.

There was continued lack of oversight by the provider. Leadership was not effective and had not resulted in improvements to the service. Staff did not understand regulatory requirements. Feedback was not used to drive improvement. Staff did work well with professionals.

Staff training was not up to date. Staff did receive supervision and appraisal. People were supported with their nutritional and healthcare needs. Improvements to the environment had started to take place.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support good practice.

People were not supported with their independence. There were missed opportunities with medicines, cooking and activities of daily living. Staff knew people well and understood their needs. Support was given when needed. Staff were caring, kind and compassionate.

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 18 December 2018). The provider completed an action plan after the last inspection to show what they would do and by when to improve. This was updated each month.

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

Why we inspected

We brought forward this planned inspection because concerns had been raised by stakeholders involved in the service. There were concerns about the lack of improvements at the service since the previous inspection.

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

The overall rating for the service has changed from requires improvement to inadequate. 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 Bracken Ridge Manor on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to supporting people with their independence, the management of risk, medicine records, staff training, care records, quality assurance systems and oversight of the service.

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 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.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of 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.

Bracken Ridge Manor is an adapted building in Loftus. It is an established nursing home for up to 17 people who live with a mental health condition. Each person had their own bedroom on the first and second floor with access to several communal areas on the ground floor. At the time of inspection, there were 13 people using the service.

This inspection took place on 19 and 26 November 2018.

A registered manager had not been in post since 17 August 2018, however the new manager did have their interview with the CQC registration team to become registered manager on 26 November 2018. They became a registered manager on 27 November 2018. 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.'

At the last inspection on 23 March 2016 we rated the service to be Good.

At this inspection, we found the service had deteriorated to be rated requires improvement.

This is the first time the service has been rated to be Requires Improvement.

We found three breaches in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to requirements relating to safe care and treatment, good governance and staffing.

Staff understood and managed the risks to people, however records did not reflect this. Accidents and incidents had taken place and action taken to reduce the risk of reoccurrence. The health and safety of the building was managed; however, one certificate was out of date. There were enough staff on duty at all times. One staff member with regular contact with people did not have a disclosure and barring services certificate needed to work with vulnerable people. Fire training and some fire records were not up to date. Although the building was clean, improvements were needed to effectively manage infection prevention and control. Not all water temperatures were within safe levels. Medicines were safely managed, though some records needed to be reviewed. There were no systems in place to ensure lessons were learned.

All staff were experienced in supporting people who lived with a mental health condition. Staff followed nationally recognised guidance for supporting people. Staff worked closely with mental health teams to ensure people lived fulfilled lives. Staff were not supported with regular review or training during their induction. Established staff had not received regular supervision or training and policies for these were not effective. People were supported with their nutritional needs and were involved in menu planning. Everyone using the service had capacity to consent and staff involved them in all aspects of their care, yet Mental Capacity Act assessments had been carried out. Some areas of the building needed to be updated.

An experienced and knowledge team was in place who supported people with their mental health. This support varied depending on the needs of people each day and support was dignified at all times. Staff actively encouraged people to be fully involved in their care. Staff used therapeutic interventions to support people when needed. Staff worked hard to make the service a home and people told us there were a family. All had regard for one another.

People received the care and support which they needed. Staff had extensive knowledge of each person, the history of their mental health condition and the strategies which were effective in providing the most appropriate support for people. However, records did not reflect this. People were independent with their social activities, and staff supported people with providing activities at the service. Information about how to make a complaint was available to people, however no complaints had been made since the last inspection.

Quality assurance systems were ineffective and had led to deterioration at the service. The registered manager required support from the provider to make the necessary improvements to the service. People and staff spoke highly of the registered manager. Feedback was sought during meetings for people and staff. Some of this feedback was addressed, but not all. Surveys had not been effective because people did not want to complete them, however other methods of feedback had not been considered. People were an active part of their local community and were involved in local events. The service worked closed with health and social care professionals. Notifications had been submitted when required.

You can see what action we told the provider to take at the back of the full version of the report.

Bracken Ridge Manor is registered to provide care and accommodation to a maximum number of 17 people with mental health conditions. The service is also registered to provide nursing care. The home is a converted property on three floors with the majority of bedrooms being on the first floor and second floor and the usual living accommodation on the ground floor. The home is situated on the High Street at Loftus with easy access to local amenities and directly on a bus route.

The home had a registered manager in place. 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 registered provider had some systems in place to monitor and improve the quality of the service provided, however at the time of the inspection formal auditing of care plans and medicines had not taken place. After our inspection the registered manager sourced and completed both audits and sent them on to us. The registered provider visited the service on a regular basis to speak with people, staff and monitor the quality of the service provided; however they did not keep a record of these visits. We could not determine what actual check had been made.

Records showed that meetings with staff and people who used the service were infrequent. The registered manager told us they spoke with people and the staff team at other times but didn’t keep a record of this.

There were systems and processes in place to protect people from the risk of harm. Staff told us about different types of abuse and the action they should take if abuse was suspected. Staff we spoke with were able to describe how they ensured the welfare of vulnerable people was protected through the organisation’s whistle blowing and safeguarding procedures.

Appropriate checks of the building and maintenance systems were completed to ensure health and safety. However, we did note that some fire doors identified by the fire authority in December 2015 as needing repair had not been repaired at the time of the inspection. The registered manager told us this repair was scheduled for the day after the inspection.

Risks to people’s safety had been assessed by staff and records of these assessments had been reviewed. Risk assessments had been personalised to each individual and covered areas such as nutrition, behaviour that challenged, smoking, self-neglect and vulnerability when out in the community. Staff supported and encouraged people to take responsible risks. This enabled staff to have the guidance they needed to help people to remain safe.

We saw that staff had received supervision on a regular basis and an annual appraisal. Staff had been trained and had the skills and knowledge to provide support to the people they cared for. People told us that there were enough staff on duty to meet people’s needs.

Staff understood the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards which meant they were working within the law to support people who may lack capacity to make their own decisions.

We found that safe recruitment and selection procedures were in place and appropriate checks had been completed before staff began work. This included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.

Appropriate systems were in place for the management of medicines so that people received their medicines safely.

There were positive interactions between people and staff. We saw that staff treated people with dignity and respect. Staff were attentive, respectful and interacted well with people. Observation of the staff showed that they knew the people very well. People told us they were happy and well supported.

We saw that people were provided with a choice of healthy food and drinks which helped to ensure that their nutritional needs were met. People were weighed and nutritionally screened.

People were supported to maintain good health and had access to healthcare professionals and services. People were supported and encouraged to have regular health checks and were accompanied by the registered manager to hospital appointments.

We saw people’s care plans were person centred and written in a way to describe their care and support needs. These were regularly evaluated, reviewed and updated.

People were encouraged to pursue their hobbies and interests. People were supported to access and engage in the local community and outings of their choice.

The registered provider had a system in place for responding to people’s concerns and complaints. People were asked for their views in the way of an annual survey. People said that they would talk to the registered manager or staff if they were unhappy or had any concerns. There had not been any complaints in the last 12 months

We found that in the main care plans provided staff with the information they needed to meet people's needs, although there was the need for some to be updated.

We found that a range of health and care professionals were involved in meeting people's needs.

We saw that the environment was clean and generally well maintained. There were effective systems were in place to ensure safety.

There were sufficient staff and appropriate skill mix to meet people's health and social care needs.

Records were accessible and stored securely, however some care plans needed to be dated and some needed to be developed.

their rights.

People who used the service told us, "It is lovely here, I have my own room with my personal things in."

Another person told us, "I like the staff here, there is always someone to talk to and also the food is very good".

People were involved in the local community as much as they wanted to be. One person was doing some voluntary work two days a week, helping keep paths clear and repairing stone walls on the North Yorkshire Moors.

Another person was in a walking group and enjoyed the exercise and fitness. There was lots of artwork around the home and a resident was in the process of drawing caricatures, which would then be displayed.

One person attended cookery classes, promoting healthy eating.