Background to this inspection
Updated
22 January 2020
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
This inspection was carried out by two inspectors.
Service and service type
Bruno’s cottage is a ‘care home’. People in care homes receive accommodation and nursing or personal care as 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 had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used all of this information to plan our inspection
During the inspection
We observed the interactions between staff and people living at the service and spoke to one person who used the service. We spoke with six members of staff including the director, registered manager, assistant manager and care workers.
We reviewed a range of records. This included seven people’s care records and multiple medication records. We looked at four staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.
Updated
22 January 2020
About the service
Bruno's Cottage is a residential care home registered to provide accommodation with personal care for up to six people with a range of needs including people with learning disabilities and people on the autism spectrum. There were seven people living at the service at the time of inspection.
People’s experience of using this service and what we found
The service rarely applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.
People’s experience of using this service and what we found
The leadership and the management of the service was ineffective. The provider and registered manager did not have sufficient oversight of the service to ensure people received the best possible care.
Audits had not identified issues regarding medicine recording, care plans and risk assessments not being up to date and relevant to the person. This put people at risk of serious harm.
Audits had not been completed for infection control and water temperatures.
Not all staff working with people had the necessary training to support them safety. Care plans and risk assessments were not kept up to date and relevant. When incidents or accidents occurred, these had not always been reviewed and any lessons learnt had not been identified or acted on. This put people at risk of harm that could have been avoided.
Medicine records were not always completed with all the information required. People had not been consistently safeguarded from abuse.
People were subject to high levels of control and restrictions from staff. This resulted in people not always being treated in a dignified manner. Their privacy was also affected by some of the control measures in place.
The environment had not been kept in a clean and hygienic state. We found issues relating to infection control.
The provider and registered manager had not kept the Commission informed of any changes to their registration or of notifying us of events they are required to by law.
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 (published 8 August 2017). The overall rating for the service has changed from Good to Inadequate. This is based on the findings at this inspection.
Why we inspected
We received concerns in relation to the number of people living at the service, and how the provider met the needs of people with complex behaviours. As a result, we undertook a focused inspection to review the Key Questions of Safe and Well-led.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Bruno’s cottage on our website at www.cqc.org.uk.
You can see what action we have asked the provider to take at the end of this full report
Enforcement
We have identified breaches in relation to keeping people safe, protecting people from unsafe or improper treatment, cleanliness of the environment and systems and procedures at this inspection.
We have also identified breaches relating to the providers registration with the Commission.
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
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 the 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.