Bradbury Grange

Bradbury Grange is a residential care home providing personal care to older people and people living with dementia. At the time of the inspection, 47 people were living at the service. Accommodation is spread over two floors in a large detached property. On each floor there was a large communal lounge and dining room where people could choose to spend their time. The service can support up to 50 people.

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

People, staff and relatives told us there were not enough staff deployed to ensure people received the care and support they needed when they needed it. There were days when there was not enough staff. Agency staff covered some shortfalls, but people told us that agency staff did not know them and how they liked to be cared for.

Staff said they were demoralised and felt unsupported and not listened to by the management team. At the time of the inspection there was no registered manager in post. The registered manager had recently left the service. The provider was trying to recruit a new manager. People told us that they were bored, there was nothing to do. People, relatives and staff said they had reported this to management, but little action had been taken. Staff were recruited safely. Safety checks had been completed before staff started working with people.

Some people had medical conditions. Staff had not received specialist training in these areas like diabetes, catheter and stoma care. Risks to people’s health and wellbeing had been assessed and there was guidance in place on how to mitigate these risks. However, risk assessments gave little guidance on how to support people consistently and in a way that suited them best when they became upset and distressed.

Medicines were managed safely. Some people were supported to take their medicines independently and this was assessed and monitored. However, when people were prescribed ‘as and when’ medicines when they were distressed there was no guidance in place to make sure these medicines were given consistently and safely.

Safety checks and risks within the environment were checked and action taken if any shortfalls or concerns were identified. Fire exits were accessible for people in the event of an evacuation. The environment was clean and safe. There were procedures to protect people from the risk of infection. Some areas of the service were in need of redecorating and improvements to support people living with dementia.

People were protected from abuse and avoidable harm and were treated with respect and dignity. People were supported to have day to day choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. Staff helped to maintain people's independence by encouraging them to do as much as possible for themselves.

People's needs were assessed and reviewed to ensure care being delivered was up to date and reflective of their needs. People had care plans that provided guidance for staff on the support and care that they needed on a daily basis. People received a healthy, balanced and nutritious diet that supported their health and wellbeing.

The service worked with healthcare professionals to ensure people's health needs were met. People and relatives said GP’s and other specialists were contacted when needed. When health care professionals had raised concerns, these had been responded to and action taken. Visiting professionals told us they thought the service had improved over the past couple of years, but they were concerned this may not continue due to the registered manager leaving. When accidents or incidents occurred, learning was identified to reduce the risk of them happening again.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 31 January 2020).

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 the provider had made improvements regarding the previous breach of regulations, however we found breaches of the regulations in regard to staffing levels, staff training and the quality and safety of the service. The provider remained in breach of regulations.

At our last inspection we recommended that the provider follows good practice guidance in relation to working with other agencies to provide consistent and effective support. At this inspection we found the provider was working with other agencies to ensure people received effective and safe care.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

The inspection was also prompted in part due to concerns received about the care and support people received and staffing levels at the service. A decision was made for us to inspect and examine those risks.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has not changed from requires improvement based on the findings of this inspection.

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 Bradbury Grange 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 staffing, staff training and the quality and management at this inspection.

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

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 from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

¿ The provider had offered staff the opportunity to have free meals whilst on shift, to prevent them having to leave the service mid-shift. Staff changed clothing into their uniforms at the service and were offered a laundry service to ensure their uniforms were washed at the correct temperature.

¿ Staff previously worked across the whole service. The registered manager had deployed staff to work in one area of the service only, to minimise the risk of the spread of infection.

¿ Staff offered people constant reassurance when they were confused about why things were different. Staff explained information in a way people understood and took the time to listen to their concerns.

Further information is in the detailed findings below.

Bradbury Grange is a residential care home providing personal care to older people and people living with dementia. At the time of the inspection, 44 people were living at the service. Accommodation is spread over two floors in a large detached property. On each floor there was a large communal lounge and dining room where people could choose to spend their time. The service can support up to 50 people.

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

Fire safety risks had not always been assessed and well managed. Emergency exits in each area of the service had been blocked by items stored in stairwells and through chairs restricting access to the fire escapes. This would hinder evacuation using emergency evacuation equipment if there was a fire. Some hand rails around the service had been damaged which created sharp edges and splintered wood, which put people at risk of harm. Risks to people's individual health and wellbeing had not always been assessed which put them at risk of infection and harm.

The service worked closely with healthcare professionals to ensure people's health needs were met. However, we found one instance where the service and healthcare professionals had not worked together and communicated in an effective manner which led to one person not having their catheter changed as they should have done. This increased the risks of infection. We made a recommendation about this.

There were systems in place to check the quality of the service. However, these systems were not always robust, they had not identified the concerns we raised in relation to management of risk, fire safety and ensuring joined up and consistent support to meet catheter care needs.

People had received their medicines as prescribed and these medicines were available to them in a timely manner. Staff demonstrated a good understanding of medicines and the needs of the people at the service.

There was enough staff to keep people safe. The manager was able to deploy more staff as and when people's needs changed. Staffing was arranged flexibly. Staff were recruited safely.

Prior to people moving in to the service their needs were assessed. These assessments were used to develop the person’s support plans and make the decisions about the staffing hours and skills needed to support the person. People were reassessed as their needs changed to ensure the care they received met their needs. Some people had been involved in planning and discussions about their wishes and preferences in relation to their end of life care.

People felt safe living at Bradbury Grange. Staff had the knowledge and training to protect people from abuse and avoidable harm. Staff had received training to enable them to meet people's specific health needs. People had choice over their care and support and their choice and privacy was respected by staff. People told us staff were kind and caring. Comments from people and their relatives included, “I am absolutely safe”; “I feel safe because of the surroundings, the staff and my room” and “I can recommend it here, it is very friendly and sociable.”

People were supported to have maximum choice and control of their lives and staff them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People had access to a range of different activities throughout the week. People told us that they took part in these and that they were enjoyable.

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 21 December 2018) and there were two 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 the provider had met both breaches of regulations. However, the service remains rated requires improvement because there were was a new breach of regulation in relation to management of risks. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

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.

Bradbury Grange 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. Bradbury Grange can accommodate 50 people. At the time of our inspection there were 50 people living at the service.

Accommodation is spread over two floors in a large detached property. On each floor there was a large communal lounge and dining room where people could choose to spend their time.

There was no registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run. A new manager had been appointed in September 2018, they told us they planned to submit an application to register with CQC.

We last inspected the service in March 2017 and the service was rated Good overall. During this inspection we found two breaches of Regulation and the service is no longer rated Good.

Recruitment processes were not sufficiently robust to ensure that people were supported by staff that were recruited safely. The area manager and manager had identified this prior to our inspection and were taking steps to make sure that recruitment processes were robust before any further recruitment took place.

Potential risks to people’s health and welfare had been assessed, however there was not consistent, clear guidance for staff to follow to mitigate the risk and keep people safe. The manager had identified this and was undertaking a review of each person’s care files.

Accidents and incidents had been recorded and analysed to identify patterns and trends, action had been taken to reduce the risk of them happening again. Checks had been completed on the environment and equipment to make sure it was safe.

People’s medicines were managed safely. Systems were in place to make sure people received their medicines and these were effective. Medicine records were accurate.

Care plans contained guidance about people’s choices and preferences. Care plans were reviewed regularly and with people where they were able or their representative. People were supported to remain comfortable at the end of their lives.

Staff met with people before they moved to the service to make sure that staff could meet their needs. Staff monitored people’s health and referred them to healthcare professionals when their needs changed. Staff followed the guidance given by health professionals to keep people as healthy as possible. People had access to professionals such as a dentist and optician. People were encouraged to lead as healthy lifestyle as possible, for example moving in their chair or bed. People had a choice of meals and were supported to eat a balanced diet.

People were supported to have maximum choice and control over their lives and staff supported them in the least restrictive way possible, the policies and systems in place supported this practice.

People were supported to be as independent as possible and where possible were involved in developing their care and support. People had access to activities they enjoyed and these reflected their interests. People were treated with kindness, staff respected people’s dignity and privacy. People were relaxed in the company of staff and staff understood how to support people when they were anxious.

People were protected from harm and abuse. Staff knew how to recognise signs of abuse and how to report any concerns. Staff were confident that the manager would deal with their concerns appropriately. The manager would deal with concerns to the local safeguarding authority and followed the guidance given.

There were enough staff to meet people’s needs. Staff had received supervision and appraisal to discuss their development and training needs. New staff received an induction, staff received training appropriate to their role and staff competency was checked.

There was an open culture within the service, people and staff told us the management team was approachable. The provider had a complaints policy, this was displayed in the main reception, complaints that had been received were recorded and investigated following the policy.

People, staff and relatives were asked their opinions about the service and the feedback was positive. Checks and audits to measure the quality of the service had been completed. When shortfalls had been identified, an action plan was put in place and signed off when completed. Records such as care plans were accurate and reflected the care being given.

The registered manager worked with other agencies such as the clinical commissioning group to improve the care that people receive. The management team attended local forums and training to continuously improve the quality of the service.

The service was clean and odour free, staff used gloves and aprons when needed to reduce the risk of infection. The building had been adapted to meet people’s needs.

Services that provide health and social care to people are required to inform the Care Quality Commission (CQC), of important events that happen in the service. CQC check that appropriate action had been taken. The registered manager had submitted notifications to CQC in a timely manner.

It is a legal requirement that a provider’s latest CQC inspection report rating is displayed at the service where a rating has been given. That is so that people, visitors and those seeking information about the service can be informed of our judgements. We found the provider had conspicuously displayed their rating on a notice board in the entrance hall and on their website.

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

There were 39 people using the service at the time of the inspection, six of whom lived with dementia. People were able to converse with us.

At our last inspection on 6 April 2016 we issued four warning notices in relation to breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in regard to person centred care; consent; safe care and treatment; and governance, The registered provider sent us an action plan detailing the improvements they would make and confirmed they would be meeting the requirements of the regulations by June 2016. This inspection was carried out to follow up on compliance with these notices. At this inspection we found that the registered provider had met the requirements detailed in the warning and requirement notices and had made improvements to the culture of the service and the care people received.

There was a new manager in post since February 2017, who had registered with the Care Quality Commission (CQC) in May 2017. A registered manager is a person who has registered with the CQC 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.

Staff knew how to recognise signs of abuse and how to raise an alert if they had any concerns. Risk assessments were centred on the needs of the individual. Each risk assessment included clear measures to reduce identified risks and guidance for staff to follow or make sure people were protected from harm.

Accidents and incidents were appropriately recorded and monitored to identify how the risks of recurrence could be reduced.

People, relatives and staff told us there was a sufficient number of staff deployed to consistently meet people’s needs. Staffing levels had been calculated taking into account people’s specific needs and dependency levels. There were thorough recruitment procedures in place which included the checking of references and full employment history.

Medicines were stored, administered, recorded and disposed of safely. Staff were trained in the safe administration of medicines and kept relevant records that were accurate. Following an audit in medicines, the need for an improvement in the recording of PRN medicines had been identified a week prior to our inspection, and this was being addressed.

Staff knew each person well and understood how to meet their support and communication needs. Staff communicated effectively with people and treated them with kindness and respect.

Staff had received mandatory training and were scheduled for refresher courses. All members of staff received regular one to one supervision sessions. Staff reported feeling well supported in their roles.

The CQC is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Appropriate applications to restrict people’s freedom had been submitted and the least restrictive options had been considered. Staff sought and obtained people’s consent before they helped them. People’s mental capacity was assessed when necessary about particular decisions; meetings with appropriate parties were held and recorded to make decisions in people’s best interest, as per the requirements of the Mental Capacity Act 2005.

The staff provided meals that were in sufficient quantity and met people’s needs and choices. People told us they enjoyed the food provided and their meal times. Staff knew about and provided for people’s dietary preferences and restrictions.

People’s individual assessments and care plans were reviewed monthly or when their needs changed. Clear information about the service, the facilities, and how to complain was provided to people and visitors. Formal and informal complaints were appropriately documented and followed up.

People were promptly referred to health care professionals when needed. Their recommendations were acted on. Personal records included people’s individual plans of care, life history, likes and dislikes and preferred activities. The staff promoted people’s independence and encouraged people to do as much as possible for themselves.

People were involved in the planning of activities that responded to their individual needs. People and their relatives’ feedback was sought at dedicated meetings, and through satisfaction surveys.

Staff told us they felt valued by the area manager, the new registered manager and the deputy manager, and that they had confidence in their leadership. The registered manager was open and transparent in their approach. They had driven improvements in the home and placed emphasis on continuous enhancement of the service.

There was a system of monitoring checks and audits to identify the improvements that needed to be made. The area manager and registered manager acted on the results of these checks to improve the quality of the service and care.

Bradbury Grange is a care home which provides care and support for up to 50 older people. There were 36 people living at the service at the time of our inspection. People cared for were all older people; some of whom were living with dementia and some who could show behaviours which may challenge others. People were living with a range of care needs, including diabetes and Parkinson’s. Many people needed support with all of their personal care, and some with eating, drinking and mobility needs. Other people were more independent and needed less support from staff.

Bradbury Grange is a large domestic-style house. People’s bedrooms were provided over two floors, with a passenger lift in-between. There were sitting/dining rooms on the ground and first floors. There was a large enclosed garden and adjacent garden room to the rear.

The service did not have a registered manager in post at the time of our visit and had not had one since December 2015.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.

Bradbury Grange was last inspected on 30 September and 1 October 2015.They were rated as inadequate overall at that inspection and placed into Special Measures. The provider sent us regular information and records about actions taken to make improvements following our inspection.

At this inspection we found that significant improvements had been made in some areas. In others, however, the changes made had not completely addressed the issues.

Assessments about individual risks had not always been followed through into practice; leaving people exposed to continued risk of harm. Some people’s needs had not been consistently met in relation to their healthcare or well-being.

The principles of the Mental Capacity Act (MCA) 2005 had not been applied in some cases; which led to people’s consent not being appropriately obtained.

Auditing carried out for the purpose of identifying shortfalls in the quality and safety of the service had not been wholly effective.

People’s safety had been protected through cleanliness and robust maintenance of the premises. Fire safety checks had been routinely undertaken and equipment had been serviced regularly.

There were enough staff deployed to meet people’s needs and they had received appropriate training and supervision to help them carry out their roles effectively. Staff were caring and responsive to people’s needs and interactions between staff and people were warm and respectful. Recruitment processes had been followed to ensure staff were suitable for their jobs.

People reported enjoying their meals, and any risks of malnutrition or dehydration had been adequately addressed. There were a wide range of meaningful activities on offer and a proactive volunteer group provided extra support and funding for outings and special occasions.

The interim manager was widely praised by people, relatives and staff for his commitment to improving the service. We found a more open, transparent culture amongst staff and management and the provider had displayed their improvement plans prominently. People knew how to complain but said they felt no need to as, “Things have been turned around here”.

As this service is no longer rated as inadequate, it will be taken out of special measures. Although we acknowledge that this is an improving service, there are still areas which need to be addressed to ensure people’s health, safety and well-being is protected. We identified a number of continued breaches of Regulations. We will continue to monitor Bradbury Grange to check that improvements continue and are sustained.

One person said 'This is a very, very good home. I visited many homes and this is the best one.' Another person said 'We are very well looked after.'

A visitor said 'It's lovely here; I have no complaints at all.' Another visitor said 'It is an excellent home. The staff are kind and caring, I cannot think of anything that could be better.'

The home was clean, well maintained and felt very homely. People said that they were very happy with their bedrooms and with the facilities. One person said 'The rooms are lovely, the bedrooms and bathrooms are very good, very clean.' The home was well maintained and suited people's needs.

People told us that the food was very good and that they always had a choice of meals. One person said 'If you want anything, you just have to ask and they get it. There are always drinks and snacks available too.'

People's health and personal care needs were supported and the service worked closely with health and social care professionals to maintain and improve people's health and well-being. People were treated with dignity and respect and the service responded to people's changing needs. People told us that they felt safe.

The home was well managed and there was always a senior member of staff on duty. The manager and deputy manager were on call for out of hour's advice and support.

There were enough staff on duty to meet people's needs safely. One person said 'I am never rushed. The staff are there when you need them.' Another person said 'It doesn't matter when you call them, day or night; there is always someone around, even if you just want a cup of tea!'

People said that they were very happy with the care and support they received and that their needs were being met in all areas. They said that the staff treated them with respect, listened to them and supported them to raise any concerns they had about their care. People told us that the service responded to their health needs quickly and that the manager talked to them regularly about their plan of care and any changes that may be needed.

Many comments received were complimentary of the service. One lady said 'It's lovely here' another said 'I'm quite happy here. Staff treat me well'. Other people were complimentary of the food and had no concerns with regard to the quality of care.

People said that they had an active say on ways to improve their care. The manager said they were receptive to comments and concerns and strived to resolve any issues as soon as possible. People had their comments and complaints listened to and acted on, without the fear that they would be discriminated against for making a complaint. Staff told us if a person using the service complained to them they 'would report it to the manager'. Staff were confident that people were able to express concerns if necessary.