Archived: Bransfield Manor Care Home

Updated 6 January 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection took place on the 23 October 2015. We returned on the 28 October as the registered manager was not present on the first day of our inspection.

The inspection was carried out by two inspectors.

We reviewed records held by CQC which included notifications, complaints and any safeguarding concerns. A notification is information about important events which the service is required to send us by law. We did not ask the provider to complete a provider information return (PIR) on this occasion.

During the inspection we spoke withthree people who lived atBransfield Manor, two staff, tworelatives, the registered manager, and the provider. We observed care and support in communal areas by using the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We looked at a variety of documents which includedfour people’s care plans,four staff files, training programmes, medicine records,duty rotas and quality assurance records. We also looked at a range of the provider’s policy documents. We asked the registered provider to send us some additional information following our visit, which they did.

At the last inspection on the 11 and 12 November 2014, we asked the provider to take action to make improvements (for example care and welfare of people, and requirements relating to workers). We also issued the provider a warning notice in relation to a breach of Regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

At this inspection we identified the provider had taken action to address the areas of concern within the warning notice.

Updated 6 January 2016

Bransfield Manor is a care home that provides care and accommodation for 17 older people living with Dementia and mental health issues. On the day of our inspection 10 people were living at the home.

The inspection took place on the 23 and 29 October 2015 and was unannounced.

A registered manager was 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.

At a previous inspection in November 2014 the provider was not meeting the requirements of the regulations and we issued a warning notice for the concerns we found in the monitoring of service quality.

We undertook a further inspection of the home in October 2015 to check that actions from the warning notice had been implemented and improvements had been made.

At this inspection we found staff did not show a level of understanding that people living with dementia have specialist needs. We did not observe staff consistently respecting people and treating people as individual’s and focusing on their needs, abilities and achievements.

There were not sufficient numbers of staff to meet people’s needs. People were left on their own in the lounge for periods of time which was a risk to their safety. We observed people being left unattended for periods of ten minutes or more.

Staff had written information about risks to people and how to manage these in order to keep people safe. However we did not observe that staff followed these guidelines when undertaking tasks such as helping people who had limited mobility to move.

Staff were adequately trained and this was observed in their approach to care and support of people. Staff did not always spend time with people in a social manner. We did not see many occasions when staff sat and interacted positively with people.

We identified that people had generally maintained weight however; people were not being appropriately supported in meeting their nutritional requirements particularly at lunchtime.

Care plans reflected people’s current needs. The plans we saw contained clear guidance to staff about how they could meet people's assessed needs. However we observed staff did not always provide care and support as directed.

The legal framework around the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) had been followed. Staff we spoke with understood the requirements of the Act and how it affected their work on a day to day basis. The registered manager had completed the necessary MCA two stage assessments. Records detailed ‘best interest’ decisions and who had been consulted in making these decisions for people who lacked capacity.

Some DoLS applications had been made to the local authority, as required by the where a person’s freedom may be restricted to keep them safe.” For example being supported by staff to go out of the home.

Medicine procedures for the safe storage of medicines were in place. However we could not identify consistent best practice for the administration of medicines as we were unable to observe people being given their medicines, as people did not have lunch time medicines prescribed. .

People were at risk harm due to the lack of robust window restrictors in the home. The home had not followed best practice guidance for health and safety in Care homes as directed by the Health and Safety Executive (HSE).

The premises were not adapted to support the needs of people living with dementia. For example; had no signposting to peoples rooms or bathrooms; memory boards, orientation signage such as date and time displayed.

Staff ensured people had access to healthcare professionals when needed. For example, details ofdoctorsand opticians visits had been recorded in people’s care plans. Complaint procedures were up to date and relatives told us they would know how to make a complaint if they needed to.

There were complete pre-employment checks for all staff. This included full employment history and reasons why they had left their previous employment. This meant as far as possible only suitable staff were employed.

The home had a satisfactory system of auditing in place to regularly assess and monitor the quality of the service. We found that the registered manager had implemented some systems to identify actions that were required to make sure improvements to practice were being made. The provider and registered manager had and continued to take action to address shortfalls identified at previous inspections to ensure that people received appropriate care.

The registered manager met CQC registration requirements by sending notifications when appropriate. We found both care and staff records were stored securely and confidentially

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.