Archived: Brundall Care Home

Updated 4 May 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked 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.

This comprehensive inspection was carried out by two inspectors and an Expert by Experience on 20 February 2018 and was unannounced. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Prior to the inspection we reviewed the contents of notifications received by the service. Services have to notify us of certain incidents that occur in the service, these are called notifications.

Some people using the service were unable to communicate their views about the care they received. We carried out observations to assess their experiences throughout our inspection.

We spoke with three people using the service, two relatives, four care staff, the operations manager, a company director and the manager.

We reviewed five people’s care records, two staff personnel files and records relating to the management of the service.

Updated 4 May 2018

Brundall Care Home is a residential care home registered to provide support to 39 people, some of whom were living with dementia. At the time of inspection there were 24 people using the service.

At the last inspection on 5 July 2016 the service was rated ‘Good’ overall. At this inspection we found that the service had been unable to sustain the improvements we observed at our last inspection. We identified widespread failings in the service which put people at risk of harm. The service is now rated ‘Inadequate’ overall.

The service did not have a registered manager. However, the person managing the home at the time of inspection was in the process of registering with us. 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 5 July 2016 inspection the service achieved a rating of ‘Good’. This was following two previous inspections where the service had been rated ‘Inadequate’ overall and where the Commission took enforcement action against the service. The provider had ineffective systems in place to oversee the service and ensure its compliance. This meant that we found at this visit the improvements that had been made previously had not been sustained.

Risks to people were not always identified and clear plans to mitigate risks were not in place for all the people whose records we reviewed. The manager and care staff did not always recognise risks in the environment, such as items which could cause potential harm. Care planning did not always make it clear how care should be delivered to ensure people’s safety.

Care planning around nutrition and hydration was not consistently clear about the support people required. The service did not follow National Institute for Health and Care Excellence (NICE) guidance around the assessment of nutrition and the actions required when people were assessed as at risk of malnutrition. NICE guidance is publically available and provides the reader with up to date information about best practice in providing care to people.

There were shortfalls in the way people’s pressure care needs were assessed and care planned. This put people at risk of a deterioration in their skin integrity.

People and/or their representatives were not consistently involved in the planning of care. Care plans and the records we reviewed did not reflect people’s views and preferences.

People’s records were not consistently personalised to include information about their likes, dislikes, hobbies and interests. Where people were living with dementia, there were not sufficient life histories in place. Care plans did not set out people’s preferences around how they would like their care delivered. This meant that staff did not have the information needed to deliver personalised care.

Sufficient end of life care plans were not in place. The service had not referred to NICE guidance and the Gold Standards Framework to create care plans that set out people’s wishes and needs in sufficient detail.

The environment was not safe. There were hazards which could compromise staff’s ability to evacuate the building quickly in the event of a fire and some fire exit and evacuation signs were confusing. There were exposed hot water pipes throughout the service which posed a risk of burns if people were to touch or fall against them. We tested a sample of hot water taps and found two did not have valves to stop them reaching scalding temperatures. There were substances and items in some people’s bedrooms that could be harmful to people if ingested in error. These included prescription creams.

The audit and management systems in place at the service were ineffective. The manager had not independently identified the serious safety concerns we identified and taken action to protect people. Whilst audits carried out on behalf of the provider had identified some of the shortfalls, prompt action had not been taken to ensure people were protected from harm.

Some parts of the service were cold and this had not been identified by staff or the manager. Staff opened windows around the service and did not have an awareness of how to support people to maintain a comfortable temperature.

Some interactions we observed were not kind and caring. We observed that staff became frustrated with some people using the service and did not demonstrate a knowledge and understanding of people living with dementia. There were no plans in place to guide staff on supporting some people who had behaviours that they found challenging.

People’s capacity to make decisions was assessed and Deprivation of Liberty Safeguards (DoLS) applications had been made where appropriate. However, we observed that staff did not always provide people with opportunities to make independent decisions or request their consent.

There were not enough staff to provide people with care and support at the time they needed it. We observed occasions where there were no staff available to support people to mobilise safely which put them at risk of falls. We observed that a member of activities staff had to support care staff to meet people’s needs, which took them away from providing activities and engagement for people.

The home was not decorated in a way that helped people living with dementia find their way around the building. We observed people finding it difficult to orientate themselves and requiring staff support to find their way to their bedroom or communal areas.

Staff told us they thought the training provided them with appropriate knowledge for the role. However, discussions with staff and observations meant we were not reassured staff were suitably knowledgeable.

Staff received regular supervision and appraisal. However, this was ineffective in identifying areas for improvement in staff practice.

There were safe recruitment procedures in place.

Medicines were managed and administered safely. However, some prescription creams were not stored securely.

People told us they knew how to make complaints and felt they would be acted upon.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.”

Further information is in the detailed findings below.