This inspection took place on 21 December 2015 and was unannounced.
During our previous inspection on the 29 April 2015 we identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to make improvements in relation to; the management of medicines, governance systems and processes, and the safety and suitability of the premises. During this inspection we checked improvements had been made in these areas and re-rated the quality of the service provided.
Britannia Care Home provides accommodation, personal care and support for a maximum of 35 people. On the day of our inspection 31 people used the service. Most people who use the service have enduring mental health needs. The service is situated in Girlington, Bradford close to local amenities. The bedroom accommodation is a mixture of single and shared rooms, many with en-suite facilities. Communal space includes a dining room and two lounges.
The service has two registered managers. 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.
We identified a number of areas where potential risks to people’s health and safety had not been appropriately assessed, monitored and mitigated. There was a lack of robust information to assist staff in managing this risk, and where information and guidance was provided this was not always being followed.
We noted an improvement in some aspects of the premises. However, appropriate assessments were not being completed to ensure that people’s bedrooms and the overall environment was safe and appropriate to people’s specific needs.
We found recruitment procedures were not robust and consistent. This placed people at risk of harm as the suitability of staff had not been thoroughly checked before they commenced work.
No concerns were raised by people who used the service, relatives or staff about the staffing levels. We observed staff were available to respond to people’s needs. However, we found improvements were needed to ensure the staffing levels were robustly reviewed and assessed as people’s needs changed.
The staff were confident about how to identify and act upon any allegations of abuse or if they were concerned about people’s wellbeing. Procedures were in place to monitor and respond to safeguarding incidents and allegations. Improvements had been made to how money was managed.
Overall we found medicines were now managed more safe and robust way. Some minor improvements were still on-going, however the registered manager had plans in place to address these areas.
People told us the food was good. However we identified concerns about how staff monitored people’s weight and ensured their nutritional intake was sufficient.
Staff worked closely with other healthcare professionals to ensure people’s physical and mental health needs were met. However, improvements were needed to ensure any advice was translated into the care planning system to ensure staff could evidence they had taken appropriate action.
Staff acted within the legal framework Deprivation of Liberty Safeguards and the Mental Capacity Act 2005.
Most people and relatives we spoke with said they were happy with the care provided and praised the staff. People told us staff treated them with respect and were polite. However improvements were needed to ensure the care people received was consistently good and person centred.
Care records were not always complete, accurate and person centred. This risked that people would not always be provided with appropriate care and support.
Although many people who used the service accessed the community independently, some improvements were needed to ensure activities were planned more effectively, particularly for those people who did not have the confidence or ability to leave the home without staff’s support.
A complaints procedure was in place and the registered manager operated an open door policy to encourage people to come to them directly with any concerns or issues. It was not always clear that lessons had been learned from the complaints people had made.
Although some improvements had been made to some audits. Overall the systems and processes in place to monitor, assess and improve the quality of service provided were not sufficiently robust. We were concerned that the registered managers and provider did not have the knowledge and understanding to develop, implement and maintain robust governance systems.
We identified four breaches of legal requirements. You can see what action we have asked the provider to take at the back of the full version of the inspection report.
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.