The inspection was completed on 23, 24 and 31 January 2018 and was unannounced. At the time of this inspection there were 26 people living at Bradbury Home. Bradbury Home 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 care home accommodates up to 36 older people and people living with dementia in one adapted building.
Bradbury Home is a large detached building situated in a quiet residential area in Southend on Sea and close to all amenities. The premises is set out on three floors with each person using the service having their own individual bedroom and adequate communal facilities are available for people to make use of within the service on each floor.
At the last inspection on the 12 December 2016 and 3 January 2017, the service was rated ‘Requires Improvement ’. A breach of regulatory requirements was evident for Regulation 12 [Safe care and treatment] and this related specifically to medicines management. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question of ‘Safe’ and ‘Well-Led’ to at least good. The action plan was received on 15 February 2017. At this inspection, we found the service remained rated ‘Requires Improvement’. This is the second time the service has been rated ‘Requires Improvement’.
Prior to our inspection we received a statutory notification advising us of the registered manager’s absence from the service. At the time of the inspection the service was being managed on a day-to-day basis by a ‘relief’ home manager and acting head of care.
An effective robust system was not in place to assess and monitor the quality of the service. Quality assurance systems had failed to identify the issues we found during our inspection to help drive and make all of the necessary improvements. Statutory notifications as required by regulation were not always forwarded to the Care Quality Commission.
Some essential aspects of medicines management required further development. Not all risks to people were identified and improvements were required to record how these were to be mitigated so as to ensure people’s safety and wellbeing. Improvements were required to ensure that people’s care plan documentation was accessible at all times, reflected all of their care and support needs and how the care was to be delivered by staff.
Training for staff was not as up-to-date as it should be. Specifically improvements were needed to ensure staff received appropriate training relating to medication, safeguarding, moving and handling, and to ensure this was embedded in their everyday practice. Staff recruitment practices required strengthening as these were not robust or in line with regulatory requirements. Not all staff had received a robust induction, formal supervision or an appraisal of their overall performance.
Although people told us that staff cared for them in a kind and caring manner and whilst some aspects of care by staff was seen to be good, other arrangements were not as effective as they should be and could potentially impact on the delivery of care people received. The deployment of staff was not always appropriate to meet people’s care and support needs and this required review.
People’s capacity to make day-to-day decisions had been considered and assessed; and people were supported to make choices and decisions. Staff member’s understanding and knowledge of the Deprivation of Liberty Safeguards [DoLS] and the key requirements of the Mental Capacity Act (MCA) 2005 were good.
People received sufficient food and drink throughout the day and their healthcare needs were supported, having access to a range of healthcare services and professionals as required. Staff had a good relationship with the people they supported. People were supported to maintain their independence where appropriate and had their privacy respected. They were able to participate in a range of social activities of their choice.
The cleanliness of the service was maintained to a good standard and people had access to comfortable communal facilities and their bedrooms were personalised.
We have made recommendations about the management of risk and the deployment of staff within the service to meet people’s care and support needs.
You can see what action we told the provider to take at the back of the full version of the report.