Bradley House Care Home

Bradley House Care Home is a residential care home providing accommodation and personal care for up to 48 older people and younger adults, including people living with dementia. At the time of our inspection 46 people were living at the service.

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

Quality monitoring systems allowed for the effective monitoring of the service by the provider, however action plans were not always revisited. We have made a recommendation about this.

Medicine practices were not always in line with best practice guidelines. We have made a recommendation about this.

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.

People had support from safely recruited staff and there were enough staff on duty. Staff received training in safeguarding and understood their role and responsibilities to protect people from abuse. Staff continued to receive guidance and support from management when required.

People and staff spoke positively about the management of the service. There was a positive, caring culture within the service and people were treated with dignity and respect. People were happy with the care they received, they felt safe and well looked after. People felt consulted about their wishes and they knew how to make a complaint if they wished to.

Risks to people had been assessed. People accessed specialist health and social care support where appropriate. Safety checks of the premises and equipment were not always routinely carried out.

Staff had positive links with healthcare professionals which promoted people's wellbeing. Records confirmed the registered manager worked in partnership with stakeholders. We found the registered manager to be open and responsive to feedback.

For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 9 November 2017).

Why we inspected

This inspection was prompted by a review of the information we held about this service and when the service was last inspected.

Follow up

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 service was clean and hygienic; cleaning schedules had been updated to include deep cleans and increased cleaning of high touch surface areas.

The layout of the service supported the provider to implement an isolation ward separate from other areas of the service to reduce the risk of transmission in the event of an outbreak.

National guidance was followed on the use of personal protective equipment (PPE). The service had good supplies and stations were in place to ensure staff had access to PPE in a safe and accessible area. All staff had completed training on the donning and doffing (putting in and taking off) of PPE, and spot checks were completed by senior staff to ensure staff complied with the guidance.

Staff monitored people for signs and symptoms of COVID-19, and appropriate processes were in place should anyone display any symptoms of COVID-19 or receive a positive test result. Staff and people who used the service took part in regular COVID-19 testing and the vaccination programme.

National lockdown measures on visiting were in place at the time of inspection, therefore only essential visits were taking place. A visitor's protocol was in place to ensure anyone entering the service received a lateral flow coronavirus test prior to entry.

Staff supported people's social and emotional wellbeing. The provider frequently engaged with people's friends and families and supported people to maintain contact with friends and families.

The service had a registered manager in post. A registered manager is a person who has registered with 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.

We undertook this unannounced inspection on the 26 and 27 September 2017. The last full inspection took place on 21 and 22 February 2017 and we found concerns in relation to: person centred care, medicines, consent to care and quality monitoring. The service was rated ‘Requires Improvement.’

We received an action plan from the provider about how improvements were to be made. At this current inspection, we looked at the previous breaches of regulations and the action plan to check that improvements had been made and sustained over a period of time. We found significant improvements had been made in all areas, although there was one area that required further improvement.

The overall management and governance of the service had improved, although we found audits of medicines systems needed strengthening in some areas to ensure staff were consistently following best practice guidance. We received information after the inspection that more detailed checks and records were in place. The culture of the service was more open and inclusive.

The service was operating within the principles of the Mental Capacity Act 2005 (MCA). We found improvements in records when people were assessed as not having capacity to make their own decisions. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

Improvements had been made with the standard of recording in the care files. A new recording format had been introduced and care plans had been reviewed and updated to reflect the person’s current care needs. We found risk assessments were completed, reviewed and updated when people’s needs changed. Supplementary records to monitor areas such as food and fluid intake, repositioning support and personal care were completed in detail and up to date.

Staff knew how to protect people from the risk of harm and abuse and had completed risk assessments in order to minimise concerns. Equipment used in the service was maintained and any repairs were completed in a timely way. The service was clean and tidy.

People’s health and nutritional needs were met. Records indicated people had access to health care professionals and staff arranged for visits from GPs and district nurses when required. They also made referrals to specialist health care professionals such as speech and language therapists and dieticians when required.

Menus provided people with choice and alternatives; drinks and snacks were served in between meals. People had special diets catered for and staff were knowledgeable about these. They completed additional monitoring charts when people had any nutritional concerns.

People who could talk with us told us staff were kind and caring and relatives were pleased with the care delivered to their family member. During the day we observed staff were attentive to people and knocked on doors before entering bedrooms.

Staff were recruited safely and full employment checks carried out before new staff started work. There were sufficient staff on duty to meet people’s needs during the day and at night. We saw staff had access to a range of training, supervision and support. Staff spoken with said both training and management support had improved since the last inspection. They felt confident supporting people and said they had the right skills to complete caring tasks. Staff also said that communication had improved and they felt able to express their views in meetings and on a day to day basis with the registered manager.

There was a range of activities for people to participate in; these included one to one sessions, group activities and trips to local facilities.

People told us they felt able to make a complaint in the knowledge that it would be addressed. They said the registered manager was approachable and available when they wanted to speak with them. There was also a trainee manager and team leaders on each shift who could manage day to day areas of concern.

The service did not have a registered manager in post. A new manager had been appointed in August 2016 and they confirmed they had submitted their application to register with the Care Quality Commission (CQC) the previous week. A registered manager is a person who has registered with 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.

We undertook this unannounced inspection on the 21 and 22 February 2017. The last full inspection took place on 22 and 23 October 2015 and the service was compliant in all areas although we rated the service, ‘Requires Improvement’ to ensure the improvements were sustained. At this inspection we found breaches in four regulations and the service rating remains ‘Requires Improvement.’

We found there was inconsistency regarding the application of the Mental Capacity Act 2005. The registered provider and acting manager had not always followed best practice when assessing people’s capacity and discussing and recording decisions made in their best interests.

We found not everyone had a full and up to date care plan and risk assessment to guide staff in how to meet their needs in a person-centred way. Staff had not responded to changes in one person’s health care needs and action was taken to access a medical assessment following direction from a social care professional during the inspection.

There were shortfalls in the administration and recording of some people’s medicines. We also found the medicines for some people admitted for short term rehabilitation support, had been out of stock for a period of time, due to delays in obtaining the medicines. One person had not received their medicines for three days and this was addressed during the inspection. There was no guidance for staff around the use of ‘as needed’ medicines to ensure consistent administration.

The above areas breached regulations in person centred care, consent to care and safe administration of medicines. You can see what action we have asked the registered provider to take at the back of the full version of the report.

The quality monitoring system had not been effective in highlighting areas where improvement was needed such as the care records, consent to care and the management of medicines. We found action had not been consistently taken or identified in order to address these shortfalls. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

We saw there were sufficient staff on duty to meet people’s needs. We found staff had been recruited using a robust system that made sure they were suitable to work with vulnerable people. They had received a structured induction and essential training at the beginning of their employment. This had been followed by regular refresher training to update their knowledge and skills. Staff received an appraisal and recent gaps in the supervision programme were being addressed.

Relatives gave us positive feedback about the care and support their family members received. Staff approached people in a kind and caring way which encouraged people to express how and when they needed support. Staff demonstrated good communication skills and distraction techniques when managing people who may need additional support to manage their behaviours.

People liked the meals provided to them and there was sufficient quantity and choice available. We saw people’s weight, their nutritional intake and their ability to eat and drink safely was monitored. Referrals to dieticians and speech and language therapists took place when required for treatment and advice. During the day, we observed people were served drinks and snacks between meals.

People’s privacy and dignity were respected and staff provided people with explanations and information so they could make choices about aspects of their lives. There were positive comments from relatives about the staff team.

We saw people were encouraged to participate in a wide range of activities at Bradley House and to maintain their independence where possible. Relatives told us they could visit at any time and we saw staff supported people who used the service to maintain relationships with their family.

We found people who used the service were protected from the risk of harm and abuse because staff had received safeguarding training and they knew what to do should they have any concerns.

We found no evidence to substantiate the allegations made.

People we spoke with told us, 'I like it here, the staff are great and they treat me ever so well.' Another person told us, 'I have just had some cereal but the cook has gone to fetch me a bacon sandwich.'

Staff told us, 'I always tell people what time it is and ask if they want to go back to bed but sometimes they prefer to get up. It's all about respecting their choices and wishes' and 'If we had concerns about someone's weight we would contact the dietician.' The chef told us, 'I have the details of everyone's dietary needs. Some people can't eat certain things and other people need soft diets.'

We saw that staff handled medication safely and they had received training; we also saw the quality of the bed linen was acceptable.

Visiting health care professional told us they were happy with the way staff cared for people and that any instructions given by them were followed. They also commented on the staff being professional and caring. We spoke with the senior nursing officer from the placing authority who told us, 'We are happy with things at the home. We meet up weekly to discuss any issues and find that they deal with things quickly when needed.'

We saw evidence that people's care plans had been updated. Since our last visit their nutrition and hydration was being monitored. Where new people were admitted to the home, nutritional risk assessments were completed within 12 hours of their arrival and we found these were reviewed in accordance with nutritional assessment scores.

We observed there was sufficient staff supporting people in the dining room with eating their food and making sure they had sufficient hydration. Staff were also observed prompting people to eat food and offering second helpings. Special supportive cutlery was also made available to those people who wanted to eat independently.

Records showed the provider was carrying out regular nutritional audits and appropriate action was being taken where required.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. People we spoke with confirmed they were able to make choices about their care and treatment.

People were not protected from the risks of inadequate nutrition and dehydration. This was because some people were not receiving sufficient quantities to meet their needs or the support to enable them to eat and drink sufficient amounts.

People were protected from the risk of infection because appropriate guidance had been followed. We found the premises to be clean and tidy.

The provider had taken steps to provide care in an environment that was suitably designed and adequately maintained. One person we spoke with said "I like my room, it's like a hotel." Another person said "They keep my room clean and tidy."

We found people were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. People we spoke with confirmed the standard of care they received was good and the staff were caring and kind.

Relatives and others spoke positively about the staff working in the service. A relative said, 'I think it is very good. The carers talk to everybody in a friendly way. They are very cooperative if there are special needs.' Another relative told us, 'The staff are lovely, they always look us up and they are always chatty. We could approach any member of staff.' Another relative said, 'Staff are smart looking and are supported. Staff are friendly and polite.' A visiting healthcare professional said, 'The staff are always helpful.'