Archived: Bracknell Care Home

Bracknell Care Home is a care home providing personal and nursing care to a maximum of 30 older people, some of whom may be living with dementia and/or physical disability. At the time of the inspection the service was supporting 21 people.

People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The accommodation is arranged over two floors, with all rooms having en-suite toilet facilities and bathrooms. There is one large communal space that is divided into small areas. These include dining room, living space and activities area.

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

People experienced safe care and treatment, in accordance with their care plans, which met their individual needs. Care plans demonstrated that people had been fully involved in developing their care plans, which ensured their preferences were always being taken into consideration.

Staff effectively identified and assessed risks to people, which they managed safely. Staff understood their responsibilities to protect people from abuse and avoidable harm. Enough staff with the required skills and knowledge provided people with safe care. People received their medicines safely, as prescribed, from staff who had completed the required training and had their competency assessed to do so. High standards of cleanliness and hygiene were maintained throughout the home, which reduced the risk of infection. Staff followed the required standards of food safety and hygiene when preparing, serving and handling food.

People received effective care and support which consistently achieved successful outcomes and promoted a good quality of life. Staff felt valued and well supported by the management team, through a system of effective training, competency assessment, supervision and appraisal. Staff consistently delivered care in accordance with people’s support plans and recognised best practice. People were supported to eat and drink enough to maintain good health.

The service worked well with other organisations to ensure prompt referrals to healthcare services when people’s needs changed.

Staff treated people with compassion, kindness, dignity and respect. People and relatives consistently told us staff made them feel valued and listened to. Staff identified the communication needs of people with a disability or sensory loss and effectively shared this information with others when required. Staff supported people to express their views by involving them in developing their care plans and making decisions about their care. 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 knew how to make a complaint and were confident the provider would address their concerns. The service was well-led, with the registered manager providing clear and direct leadership and a safe environment, which had cultivated a positive, open and empowering culture.

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

Rating at last inspection

The last rating for this service was inadequate (published 14 May 2020) with multiple breaches. At this inspection we found improvements had been made and the provider was no longer in breach of

regulations 9 (person centred care), 11 (need for consent), 12 (safe care and treatment) 15 (premises and equipment), 17 (good governance) and 19 (fit and proper persons employed).

We did not focus on the domains of caring and responsive, however we found there to be sufficient improvement within regulation 9 (person centred care) and 10 (dignity and respect) for the service to no longer remain in breach. As the key lines of enquiries related to these domains were not inspected against, we are unable to comment on the entire domains.

This service has been in Special Measures since publication of our last inspection report. During this inspection the provider demonstrated that improvements had been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We undertook this focused inspection to check the provider had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led, which contain those requirements. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Inadequate to Requires Improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Bracknell Care home on our website at www.cqc.org.uk.

People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The accommodation is arranged over two floors, with all rooms having en-suite toilet facilities and some also having an en-suite shower or bathroom. There is one large communal space that is divided into small areas. These include dining room, living space and activities area.

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

The care and treatment of people was not always appropriate and did not always meet their specific needs. Care plans did not evidence that people were being involved to the maximum extent possible in their care or that their preferences were always being taken into consideration.

People were at risk of potential harm because the registered person had failed to ensure the proper and safe management of medicines.

People were at risk of potential harm because the registered person had not ensured the staff providing the care had the competence, skills or experience to do so safely. The registered person had not ensured staff were provided with appropriate support, training and knowledge as was necessary for them to do their job safely and effectively.Training records provided post inspection provided a snapshot of one week’s compliance with differing provider mandatory training courses.

At the last inspection it was found that the registered provider had not made sure staff employed were of good character and that all required information and checks were carried out. This meant people were potentially at risk of staff being employed to work with them who were not suitable. At this inspection it was found that the provider had still failed to ensure people were supported by appropriate staff.

At the inspection of December 2018, the registered provider had not established an effective system to enable them to ensure compliance with their legal obligations and the regulations. They had not established an effective system to enable them to assess, monitor and improve the quality and safety of the service provided. The lack of robust quality assurance meant people were at risk of receiving poor quality care and, should a decline in standards occur, the provider's systems would potentially not pick up issues effectively. We found systems remained ineffective and issues remained prevalent in all areas of care.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

A new registered manager had been appointed along with a new senior management team since the last inspection. They envisaged making changes to the service that would promote inclusivity, safe, effective and responsive care. However, this was yet to be actioned with sustainability to be achieved.

People had their healthcare needs identified and were able to access healthcare professionals such as the

GP, optician when needed. The service worked well with other professionals to provide effective health care to people.

The service had recently commenced residents and relatives' meetings as well as staff meetings to ensure there was opportunity to receive feedback about the home.

The registered manager had created strong links with the community and had commenced developing a plan for people to engage in meaningful activities in 2020.

The service responded well to complaints, with clear evidence maintained of all investigations. The documents illustrated transparency, with actions identified where shortfalls were noted. Similarly, the registered manager understood how to comply with the duty of candour. Letters were transparent in their findings and offered the opportunity for further discussion.

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

Rating at last inspection

The last rating for this service was requires improvement (published 18 December 2018) with breaches in regulations 9 (person centred care) and 17 (good governance). The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection improvement had not been made and the provider was still in breach of these regulations.

Why we inspected

This was a planned inspection based on the previous rating. However, we had recently received a number of notifications that gave us cause for concern.

Enforcement

We have identified breaches in relation to regulations 9 (person centred care), 10 (dignity and respect), 11 (consent), 12 (safe care and treatment), 15 (premises and equipment), 17 (good governance), 18 (staffing), 19 (fit and proper persons employed) of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 at this inspection. Care provided was not always person-centred; people did not always receive safe care and treatment and were not always protected from the risks of harm or abuse; staff recruitment, training and support were not adequate to ensure people were safe or that staff were competent and suitable for their roles, specifically around their understanding of capacity; effective systems were not in place to ensure the service met the required fundamental standards of care. The registered person had failed to ensure the premises were conducive to people’s changing health needs.

We are mindful of the impact of Covid-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

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.

For 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.

Bracknell Care Home is a care home with nursing that provides a service to up to 30 older people, some of whom may be living with a physical disability. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The accommodation is arranged over two floors, with all rooms having ensuite toilet facilities and some also having an ensuite shower or bathroom. At the time of our inspection there were 26 people living at the service.

The service did not have a registered manager. 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. The previous registered manager left the service in October 2017. Since that time there have been various interim arrangements for the management of the service until the present manager took up post on 1 August 2018. His application to become registered is currently being processed by CQC. The manager was present and assisted us during the inspection.

The provider did not ensure the service was managed well because there was no effective system in place for the provider to ensure the service was fully compliant with the fundamental standards (Regulations 8 to 20A of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014). This was particularly apparent where things had not been done in the 10 months period between the previous registered manager leaving and the new manager starting. The new manager had identified most areas that needed improvement to return to full compliance. He was working with the local authority and had developed an action plan to address the areas that needed to be improved.

The service employed an activities coordinator who worked 25 hours a week. However, arrangements for social activities did not ensure that all people were supported to participate in activities that were meaningful to them as individuals.

Premises risk assessments and health and safety audits were mostly carried out as required. Some safety checks had not been carried out when they should have been. For example, water temperature monitoring valves, in place to protect people from the risks of scalding from hot water, had not all been serviced or checked to make sure they were functioning correctly. This was rectified the week after our inspection.

People were not always protected by the recruitment practices in place. Checks were made to ensure staff were of good character and suitable for their role before they were deployed to work with people living at the service. However, audit systems in place had not identified that some required checks had not been correctly completed. This was rectified after the inspection and the manager put in place a monitoring system to be used prior to any new staff starting in future.

Ongoing training was not always up to date and staff felt they received the training they needed to carry out their work safely and effectively. However, staff induction training had not been completed as required by the provider's policy. After our inspection the manager put a system in place to ensure new staff were supported to complete their overdue induction as soon as possible. We have made a recommendation about staff training in writing care plans and determining appropriate goals/outcomes. We have also recommended that future ongoing staff training be updated in line with the latest best practice guidelines for social care staff. Staff formal supervision was not up to date but plans were underway to ensure one on one supervision was provided in line with the provider's policy.

People received care and support from staff who knew them well. They received personal and nursing care that was personalised to their individual needs. Care plans were reviewed monthly or as changes to people's needs occurred.

People felt safe living at the service and were mostly protected from risks relating to their care and welfare. Staff knew how to recognise the signs of abuse and were aware of actions to take if they felt people were at risk.

People's rights to make their own decisions were protected. They were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People told us they enjoyed the meals at the service and confirmed they were given choices. Meals were nutritious and varied. Medicines were stored and handled correctly and safely.

People were treated with care and kindness and all interactions observed between staff and people living at the service were respectful and friendly. People confirmed staff respected their privacy and dignity.

People and their relatives were aware of how to make a complaint. They told us they could approach management and staff with any concerns and felt they would listen and take action. They benefitted from living at a service that had an open and friendly culture and from a staff team that were happy in their work.

People living at the service and their relatives felt there was a good atmosphere and thought the service was managed well by the new manager. Staff also felt the service was now well-managed. They told us the management were open with them and communicated what was happening at the service and with the people living there.

We found breaches of two regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider was not meeting the needs of people who use the service in relation to their social care needs. The provider had not established an effective system that ensured compliance with the fundamental standards. The fundamental standards are regulations 8 to 20A 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 the report.

Bracknell Care Home is a care home with nursing that provides a service to up to 30 older people, some of whom may be living with dementia. The accommodation is arranged over two floors, with all rooms having ensuite toilet facilities and some also having an ensuite shower or bathroom. At the time of our inspection there were 26 people living at the service.

The service had a registered manager as required. A registered manager is a person who has registered with the 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. The registered manager was present and assisted us during this inspection.

For the past year the registered manager and staff had focussed on improving individual people's wellbeing. This had involved working with the person and those important to them to improve all aspects of their life as far as possible. The methods the registered manager and staff had used were frequently innovative and imaginative. The project had led to people engaging in work and activities important to them that utilised their skills and enhanced their life experiences. This had produced very positive results and led to a significant reduction in social isolation and people feeling valued and useful.

Staff were extremely skilled in supporting people to maintain relationships with their family and friends. In some cases the staff had been able to reunite people with family members they had lost touch with. In others, people had been helped to repair a damaged relationship with a family member.

End of life care was exceptional. Staff were skilled, caring and compassionate, delivering care that was extremely personalised and built on people's known wishes. People and their relatives were given strong support when discussing and making decisions about their preferences for their end of life care. Records showed staff went out of their way to ensure those wishes and preferences were respected and fulfilled.

People felt safe living at the service and were protected from abuse and risks relating to their care and welfare.

People were protected by robust recruitment processes and staff were well trained and supervised. Staff had the tools they needed to do their work and provide high quality care. Staff knew how to recognise the signs of abuse and were aware of actions to take if they felt people were at risk. People's medicines were stored and administered safely.

People received effective care and support from staff who knew them well and were well supervised. Staff training was up to date and staff felt they received the training they needed to carry out their work safely and effectively. People received support that was individualised to their personal preferences and needs. Their needs were monitored and care plans formally reviewed six monthly or as changes occurred.

People received effective health care and support. They saw their GP and other health professionals when needed. Medicines were stored and handled correctly and safely. People's rights to make their own decisions, where possible, were protected and staff were aware of their responsibilities to ensure people's rights to make their own decisions were promoted.

Meals were nutritious and varied. People told us they enjoyed the meals at the home and confirmed they were given choices.

People were treated with care and kindness. During our inspection the atmosphere at the service was calm and happy and people were chatting and laughing with each other and the care staff. People's wellbeing was protected and all interactions observed between staff and people living at the service were respectful and friendly. People confirmed staff respected their privacy and dignity.

People had access to a busy activity schedule and planned trips 3-4 times a year. Outings also took place with some people going to the local pub and amenities when staff were available.

People and their relatives were aware of how to make a complaint and told us they would speak to the registered manager or one of the staff. They told us they could approach management and staff with any concerns and felt the management would listen and take action. They benefitted from living at a service that had an open and friendly culture and from a staff team that were happy in their work.

The registered manager had worked with the provider in improving the environment for those living at the home with dementia. Changes had been made to make the premises more dementia friendly, helping to encourage and promote people's independence and sense of wellbeing. People were mostly protected against environmental risks to their safety. Premises risk assessments and health and safety audits were carried out and issues identified usually dealt with quickly. However, we identified some issues relating to valves on hot water taps that were designed to prevent scalding. When pointed out by us, the registered manager took prompt action and within five days of our inspection the work on the valves had been completed, with them all in good working order. Furniture and fixtures were of good quality and well maintained.

People, visitors and health and social care professionals felt the home was managed well and provided a comfortable, calm and homely atmosphere. Staff told us the management was open with them and communicated what was happening at the service and with the people living there.

As part of this inspection we spoke with the registered manager, the maintenance person, the chef and two of the care staff. We spoke with people who use the service but what they told us did not relate to the equipment provision at the home. We also reviewed records which included, four care plans, daily care plan notes, daily shift handover sheets, staff training records and the manager's monthly audit tool.

We found the home had taken the action they had told us they would take to reach compliance. Action had been taken to ensure people were provided with equipment to promote their independence and comfort. Systems had been put in place to ensure pressure relieving equipment was used correctly.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:

- Is the service safe?

- Is the service effective?

- Is the service caring?

- Is the service responsive?

- Is the service well led?

This is a summary of what we found-

Is the service safe?

People experienced care and support that was planned and delivered in a way that was intended to ensure people's safety and welfare. People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

People were protected from unsafe or unsuitable equipment because there were systems in place that ensured all equipment was properly maintained, tested, serviced and replaced.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The manager was aware of a recent Supreme Court judgement changing the way a 'deprivation of liberty' is determined. The manager planned to review all people at the home that the ruling may apply to and was aware of the process to follow should an application be required under DoLS legislation.

Is the service effective?

People were protected from unsafe or unsuitable equipment but systems were not in place to ensure pressure relieving mattresses were used correctly. Equipment used to support people was clean and in working order but there was a lack of equipment that could support people with dementia in their day to day living and promote their independence.

Staff we spoke with demonstrated a good understanding of people's rights to make their own decisions and their individual responsibilities under the requirements of the Mental Capacity Act 2005.

Is the service caring?

People experienced care and support that was planned and delivered in a way that was intended to ensure people's safety and welfare. People's privacy, dignity and independence were respected. People we spoke with confirmed they had been involved in making decisions about their care and support. One person commented: "They do a wonderful job, nothing is too much trouble."

Is the service responsive?

People we spoke with told us they were provided with care that met their needs and their care was delivered in the way they preferred. One person commented: "Very much so, no trouble at all." Another person told us: "If I ask, they come and do it."

Systems were in place to monitor and record incidents. There was evidence that learning from incidents took place and appropriate changes were implemented as a result of any investigation.

Is the service well-led

The provider had an effective system to regularly assess and monitor the quality of service that people received. The home held meetings three times a year for people living at the home and their relatives. This was confirmed by people we spoke with who told us they were encouraged to raise concerns or suggestions at those meetings if they wanted to.

The provider took account of complaints and comments to improve the service. All people we spoke with were aware of how to raise concerns and all felt their concerns would be listened to and acted upon. When asked if there was anything else they wanted to tell us, comments from people living at the home included: "No, this is a superb home.", "We are quite happy, they all make a fuss of us." and "The staff are very good."

We found before people received any care they were asked for their consent and the staff acted in accordance with their wishes. One relative told us "They take their time with my relative's care and do not rush them. The good thing about this home is people are encouraged to socialise. The staff make sure people are not left on their own, they are encouraged to come into the lounge and join in the activities."

People were protected from the risks of inadequate nutrition and dehydration and their personal records were accurate and up to date so staff knew what care people needed.

The provider had taken steps to ensure staff knew how to recognise the possibility of abuse and prevent it from happening. Staff were aware of the procedure to follow if they had any concerns and people living at the home told us they felt safe living there.

We saw there was an effective complaints system available. People living at the home knew who to speak to if they had any concerns. They felt any comments or complaints would be listened to and acted on. One person told us "They make it as close to home as possible, they are so good".

We saw that people were able to give feedback on the service through regular residents meetings. One person told us 'they are useful meetings ' we can talk things over with the managers'.

All seven people spoken with were happy with their care and told us that staff were aware of their care needs. We spoke with two relatives of people living in the home. Both told us they were very happy with the care their family members received.

We found that the provider had an effective system to regularly assess and monitor the quality of service that people receive.