Archived: Bransfield Manor Care Home

During this inspection we spoke with the registered provider, person in charge, three staff, two relatives and the local authority fire safety officer. We also spoke with two of the people who lived in the service.

We looked at four people's care records. We also looked at the provider's arrangements for obtaining and acting in accordance with the consent to care and treatment for people who used the service. In addition, we looked at the provider's arrangements, for undertaking the appropriate checks when recruiting staff and the provider's arrangements to monitor the quality of the service provided.

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?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, and the staff supporting them and from looking at records.

Is the service safe?

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLs) which applies to care homes. The service had not submitted applications under DoLs. Relevant staff had not been trained to understand when an application should be made, and how to submit one. Staff had not received training on the Mental Capacity Act. Policies and procedures had been developed by the registered provider to provide guidance for staff on how to safeguard the care and welfare of the people using the service. This included guidance on the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS); however assessments for those people who lacked the capacity and ability to make some specific day-to-day decisions about their care and support had not been completed. We found the home was not meeting the requirements of the Deprivation of Liberty Safeguards. The above evidence demonstrates that you do not have in place suitable arrangements for obtaining and acting in accordance with the consent of people who use the service, or the consent of another service user who is able lawfully to consent to care and treatment on that service user's behalf; or suitable arrangements for establishing and acting in accordance with best interests of people who use the service.

People who use the service were safe but we were not confident this could be sustained. This was because the registered provider and the culture of the service showed they were risk averse, which meant unnecessary restrictions were placed on people which limited their lifestyle. We saw that bungee straps had been put across one of the downstairs stairwells as a barrier to stop people freely going upstairs. There was no documentation to show the risks to people who used the stairwell as means of access to their bedrooms. All the downstairs doors were locked to prevent people easily accessing the gardens.

The service did not always keep firefighting equipment safe and fit for purpose and that best practice guidance was not being adhered to. The fire extinguishers had not been regularly maintained since 2011 and people did not have personal fire safety evacuation plans. We were told by the registered provider that the safety certification for the buildings fixed wiring check was out of date.

People did not always receive pain relief medicines that were prescribed to them.

Is the service effective?

We found not all of the information recorded within people's care records accurately reflected their needs and the care and support to be provided.

Customer satisfaction surveys showed that people had not always been supported to complete them. Survey's had been sent to relatives and to staff. Relatives had responded positively however the provider had not analysis of the information and not put in place any actions in response to the feedback received.

People had a care plan which set out their support needs. We could not find any evidence of how people had been involved in the assessment of their health and care needs and had contributed to developing their care plan.

Is the service caring?

Staff were not aware of people's preferences, interests, aspirations and diverse needs. Our observations of the care provided, discussions with people and records told us that individual wishes for care and support were not taken into account and respected. For example: One person said they would like to visit a garden centre, we spoke to staff who told us that this had not happened. The person's relative said "People only get to go out in the summer".

Is the service responsive?

Staff were not always aware of people's needs and did not always respond in good time. There were delays in making referrals to other health and social care professionals. We saw record for one person who had an increasing number of falls; the acting manager had not referred this person to the falls prevention team for further advice and guidance.

People's care needs were not reassessed to reflect their current needs.

Is the service well- led?

The registered manager's name that appears on the report was not in day to day charge of the service. We were told by the acting manager that the registered manager was no longer working for the provider.

The provider was not able to demonstrate there were suitable arrangements in place to assess and monitor the quality of the service provided and a proactive approach had not been taken to drive and maintain improvement. Improvements were still required to quality monitoring and assessing of the service.

At the time of our inspection the service provided care and support to 12 people. As part of our inspection we spoke with four people who used the service and their relatives about the care they received. We also spoke with staff about their role and responsibilities.

We considered our inspection findings to answer 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?

Is the service safe?

We saw that people had consented to their care and support and that wishes had been included as part of their care.

Risk assessments were in place to provide information to staff to help minimise the risk of harm to people.

Recruitment practice was safe and thorough and ensured that only staff suitable to work with vulnerable people were employed by the service.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place and staff gave us an example of what actions had been taken where concerns had been identified to relation to an individual. Relevant staff have been trained to understand when an application should be made, and how to submit one.

Is the service effective?

People were involved in writing the plan of their care and support. We saw that people's care plans had been regularly reviewed to ensure they remained up to date in order to reflect their needs.

The people who used the service and their relatives told us that they were "Happy" with the care and support provided and said the home was "A lovely place to be".

A visiting healthcare professional we spoke with confirmed that they were able to see people in private and that the person they had visited had been "Beautifully" cared for.

Is the service caring?

We spoke with staff who told us they "Enjoyed" their role and "Cared" about the people they supported.

We saw that staff supported people around the home in a kind and gentle way. People we spoke with told us that staff were "Very good" and "Caring".

A relative said, 'I visit my relative regularly and the staff are always very welcoming and helpful' and "The home feels like a really nice place for people to be".

Is the service responsive?

We saw that people's plan of care had been reviewed regularly and updated when their health and care needs had changed.

Staff were attentive and supported people quickly when they needed assistance. People spoke highly of staff and said "They are always there when you need help".

Is the service well-led?

Staff we spoke with were clear about their roles and responsibilities. They told us they felt "Supported" by the service and felt confident that they could raise any concerns in order for the appropriate action to be taken. This helped to ensure that people received a good quality of service at all times.

The service completed an annual customer service satisfaction questionnaire with people's relatives. However, we found concerns that people who used the service had not been involved in this or been given the opportunity to provide feedback about their views and experiences of the care provided in the home.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to gaining the views from people in order to make improvements to the service provided.

Representatives of people who used the service told us that they were involved in the planning of their relatives care and if there were any changes to the care or treatment, they were kept informed. They also told us that if they had any concerns they would have no hesitation in raising those concerns with the provider.

The people we spoke with told us that the home provided activities they liked to get involved. They told us that when they needed something that the staff would respond quickly.

We spoke with staff who demonstrated a good understanding of the needs of the people they cared for.

Representatives of people who used the service that we spoke with told us that they had been involved in discussions about the initial planning of their relatives care but not subsequent reviews. They also told us that if they had any concerns they would have no hesitation in raising those concerns with the provider.

The people who used the service that we spoke with told us that the home provided activities for them and they liked to get involved. One person told us "I especially like the art therapy classes".

We found that the manager regularly reviewed peoples care plans and risk assessments. The provider said that they had recourse to a number of professional advisory bodies, should they require specialist advice.

We spoke with staff who demonstrated a good understanding of the needs of the people they cared for. We observed staff interacting with people who used the service and saw that staff treated people with respect and dignity. However, we did note that for those people who used the service who had limited communication skills, alternative communication aids were not always used.