Bradley Hall

Bradley Hall is a residential care home providing accommodation for people who require personal care to up to 60 people. The service is purpose built, with facilities being provided over 3 floors, each floor providing communal facilities, adaptive bathrooms and bedrooms with full en-suite facilities. The service provides support to older people, some of whom are living with dementia. At the time of our inspection there were 47 people using the service.

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

This was a targeted inspection in response to concerns received regarding diabetic care and medicines. This inspection mainly focussed on these areas of concern. We found no evidence to support these concerns.

People were protected from risks related to poor diabetic health. Risk assessments were informative, and staff understood how to recognise signs and symptoms of poor diabetic health, when to raise concerns and when to seek medical advice.

People using the service told us they felt safe. One relative told us, “The staff are fantastic with my [relative]. I feel I can walk away after visiting [relative] and I know they are safe, and I can sleep at night.”

We saw people’s medicines were administered safely. Medicines were stored safely, and checks were completed to ensure medicine stocks were accurate.

Admission assessments were completed to ensure the service could meet people’s needs before they moved. Assessments reflected people’s health conditions, which were used to inform people’s care. People’s care plans were clear and reflected their needs.

The service was clean and very well presented throughout. There was a kitchenette available on each floor to provide people with access to snacks and drinks at any time.

People received support to access health services. Feedback from relatives was overwhelmingly positive. One relative described how their loved one had improved since moving to the service.

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 good (published 31 January 2023).

Why we inspected

We undertook this targeted inspection to check on specific concerns we had about diabetic care and medicines. The overall rating for the service has not changed following this targeted inspection and remains good.

We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Bradley Hall is a residential care home providing accommodation for people who require personal care to up to 60 people. The service is purpose built, with facilities being provided over three floors, each floor providing communal facilities, adaptive bathrooms and bedrooms with full en-suite facilities. The service provides support to older people, some of whom are living with dementia. At the time of our inspection there were 47 people using the service.

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

People’s safety was underpinned by the provider’s policies and processes. Action was undertaken to promote people’s safety which included responding to people’s feedback where they had expressed concerns regarding their safety in relation to other people living at Bradley Hall. Potential risks to people were assessed and measures put in place to reduce these. Lessons were learnt and improvements made through the analysis and reporting of accidents and incidents. People were supported by sufficient staff who had undergone a robust recruitment process and had undertaken training in topics to promote their safety. Medicine systems were managed safely. People lived in an environment which was well maintained and clean, with safe infection and prevention measures.

People’s health and wellbeing needs were assessed, and their health and welfare monitored by staff. Staff liaised effectively with health care professionals to achieve good outcomes for people. Staff had the knowledge and experience to meet people’s needs. People’s dietary needs were met assisted by staff’s commitment to create a positive dining experience for people and having access to snacks and drinks throughout the day. The environment was well-maintained and included facilities for people to relax and take part in activities.

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 were involved in key decisions about their day to day lives. Staff provided support and care in a kind and compassionate way, ensuring people’s privacy and dignity was maintained. Relatives were involved in key decisions and were kept informed about their relative’s health and wellbeing.

People’s needs were recorded in personalised care plans, considering all aspects of their care. The registered manager, activity co-ordinators and staff were committed to creating opportunities for people to take part in a wide range of activities. Staff were proactive and creative in encouraging community involvement to avoid social isolation. People and their relatives were aware of how to raise concerns, and in the main felt their concerns were addressed.

People and their relatives were in the main complimentary about the service they received. Staff told us they were supported by the management team and spoke of the opportunities available to them through ongoing training and development, including career progression. The provider had systems in place to monitor and improve the quality of the service provided, which included good communication and recognising and celebrating achievement across the organisation. There was a proactive approach to establishing links within the local community to enhance the quality of life and experiences of people.

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 Good (published 7 August 2018). At the time of the previous inspection the service was known as Beaumont Hall. The location changed its name to Bradley Hall in April 2022.

Why we inspected

The inspection was prompted in part due to concerns being raised in relation to the management of the home and insufficient staffing numbers having an impact on the safety and quality of care people experienced.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Beaumont Hall accommodates up to 60 people in one adapted building and provides accommodation over three floors. The service specialises in caring for older people including those with physical disabilities and people living with dementia.

At our previous inspection in July 2017 we rated the service as 'requires improvement'. We found improvements were needed to ensure that risks to people’s safety were assessed and managed.

People did not always receive their medicines as prescribed and care provided was not responsive or personalised. The provider was asked to complete an action plan to tell us what they would do to meet legal requirements for the breaches in safe care and treatment, and person-centred care.

You can read the report from our last comprehensive inspection and our focused inspection, by selecting the 'all reports' link for Beaumont Hall on our website at www.cqc.org.uk.

This inspection took place on 11 June 2018 and was unannounced. We returned on 12 June 2018 announced to complete the inspection. At the time of our inspection visit 51 people were in residence.

At this inspection we found the provider had followed their action plan and made the required improvements to meet the legal requirements.

The service had 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 registered manager understood their legal responsibilities. They provided good leadership and supported staff and people who used the service. The registered manager and the staff team were committed to providing quality care and welcomed feedback and suggestions to enhance people’s quality of life.

People were supported to stay safe. Risks associated with people’s needs had been assessed; safety measures were put in place and they were monitored and reviewed regularly. Staff were provided with clear guidance and information to follow to meet people’s needs. A new electronic care planning system was in place.

People received their medicines as prescribed. Medicines were stored and managed safely. People’s nutritional and cultural dietary needs were met and they had access to a range of specialist health care support that ensured their ongoing health needs were met.

Systems and processes were in place to safeguarding people from abuse; these covered staff recruitment practices and staff training and knowledge on safeguarding procedures. Staff were recruited safely and there were sufficient numbers of staff available to support people. Staffing levels were kept under review to ensure people received sufficient staff support.

People to be involved in decisions made about all aspects of their care. People 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 had developed positive trusting relationships with the staff team. People’s privacy and dignity was respected and independence was promoted. The design and homely environment ensured people’s safety and privacy. People continued to receive good care and support that was responsive to their individual needs.

Staff promoted and respected people’s cultural diversity and lifestyle choices. Care plans were personalised and provided staff with guidance about how to support people and respect their wishes. Information was made available in accessible formats to help people understand the care and support agreed.

People took part in a range of social activities and events and were supported to go into the wider community. This type of engagement had enhanced people’s physical and mental wellbeing, and their sense of belonging to a community. People maintained contact with family and friends.

People and relatives all spoke positively about the staff team, management and the quality of care. People had a range of methods to express their views about the service. The registered manager used feedback and complaints to bring about changes to the service.

People and relatives knew how to make a complaint and were confident that action would be taken. Records showed that there were effective systems to handle complaints and appropriate action had been taken to improve the quality of care. Where issues had been identified during this inspection visit the management team took prompt and appropriate action.

The provider’s governance system had been used effectively. Regular audits and checks were carried out and action taken when shortfalls were identified. There were arrangements in place for the service to make sure that action was taken and lessons learned when things went wrong, to improve safety across the service.

Staff morale and commitment had improved. Systems were in place to ensure staff were supported and received training and supervision to provide care effectively. Staff training incorporated best practice. Staff worked in partnership with other health care professionals to enhance people’s quality of life.

We received positive feedback about the improvements made at Beaumont Hall from health and social care professionals and commissioners. These related to how the partnership working had improved the management of the service, staffing, and quality of care provided to people in residence.

Thereafter, provider had appointed another manager but they left soon after.

This inspection took place on 7, 20 and 26 July 2017 and all visits were unannounced.

Beaumont Hall is a care home that provides residential care for up to 60 people. The service specialises in caring for older people including those with physical disabilities and people living with dementia. The service is purpose built and provides accommodation over three floors. All the bedrooms have an en-suite facility. At the time of our inspection visit there were 49 people in residency.

This service is required to have a registered manager. A registered manager was not in post. The provider had appointed another manager. They showed us evidence to confirm that they had begun the process to become the registered manager. We will continue to monitor this.

We found people’s medicines were not always stored or administered in a safe way. Risks to people’s health and safety were not effectively assessed, monitored and reviewed to ensure that the measures put in place remained appropriate.

Staff were responsive to meet people’s needs. However, care plans were not always personalised to reflect how people wished to be supported. Care plans and risks were not kept under review or monitored effectively. Further action was needed to ensure all the information was accurate and reflective of individual preferences.

The manager had identified that staff’s training and support was not up to date. They had responded to gaps in staff’s knowledge. Some training has been provided to meet the needs of people with specific health conditions. The manager has recommenced staff supervisions. Further training and support was being planned to equip staff for their role and to meet people’s care needs effectively.

The provider’s quality governance and assurance systems had been fragmented. However, since the appointment of the manager, they had re-commenced audits and checks to monitor the service. They had identified similar issues which we found during this inspection. The provider’s representative supported the manager and monitored the progress of improvements. Further action was needed to ensure all the shortfalls identified were addressed within the timescales that had been identified and sustained.

People told us they felt safe at the service. The manager and staff understood their responsibility to protect people from the risk of abuse. Staff were recruited through safe recruitment practices. People lived in a clean and well maintained environment.

People had enough to eat and drink and their dietary needs were met. People had access to health support and referrals were made to relevant health care professionals when required.

People were supported to have choice and control of their lives and staff did support them in the least restrictive way possible. The policies and systems in the service supported this practice.

During our inspection visit we saw people take part in some activities that were of interest to them. People told us that their religious needs were met. People told us staff were kind and caring towards them. Staff were treated with respect and their privacy and dignity was maintained.

People and their relatives were confident to complain and that their concerns would be addressed. A complaints process was in place and staff knew how to respond to complaints. People and their relatives had opportunities to be involved in the development of the service.

We found breaches 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 this report.

We previously carried out an unannounced comprehensive inspection of this service on 4 and 5 May 2016. We found that the provider was not meeting the standards we expected and there were breaches of legal requirements. This was because people did not receive their medicines as prescribed and systems to assess and monitor the quality of the service continued to be ineffective. Following this inspection we served warning notices which informed the provider of the date in which they were to required to improve.

We carried out an unannounced focused inspection of Beaumont Hall on 21 September 2016. This inspection was carried out to check that the provider had made the required improvements in order to meet legal requirements. At the time of our inspection there were 52 people in residence. We found that some improvements had been made.

We inspected the service against two of the five questions we ask about services. Is the service safe and is the service well-led. This is because the service was not meeting some legal requirements. This report only covers our findings in relation to those requirements.

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

A registered manager was not in post. 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 service has been without a registered manager since January 2016. This meant the provider’s condition of registration was not met. The regional director who facilitated this inspection told us that the service was being managed by a registered manager from another of the provider’s care services. They also told us that a new manager had been appointed at Beaumont Hall.

Some improvements had been made in relation to how the provider checked the quality and safety of service provided, however these systems were not yet established. We saw that some actions had been taken as a result of checks however further action was needed to demonstrate that people’s views influenced the development of the service and that staff received the training and support to carry out their roles. This was in order to drive improvement at the service.

Improvements had been made so that people received their medicines at the right times, as prescribed. We found there was clear guidance for staff to follow and the systems to store, manage and administer medicines safely were in place.

Beaumont Hall is a care home that provides residential care for up to 60 people. The service specialises in caring for older people, those with physical disabilities and people living with dementia. The service is purpose built and provides accommodation over three floors. All the bedrooms have an en-suite facility. At the time of our inspection there were 57 people in residence.

At the last inspection on 17 and 18 August 2015, we asked the provider to take action to make improvements to the staffing levels, ensuring people’s privacy and dignity was maintained and the quality assurance system was used effectively. We found that service had made some improvements, however further improvements were required.

At the time of our inspection a registered manager was not in post. The service has been without a registered manager since January 2016. However, the provider had appointed a manager in March 2016 who facilitated this inspection.

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 found that people did not always receive their prescribed medicines at the right time. Systems to ensure adequate stocks were kept were ineffective. Although checks were carried out on the medicines administered and the records, errors were not identified therefore people’s health was put at risk.

Staff training and support provided was not always kept up to date. The planning and monitoring of staff’s skills needed to improve to ensure staff were able to meet people’s needs safely.

The provider’s quality governance and assurance systems were still not used fully or monitored to ensure people’s health, safety and wellbeing was maintained. People’s confidential information was not always maintained. There was limited opportunity for people to share their views about the service to influence changes to the care being provided.

People’s care needs were assessed including risks to their health and safety. Care plans were written to reflect people’s needs, which included the measures to help promote their safety and independence. These were regularly monitored and reviewed.

People told us they felt safe at the service and with the staff that looked after them. Staff were recruited in accordance with the provider’s recruitment procedures, which helped to ensure suitable staff, were employed to look at Beaumont Hall.

People lived in an environment that was kept clean. All the bedrooms had an ensuite facility and were personalised.

We found the requirements to protect people under the Mental Capacity Act and Deprivation of Liberty Safeguards had been followed. People’s mental capacity to make decisions about their care had been assessed and their wishes were known and kept under review. The service acted in accordance with their legal responsibility to ensure that any best interest decisions made involved the relevant people and health care professionals where the person lacks capacity to make decisions or are unable to do so.

People’s views about the quality of food had been listened to and action had been taken to change the menu choices. However, the dining experiences for people varied, which meant meal times were not always pleasurable.

People told us that they were treated with care and that staff were helpful. We observed staff respected people’s dignity when they needed assistance. People’s health needs were met by health care professionals and were supported to attend routine health checks. Records showed staff sought appropriate medical advice and support when people’s health was of concern.

Although the service had a programme of activities these were not of interest to everyone. People were not always supported or encouraged to pursue their hobbies or interests.

People who used the service and relatives felt confident to raise concerns with the manager. Complaints were investigated in line the provider’s policy.

We found two breaches 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 this report.

At the time of our inspection visit the service was managed by the acting manager. The registered manager was in the process of cancelling their registration. During our visit we spoke with seven people who used the service and observed how they were supported. We also spoke with seven staff supporting people including agency staff. We reviewed information in relation to the management and monitoring of the staffing levels at the service. We considered all the evidence we had gathered under the outcomes we inspected.

Is the service safe?

People who used the service told us that they were satisfied with the care and support they received. They told us staff were available and helped them with their daily needs in a reliable manner. A few people commented that there had been times when they had to wait because staff were busy helping other people. One person said 'It's a very hard job. Most staff work very hard and are always helpful.'

Staffing levels were determined by monitoring the needs of people who used the service matched against the numbers of skilled, qualified and experienced of staff. Staff were deployed to work is specific areas and had key responsibilities. The provider monitored the staffing levels and had taken steps to assure themselves that staff respond promptly to help maintain people's safety and wellbeing.

We found that people were satisfied with how their medicines were given to them. Staff were trained and understood people's individual medicine requirements. Staff followed the medication administration procedures correctly and completed the medication administration records accurately.

The provider has a number of monitoring systems in place to assess and monitor the quality of service people received. People's views were sought through reviews of their care needs and satisfaction surveys. People were made aware of how to make a complaint and were confident that any concerns raised would be addressed. One relative told us: 'When we came here, we knew it was the right place for mother. There's been a few problems at first but when we told them [staff] they were straight on it. They're brilliant here and you can quote me.'

We found improvements were needed to the management and administration of medicines. Staff did not always follow the medication administration procedures and records were not completed accurately, which meant people's health and wellbeing was put at risk.

The provider was taking steps to improve the staffing at the service and to ensure that there were sufficient experienced and qualified staff available to meet people's needs.

Improvements were needed because the provider did not have effective systems in place to assess and monitor the quality of service delivered. People were not given the opportunity to comment on the quality of service they experienced. The provider's own audits were not carried out regularly to ensure the health, welfare and safety of people using the service was protected.