We carried out a review of the data available to us about Brocklehurst Nursing Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Brocklehurst Nursing Home, you can give feedback on this service.
Brocklehurst Nursing Home is a nursing home providing personal and nursing care to up to 43 people. The service provides support to older people, some of whom are living with dementia. At the time of our inspection there were 41 people using the service.
The home consists of four units across two floors. Each unit has its own kitchenette and small lounge. The ground floor has a large lounge and a dining area.
People’s experience of using this service and what we found
People received their medicines as prescribed. We have made a recommendation about guidance for as required medicines and topical creams. Some communal areas of the home were not always clean. We have made a recommendation to review the cleaning schedules.
Parts of the home were looking tired. A refurbishment plan was in place. We have made a recommendation that the plan is completed in a timely way.
People felt safe living at the home. Risks were identified and guidance was in place to manage them. An improvement plan was in place to ensure enough detail was included in the care plans.
There were enough staff to meet people’s needs. Staff were busy and did not have much time to sit with people. A dependency tool was used to calculate the staffing levels needed. Additional night staff had been recruited to reduce the use of agency staff. Staff were safely recruited and received the training for their roles.
Staff said the management team were visible in the home and approachable if they needed to speak with them. People’s health, nutritional and hydration needs were being met. Referrals were made to medical professionals when required.
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.
A quality assurance system was in place. Regular audits were undertaken, and any actions identified completed. The provider had oversight of the service through monthly provider audits. Relatives said there was good communication with the staff team and any concerns they had were addressed. Staff said they enjoyed working at Brocklehurst.
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 15 January 2019).
Why we inspected
We received concerns in relation to staffing levels and staff training. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.
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.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained good based on the findings of this inspection.
We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe, effective and well led sections of this full report. Additional night staff had been recruited to reduce the reliance on agency staff.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Brocklehurst Nursing Home on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
Brocklehurst is a 'care home'. People in care homes receive accommodation and nursing or personal care as 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.
Brocklehurst can accommodate up to 41 people in a two-storey purpose-built building. At the time of this inspection there were 40 people living at Brocklehurst. The care home consists of four units across two floors and is set in its own grounds. Each unit has its own kitchenette used for making drinks and snacks. Each unit accommodates people needing both residential and nursing care. Both floors are accessible by two staircases, at each end of the building, and one central lift and staircase. On the ground floor, there is a large lounge and dining room, the kitchen, laundry facilities and a hairdresser’s salon.
There was a manager in post who was registered with the CQC since July 2018. 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. They were supported in the day to day operation of the home by a deputy manager and a clinical nurse lead.
In the main, Brocklehurst provided care and support that was safe. People and their relatives told us they received care and support that was safe.
There were some aspects of the medicine administration that were not safe. This meant people were potentially at risk of harm because they did not receive their medication as prescribed. The provider took appropriate steps to correct this issue before we completed our inspection.
People were supported by a consistent staff team who had all relevant pre-employment checks to ensure they were appropriate to work with vulnerable people. The provider had suitable systems in place to take action to protect people from abuse including accidents and incidents.
Risk assessments were up to date and most contained sufficient information for staff to support people in a safe way. We identified an example where this was not the case and the staff sought to rectify this during our inspection.
People were protected from the risk of infection because suitable arrangements were in place to ensure hygiene standards were maintained. The home was visibly clean and free from unpleasant smells. Staff were knowledgeable about and demonstrated good infection control practices.
People, staff and visitors to the home were protected from harm because there was a regular programme of maintenance and checks of the premises and equipment. This included lifts, hoists, fire safety equipment and the water system.
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. The provider had submitted appropriate applications for the deprivation of liberty safeguards to the local authority and the registered manager had a good system in place to track the progress of these.
Staff were competent and had adequate professional support to support people safely and effectively. Staff received an induction, training considered mandatory by the provider and shadowed experienced colleagues prior to working unsupervised. Staff had regular supervisions and annual appraisals.
People’s nutrition and hydration needs were met effectively. People were satisfied with the food and drink on offer at Brocklehurst. The service acted proactively to ensure people maintained a balanced diet and that they received relevant health and medical attention as required. This helped to ensure people achieved a good quality of life and wellbeing.
People were supported in a friendly and respectful way. Staff responded promptly when people asked for help and were seen to support people in a patient and unhurried manner. People and relatives were complimentary about the staff and their caring attitude; they said the care they received was supportive and kind and that staff were genuinely caring.
The atmosphere at the care home was calm. We observed good rapport between people and the staff. It was evident to us that staff knew the people they cared for and supported.
The care home operated within a diverse and multicultural community and had systems in place to ensure people’s equality and diversity needs were recognised.
Concerns and complaints were managed effectively with a clear process in place. People and their relatives told us they knew how to make a complaint or raise their concerns. The registered manager had a good oversight of issues identified which helped to reduce the likelihood of reoccurrence.
Activities and events were meaningful and engaging. We observed various activities, including one-to-one activities, taking place during our inspection and some people told us they enjoyed participating in these. The activities coordinator was passionate about improving the activities on offer.
There were a range of audits which identified areas for improvement; these were fit for purpose and included medication audits, care plan audits, pressure ulcer management and health and safety. The provider also used questionnaires to find out what people, relatives and staff thought about the service provided. Responses though positive had not been formally analysed.
The registered manager was visible within the home and people and their relatives found them approachable. The local authority was positive about the impact the registered manager had had on driving improvement within the home.
Staff had appropriate mechanisms to support them in carrying out their jobs. These included staff meetings and policies and procedures.
The provider complied with the legal requirement to display its most recent rating within the home and on their website.
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(s) of safe, effective, caring, responsive and well led to at least good. They submitted an action plan in March 2017 which identified what action would be taken to address the concerns identified at the inspection in January 2017. At this inspection, we noted improvements had been made in all areas of concern identified at the last inspection such as staff recruitment, providing meaningful and appropriate activities, need for consent and records management. However further improvements were required in some of these areas, for example, need for consent and audit processes. Further information about these concerns is identified within this summary and the full report. This is the second time the service has been rated ‘Requires Improvement’ overall.
Brocklehurst is a 'care home'. People in care homes receive accommodation and nursing or personal care as 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.
Brocklehurst can accommodate up to 41 people in a two-storey purpose-built building. At the time of this inspection there were 33 people living there. The care home consists of four units across two floors and is set in its own grounds. Each unit has its own kitchenette used for making drinks and snacks. Each unit accommodates people needing both residential and nursing care. Both floors are accessible by two staircases, at each end of the building, and one central lift and staircase. There is a large lounge and dining room on the ground floor though most people preferred to dine in the communal area on their respective units. The kitchen and laundry facilities were situated on the ground floor as was the hairdresser’s salon.
There was a manager responsible for the day to day operation of the service. However our records showed they were still in the process of registering with the CQC. 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 three breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulation 2014 in relation to medicines management, need for consent and good governance. You can see what action we told the provider to take at the back of the full version of the report.
We found the service was not always safe in some respects though people told us they felt safe with the staff who supported them. People were supported by a consistent staff team and the provider had suitable systems in place to take action to protect people from abuse including accidents and incidents.
People were supported by competent staff to take their medicines safely. We found concerns with how medicines were stored. This could compromise the integrity of the medicines and put people at risk of harm.
Recruitment processes had improved. Staff employed at the home had undergone all appropriate pre-employment checks to help ensure they were suitable for the role. Staff we spoke with were aware of safeguarding policy and procedures and knew what action to take if they suspected abuse was taking place.
Risk assessments were up to date and contained sufficient information for staff to support people in a safe way.
Suitable arrangements were in place to ensure hygiene standards were maintained within the home. Staff were knowledgeable about and demonstrated good infection control practices. The home was visibly clean and free from unpleasant smells. Regular maintenance and checks of the building and equipment was carried out. This included lifts, hoists, fire safety equipment and the water system.
We found the principles of the Mental Capacity Act were not always followed; for example, in some care records, we saw consent to care was signed by relatives without the appropriate legal authorisation. This was a continuing breach of the regulation relating to need for consent.
Appropriate applications for the deprivation of liberty safeguards had been made to the local authority and the home manager had a good system in place to track the progress of these.
Staff received an induction, training considered mandatory by the provider and shadowed experienced colleagues prior to working unsupervised. Records showed staff had supervisions with their line manager. This helped to ensure staff were competent and had adequate professional support to carry out their roles.
Most people were satisfied with the food and drink on offer at Brocklehurst. The service acted proactively to ensure people maintained a balanced diet and that they received relevant health and medical attention as required. This helped to ensure people achieved a good quality of life and wellbeing.
In the main, people were supported in a friendly and respectful way. Staff responded promptly when people asked for help and were seen to support people in a patient and unhurried manner. People we spoke with were happy and settled living at Brocklehurst. They said the care they received was supportive and kind and that staff were genuinely caring. Relatives were also happy with the care provided.
Staff responded promptly when people asked for help and were seen to support people in a patient and unhurried manner. People we spoke with were happy and settled living at Brocklehurst. They said the care they received was supportive and kind and that staff were genuinely caring. Relatives were also happy with the care provided.
The atmosphere at the care home was calm. We observed good rapport between people and the staff. It was evident to us that staff knew the people they cared for and supported.
The care home operated within a diverse and multicultural community and had systems in place to ensure people’s equality and diversity needs were recognised.
People told us they knew how to make a complaint or raise concerns. There was a process in place for managing complaints and concerns raised. Some concerns were recorded within individual care records which meant the provider and home manager had limited oversight of all issues raised.
The provider had employed a dedicated activities coordinator; this helped to improve the provision of activities across the home. We observed various activities taking place during our inspection and people told us they enjoyed participating in these.
The home had not had a registered manager since April 2016. This is a condition of the provider’s registration. In December 2017, we took enforcement action for this offence and the provider was charged a fine which was paid.
The lack of consistent management had had an impact on the quality monitoring and improvement of the service. Though the provider had put in place mechanisms to offer support to interim managers these were not effective in ensuring people received a service that was of a good standard.
There were some audits in place to monitor the quality of service provided. These were not sufficiently robust as they did not identify some of the concerns we found in medicines management and care records.
People and their relatives told us they knew who the current home manager was and that they were friendly and approachable. Staff were equally complimentary about the home manager saying they were visible within the home and maintained an open door policy.
The home manager had implemented various methods to help improve communication amongst the staff team. These included the flash meetings. Staff we spoke with felt these methods had improved communication.
There were relevant policies and procedures in place and staff meetings had been reintroduced; these helped to ensure staff had appropriate guidance to carry out their roles.
Brocklehurst provides residential and nursing care for up to 41 people. The home had 35 people living there at the time of this inspection and is a large two storey detached building set in its own grounds. The home consists of four units across two floors. Each unit has its own kitchenette used for making drinks and snacks. Each unit accommodates people needing both residential and nursing support. Both floors are accessible by two staircases, at each end of the building, and one central lift and staircase. There is a large lounge and dining room on the ground floor but we found this area was infrequently used as most people preferred the communal area on their respective units. The kitchen and laundry facilities were situated on the ground floor as was the hairdresser’s salon that could be used weekly.
There was a manager responsible for the day to day operation of the service. However they had yet to register with the Care Quality Commission (CQC). 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 a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.
During the inspection the home manager was on annual leave and our inspection was supported by one of the provider’s area managers and a registered manager from one of the provider’s other services.
We made recommendations that the provider updates policy documents in relation to medication to reflect current legislation and that the provider and home manager should review how information regarding people’s care and support is communicated to staff without compromising people’s privacy, confidentiality and dignity.
We found breaches in the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulation 2014. You can see what action we have told the provider to take at the back of the full version of the report. 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.
People and relatives told us Brocklehurst Nursing home provided a safe environment in which to live. We noted that staff recruitment processes needed to be more robust to help ensure staff employed were suitable to work with vulnerable people.
Three out of four care records we reviewed contained relevant risk assessments which were reviewed and updated as an individual’s circumstances changed. We found these documents provided clear guidance and sufficient information for staff to support people safely and manage risk appropriately.
Medications were administered and stored safely. We pointed out that the top floor treatment room where medication was stored had a temperature over the recommended national guidance.
The service did not always demonstrate that it was working within the principles of the Mental Capacity Act 2005 (MCA) to ensure they sought the consent of people or their legally appointed representative before providing care and support. Applications under the Deprivation of Liberty Safeguards had been made. However there was no systematic way to track which applications had been made and when each required review.
Records demonstrated that people living at Brocklehurst had good access to healthcare professionals such as GPs and speech and language therapists when required. This meant that people’s healthcare needs were being met in line with their individual needs.
People and their relatives told us that the staff were pleasant and caring, and that in general people’s dignity and privacy were treated respectfully.
We observed that there was a good rapport and friendly interactions between residents at the home and staff caring for them.
People and their relatives gave us examples of how they were involved in making decisions about the care provided.
Care plans we reviewed did not always contain sufficient information to help care staff support people safely and responsively. There was little evidence that meaningful activities and recreation were being undertaken to provide people living at Brocklehurst Nursing Home with adequate mental stimulation.
Not all people living at the home and their relatives knew who the home manager was.
Audit and improvement processes in place needed to be strengthened to help ensure the provider and registered manager effectively monitored the quality of care provided.
There were policies and procedures in place to help ensure staff were supported to undertake their role effectively.
This was an unannounced inspection of Brocklehurst Nursing Home on the 15 and 16 December 2015. The home provides residential and nursing care for up to 41 people. The home had 35 people living there at the time of the inspection.
We last inspected Brocklehurst Nursing Home in June and July 2015. At that time we rated the service as Inadequate and the service was placed into special measures. This was because there were breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulation 2014. The breaches were in relation to safe and effective person-centred care, privacy and dignity, need for consent, complaints, staff training, good governance and the regulation which requires services to notify the Care Quality Commission (CQC) of certain types of incidents.
The purpose of special measures is to provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration. At this inspection we found there was enough improvement to take the provider out of special measures.
Prior to this inspection the provider agreed to a ‘Voluntary Undertaking’ with CQC. This meant the provider had formally agreed not to admit any new people to the home without prior written permission from CQC.
There was a manager in day to day responsibility of the service. However they had yet to register with the Care Quality Commission (CQC). 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 a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.
We found breaches in the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulation 2014. You can see what action we have told the provider to take at the back of the full version of the report.
People living at Brocklehurst Nursing Home were not always involved and consulted with on decisions about how they wished to be supported or where decisions had been made in their ‘best interests’, demonstrating their rights were protected.
People’s care records did not contain sufficient information to accurately guide staff on the care and support they required. Potential risks to people had not always been assessed and planned for ensuring people’s health and well-being was maintained.
Opportunities for on-going staff training and development were needed to help ensure people’s health and well-being is safely met by staff with the relevant knowledge and skills needed to do so.
Whilst improvements had been made to the quality monitoring system, these needed expanding upon to ensure all areas of the service were reviewed and evidenced any areas of improvement had been acted upon.
We found overall the system for managing medicines was safe. We have recommended however that the service considers current good practice guidance in relation to the administration and recording of prescribed ‘thickener’ medicines.
Opportunities for people to participate in a range of activities offering stimulation and variety to their daily routine were limited. We have made a recommendation about the type of opportunities that could be made available to people to promote their well-being and encourage their independence.
Appropriate action had been taken with regards to the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be unable to make their own decisions.
Checks were made to the premises and servicing of equipment. Suitable arrangements were in place with regards to fire safety so that people were kept safe. The home was found to be clean, spacious and well adapted to meet the physical needs of people.
People were supported by adequate numbers of staff. Relevant recruitment checks were carried out to make sure people applying to work at the service were suitable.
During our visit we saw examples of staff treating people with respect and dignity. People living at the home and their visitors were complimentary about the staff and the care and support they provided.
People were offered adequate food and drink throughout the day, ensuring their nutritional needs were met. Where people’s health and well-being was at risk, relevant health care advice had been sought so that people received the treatment and support they needed.
The registered manager had a system in place for reporting and responding to any complaints brought to their attention.
Information in respect of people’s care was held securely, ensuring confidentiality was maintained.
We inspected this service on the 16 June and 6 July 2015. Both days of the inspection were unannounced. This meant the service did not know when we would be undertaking an inspection.
The home had not had an inspection since it had been with the current provider. The home was previously managed by Anchor Homes and was last inspected in March 2014. Sure Care (UK) Limited began managing the home in May 2014. This planned inspection was bought forward following concerns raised with the Care Quality Commission (CQC) about the safety of people living in the home.
Brocklehurst Nursing Home is a large two storey detached building set in its own grounds. The home provides residential and nursing care for up to 41 people. The home had 38 people living there at the time of the inspection.
The home consisted of four wings across two floors. Each wing had its own kitchenette used for drinks and snacks. Each wing accommodated people needing both residential and nursing support. Both floors were accessible by two staircases, at each end of the building, and one central lift and staircase. There was a large lounge and dining room on the ground floor but we found this was little used as most people used the communal area on their respective wings. The kitchen and laundry facilities were situated on the ground floor as was the hairdressers who could be used weekly.
The home had a new manager who stated their intention to register with the Care Quality Commission. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run. The new manager had been in post since April 2015, three months prior to the inspection. The service had been previously managed by the area manager since the previous manager left in January 2015.
At this inspection we found a number of breaches to the regulations as identified below.
Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 focuses on people receiving the support they need. We found the home did not use all the available information to appropriately assess and meet people’s needs. This included information from professionals and from the homes own assessments.
We also found people were not supported to be involved as much as they could be with decisions about their own care. We found family members were routinely used as the first point of contact rather than the individual themselves. We found and people told us that people’s personal hygiene needs were not being met in a timely manner.
We found the home had not taken into consideration the practicalities of meeting people’s specific support needs. This included the management of hearing aids, glasses and false teeth. This included an absence of detail as to how to review the person’s condition and ensure their support aids remained in functioning and working order.
We also found a lack of assessment and review of people’s needs, contradictions within care plans and across file information left a risk of people receiving care that was unsuitable or unsafe. This included the support people needed to prevent pressure areas and sores, and support people needed with the care of their mouths. We saw four assessments from the nursing home team for people in the home who required specific support with the care of their mouth and none of them had a care plan in place to deliver this.
We found this to be a breach of Regulation 9 of the Health and Social Care Act (Regulated Activities) Regulations 2014.
We found the people who lived in Brocklehurst were not treated with dignity and respect. We found staff acted without due care and diligence about people’s feelings. Staff appeared too busy to be concerned about the things that would separate basic care from good care. This included asking people for their thoughts on their own care.
We also found the lack of regard for people’s personal possessions and toiletries showed staff did not pay attention to people’s choices around what they wanted to use or not.
We found this to be a breach of Regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
Throughout the day we observed when staff communicated with people, it was often to instruct them as to what they were to do next. This included telling people they were now moving to lounge for the day or going back to their room for a rest. Within people’s files there was a lack of evidence of formal consent. We noted a number of consent documents but these were mainly not signed. There was confusion within the files we looked at to ascertain if people were able to give their own consent or if suitable people had been appointed to support them in making decisions. There was a lack of appropriate and legal consent
We found this was a breach of Regulation 11 Health and Social Care Act (Regulated Activities) Regulations 2014.
Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 focuses on the safety of people living in the home. We found a number of areas of concern under this regulation. We found the home did not have specific policies and procedures for managing medicines including receiving and destroying stock. The home had a complex system for administering medicines from two different pharmacies. A number of errors had been picked up prior to the inspection and there had been minimal action taken to improve the situation. We found people were not receiving their medicines on time which may have impacted on their health and wellbeing. Staff had not received any training on medicines for some time and some were not confident in the home’s system as they continued to find errors.
We also found there was not an overall health and safety audit for the building and the people who lived within it. We found doors to stairwells were accessible to all, leaving a potential risk to people who required support with their mobility. None of the risks associated with the building and the people who lived there had been assessed.
We found when people had been assessed as requiring additional support it was not always provided. Staff were not delivering care in a safe way to people who lived in the home as they were not delivering care to minimise assessed risks. This was because when risks had been assessed appropriately, risk management plans and strategies were not being identified or implemented to best meet the needs of the people in the home.
We found the home did not have suitable plans in place to manage major incidents. This included a lack of specific planning to support the people who lived in the home and a lack of contingency planning if the home became uninhabitable.
When reviewing staff records and from speaking to staff it was clear they had not received the ongoing training and support they required to ensure their competence in specific clinical roles. We found care staff were expected to ensure people received their medicines had had no medicines training. The lack of support, supervision, training and professional competency testing of the clinical team had led to avoidable mistakes.
We found this was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014
During the inspection we also found the home had not safeguarded people who lived there against potential acts of abuse due to a lack of effective systems to prevent and recognise abuse. This included acts of neglect and illegal restraint. Over the course of the inspection the CQC raised six safeguarding alerts to be investigated by the local authority to ensure people were safe and protected.
We found this was a breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014
We found the provider was not meeting the nutrition and hydration needs of the people living in the home. Where risks were identified the service was not acting to reduce the risks to people and thus not ensuring their health and wellbeing was maintained. We found records used to support people were inaccurately completed and referrals to specialist support were not always made.
We found this was a breach of Regulation 14 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014
The home had an activity co-ordinator told us they were unable to develop the role as they would like as there was not enough time to do this.
The manager told us they did not have any records of any complaints made prior to them starting in post in April 2015. The CQC was however aware of two ongoing complaints that had progressed to safeguarding. The provider didn’t record any issues/concerns/complaints received or what action was taken as a result.
We found this was a breach of Regulation 16 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014
Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 focuses on how the home ensures the service is meeting the needs of people living there and looks at ways at improving service provision. We would expect this to be done by the home with the provider monitoring and auditing provision to ensure it meets the regulations outlined under the Health and Social Care Act. We would also expect them to be regularly sourcing feedback from people in the home and other interested parties to ensure they are meeting their needs. We found a number of areas of concern under this regulation.
We also found a lack of complete records for decisions taken and reached in relation to the care and treatment provided to people. This included procedures not being followed in line with the Mental Capacity Act 2005 to ensure people were supported lawfully and where they could make decisions around their own care they were allowed to do so.
A lack of monitoring and audits meant the manager had no information upon which they could seek to drive improvements. The quality of the service could not be measured. We found a number of acts of omission that could have led to people being at risk. These omissions would have been highlighted if the provider had monitoring in place
The provider was not seeking feedback from the people who used the service, their family members, other professionals or the staff who worked in the home. As a consequence they did not know how the service was perceived by those using it, commissioning and supporting it and from those who worked in it.
The above showed us that systems and processes had not been established and operated effectively to assess, monitor and improve the quality and safety of support provided to people that lived in the home. The home had no way to ensure they were meeting the regulations of the Health and Social Care Act.
We found this was a breach of Regulation 17 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
We found the kitchen and laundry were well managed. There were systems in place for appropriate risk assessment, cleaning and audit.
Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 focuses on ensuring the home has enough suitably qualified and trained staff to meet the needs of the people living in the home. We found the home were not assessing the needs of the people within it to determine the staffing levels required to support them. We found when circumstances changed staffing did not change to reflect this. On the day of the inspection staff numbers were not proportionate to people’s needs. We saw people waiting for a long time to have their call bell answered and staff waiting for a second member of staff to enable people to be moved safely.
Staff had received minimal training and formal support since the current provider had taken over the home in May 2014. New staff had not received an induction and staff had not received an appraisal by the time of the inspection. There was a lack of formal support and training for staff to confidently complete their role.
We found this was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014
Upon reviewing the information within the home. It was clear the Care Quality Commission had not been informed of all information required under the provider’s registration. This included notifications for allegations of suspected abuse including omissions of care and potential neglect. We had received information directly from the local Authority and not from the home via a notification.
We found this was a breach of Regulation 18 of the Health and social Care Act (Registration) Regulations 2009
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.
Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.
The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.
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. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.
For adult 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.