Bretby House

Updated 12 October 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by an inspector and an Expert by Experience who carried out phone calls with relatives of people using the service. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Bretby House is a ‘care home.’ 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 we looked at both during this inspection.

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We used the information the provider sent us in the provider information return. This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We asked commissioners of the service for feedback and used information gathered as part of our ongoing monitoring activity to help plan the inspection. We used all of this information to plan our inspection.

During the inspection

During the inspection we spoke with 6 people living at the home and 8 relatives of people living at the home. We spoke with 5 staff members, the registered manager and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We looked at 4 staff files related to recruitment and sampled 11 records related to people’s care as well as a sample of medicines records. We spoke with 2 health professionals who worked with the service.

Updated 12 October 2023

About the service

Bretby House is a residential care home providing personal care to up to 24 people in one adapted building. The service provides support to older people. At the time of our inspection there were 23 people using the service.

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

Systems did not ensure consistently safe practice and oversight in relation to health and safety, recruitment and learning from incidents as far as possible.

We received mixed feedback as to whether there were always enough staff. Staffing arrangements and agency use were under review at the time of the inspection to ensure there were always enough staff, suitably deployed to meet people’s needs.

Staff told us they felt supported although we saw staff training gaps across a number of core areas.

Improvements were required to ensure some people had the additional support they needed to manage their food and fluid intake safely.

Building work was planned to address poor storage arrangements, which compromised the safety of the home and infection control standards.

People were not supported to have maximum choice and control of their lives although staff supported them in the least restrictive way possible and in their best interests. The policies and systems in the service did not support good practice in line with the requirements of the Mental Capacity Act (2005).

Improvements were required and underway to engage people further through meaningful activities and further involvement in decisions about their care. Concerns that compromised people’s dignity and respect were not robustly addressed by the provider.

Improvements were needed and underway to ensure people’s needs and preferences around activities, communication and end of life care planning could be met.

Audits were not effective and were not always completed as planned to drive improvements. This had compromised the quality and safety of the service. Systems and processes were not robust to support continuous improvements at the home.

People told us they felt safe and safeguarding concerns had been appropriately referred to the local authority. People’s risks were understood by staff members. People’s medicines were stored and managed appropriately.

People were mostly positive about the food offered. People were supported to access healthcare services when needed.

People’s care needs had been gathered with input from their relatives. People’s needs were assessed and relevant guidance was included in their care plans.

People were supported by staff who endeavoured to promote their dignity and independence. We saw caring and positive interactions between people and staff.

People often appeared content and received caring and considerate support from staff. Staff had developed positive relationships with people.

People and relatives felt able to complain if they needed to, and complaints that were logged were responded to effectively.

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.

Why we inspected

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.

The inspection was prompted in part due to concerns received about infection control and staffing, and concerns at the provider’s other services. A decision was made for us to inspect and examine those risks. We identified concerns about infection control on the inspection and we prompted the nominated individual to review their staffing arrangements to help mitigate risks.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified breaches in relation to governance, safe care and treatment including infection control and the Mental Capacity Act (2005) at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

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