Bretby House

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.

Bretby House is a residential care home providing personal care for up to 24 older people, some of whom live with dementia. At the time of the inspection the service was supporting 21 people. The care home accommodates people in one adapted building.

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

People told us they felt safe. Relatives had no concerns about the safety of their loved ones. Staff knew how to escalate concerns and were aware of potential risks when providing support. People received their medicines when they needed them. Staff wore gloves and aprons to ensure they protected people from cross infection. Systems were in place to review incident and accidents to see if there were any lessons to learn from these.

Staff told us they had received the training they needed to care for people effectively and they felt supported in their role. People accessed healthcare services to ensure they received ongoing healthcare support. People, as much as practicably possible, had choice and control of their lives and staff were aware of how to support them in the least restrictive way and in their best interests; the policies and systems in the service supported this practice.

People and relatives made positive comments about the staff that supported them. People told us the staff encouraged them to be independent, protected their privacy and treated them with dignity and respect.

People had care plans in place which provided staff with information about their needs and preferences and how they would like these to be met. A complaints procedure was in place and people and their relatives knew how to raise concerns and felt confident these would be addressed.

People, relatives and staff thought the service was managed well. The registered manager was described as approachable, open and transparent in the way they managed the service. Systems were in place to monitor the delivery of the service. The provider invested in the home and several areas have recently been redecorated to make the home more dementia friendly.

Rating at last inspection

The last rating for this service was good (published 2 March 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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

Bretby House is a residential care home which provides accommodation with personal care for up to 24 older people. At the time of our inspection 21 people were living at the home.

A registered manager was in place. 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 and associated Regulations about how the service is run.

At the last inspection improvement was required in monitoring people at risk of losing weight, the choice of meals available to people and mealtime support for people that required assistance to eat their meals. There had been an improvement. People told us the quality and choice of food available had improved although there were some issues with the people telling us their dinner and puddings could have been served hotter. People were able to choose what they ate and drank and were supported to maintain a healthy diet with input from dietary specialists. People were supported to receive care and support from a variety of healthcare professionals and received appropriate treatment if they were unwell.

People and relatives told us they felt the home was a safe environment for people to live in. Staff spoken with could identify the different types of abuse and explained how they would report abuse. People were protected from the risk of harm and abuse because staff knew what to do and were effectively supported by the provider’s policies and processes. Risks to people were being monitored and staff identified risks to people and explained how those risks should be managed. Staff had a good understanding of the risks and the action that was required. The care plans and risk assessments were reviewed and updated regularly although on occasion, the information contained within the care plan did not always reflect that contained within the risk assessments.

We saw all staff were busy but were available to provide support to people when needed. This included support for people to eat, drink and move around the home safely. Requests for assistance from people were responded to promptly. The provider’s recruitment processes ensured suitable staff were recruited.

People received appropriate support to take their prescribed medicines and accurate records were kept of the medicine administered to people. Medicines were stored securely and consistently at the recommended temperature given by the manufacturer and were safely disposed of when no longer required.

People were assisted by suitably trained staff that told us they received training and support which provided them with the knowledge and skills they needed to do their job effectively. People and relatives felt staff were knowledgeable on how to support people effectively and that staff possessed the necessary skills.

We found mental capacity assessments had been completed for people who lacked the mental capacity to consent to their care and welfare. The provider had taken suitable action when they had identified people who did not have capacity to consent to their care or treatment. Applications had been made to authorise restrictions on people's liberty in their best interests.

People's care records contained information relating to their specific needs and there was evidence that the care plans were updated when people's needs. People and relatives told us they were involved in developing and reviewing their care plans. People were supported by caring and kind staff who demonstrated a positive regard for the people they were supporting. Staff understood how to seek consent from people and how to involve people in their care. We saw staff interacting with people in a friendly and respectful way and that staff respected people's choices and privacy.

People were supported by staff that provided activities on a regular basis. People told us they had no complaints but were confident if they did, that the provider would deal with it effectively. No complaints had been raised but we saw there was a complaints process in place.

The registered manager carried out audits and checks to ensure the home was running properly to meet people's needs and to monitor the quality of the care people received.

One person told us, 'The staff are like my friends.' A relative we spoke with was complementary about the service provided. We observed staff treating people with respect and dignity. This meant people were happy with the service provided.

People's needs had been assessed and care was provided in a personalised way. A range of healthcare professionals including doctors, district nurses and the optician ensured that people's health needs were met. This meant that people's care and health care needs had been monitored and met.

Systems were in place to protect people from harm.

Staff were supported to be able to carry out their roles safely. Staff felt they were able to raise concerns and these were listened to. This meant that staff felt supported by the manager and provider.

People were consulted about the service they received. Systems were in place to identify any shortfalls in the quality of the service being provided and actions were taken to improve the service. This meant that the quality of the service was monitored on an ongoing basis.