Brackley Fields Country House Retirement Home

Brackley Fields Country House Retirement Home is a residential care home providing accommodation and personal care for up to 32 people. The service provides support to younger and older people and people with dementia. At the time of our inspection there were 24 people using the service.

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

Records required improvement. We found gaps in the recording of personal care tasks and risk strategies. People’s records did not evidence person centred care was always delivered.

Not all risks were clearly identified and mitigated. Injuries had not always been recorded and follow up information was limited.

Medicine records required improvement. Although people received their medicines, records did not always evidence the reason why an 'as required' medicine had been given and staff did not always have the information required to understand when ‘as required’ medicines should be given.

Not all records were audited to identify when information had not been recorded. Systems and processes to ensure good oversight and improvements were put into place were not always effective.

People, staff and relatives raised some concerns with staffing levels. We were told that due to staffing levels some tasks were not completed, or people had to wait for support to be offered. We made a recommendation regarding reviewing staffing levels.

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; however, the policies and systems in the service did not always support this practice.

The environment was clean, and people had personalised rooms. However, areas of the service required updating.

Staff supported people to have their health needs met. Referrals were made to healthcare professionals as required. Nationally recognised best practice guidance to identify and monitor people who were at risk of developing skin pressure damage or malnutrition was used.

People were supported by kind caring staff who had been safety recruited and received training to understand people’s needs. People and relatives told us staff were kind, caring and compassionate and treated people with dignity and respect.

People, relatives and staff knew how to complain. The registered manager understood their responsibility to open and transparent when things went wrong. Lessons learnt were shared with staff and incidents and accidents were reviewed to identify and trends or patterns to reduce the risk of reoccurrence.

Staff wore appropriate personal protective equipment and the provider followed government guidance on testing for COVID-19.

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 4 September 2019)

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We undertook this inspection as part of a random selection of services rated Good and Outstanding.

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.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to medicines, records and oversight at this inspection.

We have recommended the provider reviews the current staffing levels.

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.

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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

We have made a recommendation that the provider identifies a support tool to ensure correct staffing levels.

We have made a recommendation that the provider completed detailed quality audits and changes governance systems to support detailed recording of information.

Audits on people’s care files failed to identify when records required reviewing and updating. This meant that all the necessary information was not recorded or acted upon when required.

Systems and processes were not in place to ensure person centred care was always offered.

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 did not support this practice.

Not all staff and people we spoke to felt there were enough staff on duty. However, people told us that they had good relationships with staff who were kind and caring and that staff had a good knowledge and understanding of the people using the service. Staff respected people's privacy and dignity. They treated people courteously.

People were protected against the employment of unsuitable staff. The provider followed safe staff recruitment procedures. Records confirmed that Disclosure and Barring Service (DBS) checks were completed and references obtained from previous employers. These are checks to make sure that potential employees are suitable to be working in care.

All staff completed an induction which included full training and shadow shifts, to ensure they had the knowledge and skills to carry out their roles and responsibilities.

Staff were confident in their roles and the training provided covered all areas of their jobs.

People had risk assessments detailing how to care and support people safely however not all care plans recorded people’s like and dislikes or routines.

People who had specific religious needs, were supported by staff who had a good understanding and the environment was adapted to ensure these needs could be met.

Staff worked with external professionals to ensure people were supported to access health services and had their health care needs met. We saw evidence of referrals being made to district nurses, occupational therapists and the falls team. A healthcare professional told us, “Staff are very knowledgeable about residents and always follow my advice.”

Domestic staff completed cleaning schedules to ensure the property was kept clean and people’s rooms were personalised and decorated to their taste and choice of colour.

The management team carried out regular audits and checks on the environment.

The provider had policies and systems in place to safeguard people from abuse and they followed the local safeguarding protocols.

Medicines were managed safely, medicines were administered as prescribed.

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 requires improvement (published 21 July 2018). The service has now improved to good.

At this inspection we found improvements had been made and the provider was no longer in breach of regulation 17. However, we made recommendations relating to staffing, record keeping, governance and person-centred care.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Brackley Fields Country House Retirement Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Brackley Fields Country House Retirement Home is registered to provide accommodation and support with personal care for up to 35 people in one adapted building. At the time of the inspection there were 27 people living in the home.

There was a registered manager in post at the time of our 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.

At the first unannounced comprehensive inspection on 1 and 2 June 2016, we found the service to be rated ‘Requires Improvement’.

Staffing levels were not always sufficient and had not been calculated to meet the dependency levels of people living in the home. Individual care plans and risk assessments were not personalised or accurate and provided conflicting information regarding people's needs. The quality monitoring in place had not highlighted the inconsistencies in individual care plans and risk assessments. Not all staff received regular one to one supervision and staff meetings were not being held on a regular basis.

The provider was in breach of one regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to take action to make improvements in relation to the staffing of the service. The provider submitted an action plan detailing the improvements that they would make to comply with the regulations.

At the second unannounced comprehensive inspection on 15 and 16 December 2016, we found the service continued to be rated ‘Requires Improvement’.

Sufficient numbers of staff were not consistently deployed to provide people’s care. Following our inspection in June 2016, staffing levels had been increased but the number of staff deployed did not always reflect the number of staff that the provider had determined were necessary. Systems in place to monitor the quality and safety of the service were not sufficient. Planned audits had not always taken place and failed to identify risks associated with inconsistent staffing levels, management of medicines, record keeping and accidents and incidents.

The provider was in breach of two regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to take action to make improvements in relation to the staffing and governance of the service. The provider submitted an action plan detailing the improvements that they would make to comply with the regulations.

At the third unannounced comprehensive inspection on 31 July and 1 August 2017, we found that the service continued to be rated ‘Requires Improvement’.

Ineffective quality assurance systems were in place to monitor the care and support people received. The improvements that were required to the service had not been identified, and there had been on-going shortfalls as a result. Improvements that were required to fire safety procedures had not been acted upon in a timely manner and environmental audits had not identified on-going deficiencies in fire safety measures. Adequate monitoring of people's falls had not been carried out; insufficient action had been taken to support people who were at high risk of falls. Improvements were required to ensure people received their medicines. People could not be assured that they would receive their prescribed medicines safely. Arrangements in place to ensure that staff had sufficient skills and knowledge to provide people with appropriate support were not sufficient. There was a lack of oversight of staff training. Improvements were required to ensure the staff adequately monitored people's nutritional needs. Some people had been identified as being at high risk of malnutrition. Staff did not follow the guidance to access appropriate medical advice.

The provider was in breach of two regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We imposed conditions on the provider’s registration to drive the improvements needed in relation to falls management, people’s nutritional needs, fire safety, medicines, staff training and the governance of the service.

This was the fourth unannounced comprehensive inspection of the service and the service continues to be rated overall ‘Requires Improvement’.

Whilst improvements had been made, the provider had not taken sufficient action to meet all the breaches of regulation identified at the previous inspection. People’s medicines were administered as prescribed; however, the medicines administration records were not always completed accurately to provide a clear account of the medicines administered to people. Audits of medicines had not identified these omissions.

People’s capacity to consent to their care and support was not always assessed. People supported by the service were not able to consent to some aspects of their care. However, written capacity assessments and best interest checklists were not in place. Staff did demonstrate that they understood the principles of the Mental Capacity Act 2005 and gained people’s consent when supporting them.

Health and safety checks had not identified risks posed to people by hot water and some areas of the home, which may pose a risk to people’s safety, were not secured.

However, we identified that the provider had made the improvements required to meet the previous breaches in regulation in other areas. Appropriate fire safety measures had been implemented, doors were fitted with automatic closers and on-going fire safety checks were in place.

People had adequate falls risk assessments and these had been reviewed as necessary. There was sufficient analysis, oversight and action in relation to people's falls.

People's nutritional and hydration needs had been assessed and appropriate action taken. There was sufficient oversight, monitoring and action in relation to people's nutritional needs. Healthcare professionals had been involved as necessary.

Appropriate induction and training was in place for staff. All new staff had an appropriate induction. A training plan was in place and training was updated within appropriate timescales.

A system of scheduled audits was in place to monitor all areas of the service. The nominated individual had regular meetings with senior staff to discuss the outcomes of these audits.

Recruitment procedures protected people from receiving unsafe care from care staff that were unsuitable to work at the service. People felt safe in the home and received care and support from staff that understood their responsibility to keep people safe. Staff had appropriate support and received one to one supervisions with their line manager.

People received enough to eat and drink and had a choice of meals and snacks. People were supported by staff to use and access a variety of other services and social care professionals. The staff had a good knowledge of other services available to people and we saw these had been involved with supporting people living in the home.

People were supported to have health appointments when required to make sure they received health care to meet their needs.

Care plans reflected how people's needs were to be met and people had been involved in deciding how their care would be provided. People were supported to take part in activities they enjoyed. Staff were committed to the work they did and had good relationships with the people who lived in the home. People felt relaxed with staff, and were comfortable in their presence.

People were listened to, their views were acknowledged and acted upon. Care and support was provided in the way that people chose and preferred. There was a complaints procedure in place to enable people to raise complaints about the service.

At this inspection, we found the service continued to be in breach of one regulation of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014. Full details regarding the actions we have taken are added to reports after any representations or appeals have been concluded.

Brackley Fields Country House Retirement Home is registered to provide accommodation and support with personal care for up to 34 people. At the time of this inspection there were 31 people living in the home.

There was a registered manager in post at the time of our 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.

At the last inspection on 15 and 16 December 2016 we found that the provider was in breach of two regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider did not have sufficient arrangements in place to monitor the quality and safety of the care and support provided in the home. We asked the provider to make improvements to the governance of the service. During this inspection we found that actions required to improve the governance of the service had not been completed. At the last inspection we also found that sufficient numbers of staff were not consistently deployed to provide people with their care. We asked the provider to take action to make improvements to staffing levels. During this inspection we found that the required improvements had been made.

Ineffective quality assurance systems were in place to monitor the care and support people received. The improvements that were required to the service had not been identified, and there had been on-going shortfalls as a result.

Improvements that were required to fire safety procedures had not been acted upon in a timely manner and environmental audits had not identified on-going deficiencies in fire safety measures.

Adequate monitoring of people’s falls had not been carried out; insufficient action had been taken to support people who were at high risk of falls. Improvements were required to ensure people received their medicines. People could not be assured that they would receive their prescribed medicines safely.

Staff did not always have the skills that they needed to provide people’s care safely. Arrangements in place to ensure that staff had sufficient skills and knowledge to provide people with appropriate support were not sufficient. Staff had not been provided with sufficient training in key areas such as manual handing and first aid. There was a lack of oversight of staff training.

Improvements were required to ensure the staff adequately monitored people's nutritional needs. Some people had been identified as being at high risk of malnutrition. Staff did not follow the guidance to access appropriate medical advice. People were supported and encouraged to eat well and maintain a balanced diet. People were in the main supported to maintain good health, as staff had the knowledge and skills to support them and there was prompt access to healthcare services when needed.

Staff were unclear of the lines of leadership and management of the service. There was a lack of confidence regarding how their concerns would be dealt with; staff were not always assured their concerns had been addressed. Staff were aware of the importance of managing complaints promptly in line with the provider’s policy. People living in the home were confident that any issues would be addressed and that if they had concerns they would be listened to.

Recruitment procedures protected people from receiving unsafe care from care staff that were unsuitable to work at the service. People felt safe in the home and received care and support from staff that had a good understanding of their role in safeguarding people. Staffing levels ensured that people received the support they required at the times they needed it. People or their representative were involved in decisions about their care and support needs. Care plans were written in a person centred approach and detailed how people wished to be supported.

There were formal systems in place to assess people’s capacity for decision making under the Mental Capacity Act 2005. Staff provided people with information to enable them to make informed decisions and encouraged people to make their own choices.

Staff were committed to the work they did and had good relationships with the people who lived in the home. People interacted in a relaxed way with staff, and enjoyed the time they spent with them. Staff listened and respected people's views about the way they wanted their support to be delivered. People participated in a range of activities and received the support they needed to help them do this. People were able to choose where they spent their time and what they did.

At this inspection we found the service to be in breach of two regulations of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014. Details regarding the action we have taken can be found at the end of the inspection report.

Brackley Fields Country House Retirement Home is registered to provide accommodation and support with personal care for up to 34 people. At the time of this inspection there were 32 people living in the home.

There was a registered manager in post at the time of our 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.

People could not be assured that sufficient numbers of staff to provide their care and support in the way in which they wished to receive it. Following our inspection in June 2016, staffing levels had been increased but the number of staff deployed did not always reflect the number of staff that the provider had determined were necessary. There were insufficient contingency plans in place to manage staff shortfalls.

Systems in place to monitor the quality and safety of the service were not sufficient. Planned audits had not always taken place and failed to identify risks associated with inconsistent staffing levels, management of medicines, record keeping and accidents and incidents.

People were not always protected from the risks associated with accidents; staff did not monitor people sufficiently after an accident to detect injuries that may not be apparent at the time of the accident.

Recruitment procedures protected people from receiving unsafe care from care staff that were unsuitable to work at the service; however there was no process in place to review criminal records checks. Staff received training in areas that enabled them to understand and meet the care needs of each person.

Although care plans were written in a person centred approach and detailed how people wished to be supported, the provider was unable to consistently demonstrate that people had been involved in planning their care.

Care records contained individual risk assessments and risk management plans to protect people from identified risks and help to keep them safe. They provided information to staff about action to be taken to minimise any risks whilst allowing people to be as independent as possible.

People felt safe in the home and relatives said they had no concerns. Staff understood the need to protect people from harm and abuse and knew what action they should take if they had any concerns.

People were supported to take their medicines as prescribed. Records showed that medicines were obtained, stored, administered and disposed of safely. People were supported to maintain good health and had access to healthcare services when needed.

People were actively involved in decisions about their care and support needs. There were formal systems in place to assess people’s capacity for decision making under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).

Staff had good relationships with the people. People participated in a range of activities and received the support they needed to help them do this. In the main people were able to choose where they spent their time and what they did.

Staff were aware of the importance of managing complaints promptly and in line with the provider’s policy. Staff and people were confident that issues would be addressed and that any concerns they had would be listened to.

At this inspection we found the service to be in breach of two regulations of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014. The actions we have taken are detailed at the end of this report.

Brackley Fields Country House Retirement Home is registered to provide accommodation for persons who require personal care support for up to 34 people. On the day of the inspection 32 people were living in the home.

There was a registered manager in post at the time of our 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.

Staffing levels had not been calculated to reflect the dependency levels of people living in the home and were not always sufficient to ensure that the needs and choices of people living in the home were always met. Although this was applicable to all shifts in the home the impact was greater during the night.

This was a breach of one regulation 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 report.

Staff had an in-depth understanding of peoples care and support needs and understood how to care for them safely. However individual care plans and risk assessments were not personalised or accurate and provided conflicting information regarding people’s needs. This was discussed with the provider and they began an immediate review of all care plans and risk assessments in place.

Regular quality monitoring was on-going in the home; however this had not highlighted the inconsistencies in individual care plans and risk assessments. Systems were in place to gather feedback from people and their relatives and the provider had acted in response to suggestions for improvements.

Although staff felt supported by management not all staff received regular one to one supervision and staff meetings were not being held on a regular basis. This meant that staff did not have a forum to raise any concerns or ideas for improvement they may have; they had shared their concerns about staffing levels with the deputy manager bit not with the registered manager

People felt safe in the home and relatives said they had no concerns. Staff understood the need to protect people from harm and abuse and knew what action they should take if they had any concerns. Recruitment procedures protected people from receiving unsafe care from care staff that were unsuitable to work at the service. Staff received training in areas that enabled them to understand the care needs of each person.

People were supported to take their medicines as prescribed. Records showed that medicines were obtained, stored, administered and disposed of safely; however some aspects of medicines administration practice needed improvement.

People were actively involved in decisions about their care and support needs. There were formal systems in place to assess people’s capacity for decision making under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).

Staff had good relationships with people who lived in the home; they worked hard and did their best to provide care in a way that met people’s needs and choices.

We found that the provider had responded swiftly to ensure that the staff who were due to work on the night shifts had the required fire safety training before their shifts were due to commence, to ensure that people who used the service were protected from the risks of fire. The Fire Safety Officer has confirmed that provider is now compliant with Fire Safety Regulations. We found that a training programme had been put in place to ensure that staff were able to meet the needs of people who used the service.

The provider sent us an action plan that set out the improvements they were going to make to the service. This included the development of a staff training matrix to ensure that staff had the required training at the right time. Staff training records showed that an appropriate training programme was in place. Records showed that the provider conducted accurate safety checks on the hot water dispensed in bathrooms to ensure that people were able to bathe in safe and comfortable water temperatures.

This is a summary of what we found-

Is the service safe?

People told us that they felt safe living at Brackley Fields Country House Retirement Home. Bedrooms were fitted with appropriate safety devices such as radiator guards and window restrictors and no slip or trip hazards were identified within the environment. Appropriate risk assessments were in place to ensure people's health and safety. However staff had not had all of the required training provided within the appropriate timescales. We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to staff training and quality assurance.

Is the service effective?

People were happy with the care that had been delivered, one person said 'I am well looked after here, the staff are lovely and are very friendly; I am very happy here'.

Staff related well to people and knew how they liked to be supported. All of the people living at Brackley Fields had an individual plan of care; these contained the right information. People looked comfortable and relaxed within their environment and looked well cared for.

Is the service caring?

People told us the staff were nice to them and that there were enough staff to meet their needs. We also found that staff ensured people had access to appropriate health care professionals and services. We spoke with a relative who said 'The staff couldn't do enough for our relative, all of the family agreed the care could not have been better, we couldn't have asked for more, the staff were wonderful'.

Is the service responsive to people's needs?

We saw that staff were mindful of people's privacy and that they treated them with respect; for example we saw that staff referred to people by their preferred name and obtained people's consent before providing any support. Records showed that people had access to health professionals such as general practitioners, district nursing services, specialist nurses, dental services, podiatrists, opticians and other NHS services when required.

Is the service well lead?

The registered manager had identified areas for improvement through the quality assurance process; including the need to increase staffing levels and equipment to meet people's needs and reduce the risks of falls. We found the registered manager had responded to the outcome of satisfaction surveys and meetings with people who used the service to improve the quality of the service. The people we spoke with confirmed that staff and management responded to their views.

However quality assurance systems had failed to identify that the required training in fire safety had not been renewed for existing staff, in addition although safety checks on the hot water dispensed in bathrooms had been checked on a weekly basis we found that the thermometer in use for routine hot water checks was not working properly.

This meant that some of the quality assurance checks designed to ensure the health and safety of the people who used the service were not always effective. We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to staff training and quality assurance.

We spoke with two staff members that worked at the service. They told us that they enjoyed their roles and that they felt like part of one big family.

We spoke with two family members of people that used the service. They both spoke very positively about the service. One of them told us 'I am very happy with the level of service, the staff are very attentive and the service very responsive'.

We spoke with a professional who was visiting the service. They told us that they had no concerns about the service and that the staff listened and took advice and recommendations on board.

We saw that people's likes, dislikes and preferences were taken into consideration. We found that people's needs and risks had been identified, however, we were concerned as we could not always evidence that people's needs were being met and the risks managed appropriately.

We saw that there was a safeguarding policy in place, there were adequate staffing levels at the service and that the provider conducted an annual feedback survey.