9 and 13 July 2015
During an inspection looking at part of the service
We inspected the service on 9 and 13 July 2015. The inspection was unannounced. Bramcote House Nursing Home is situated in Bramcote, Nottingham and is a nursing home registered to accommodate 22 people. There were 13 people using the service when we inspected.
The service did not have a registered manager in place at the time of our inspection, although the manager had applied to register and we approved this application shortly after the 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.
When we last inspected the service on 6 January 2015 we found there were improvements needed in relation to how people received care and support which met their needs, staff recruitment, staffing levels, people being protected from harm and the oversight of the quality of the service. The provider sent us an action plan telling us they would make all of these improvements by the end of March 2015. We found at this inspection that although the manager had made improvements to the care people were receiving, people were still being placed at risk as there was a lack of oversight and input from the provider.
People were placed at risk from an environment which was not safe in relation to the risks of fire, unsafe water systems and a lack of testing of electrical systems.
People felt safe in the service and the manager shared information with the local authority when needed. However steps were not always put in place to learn from incidents to ensure staff were following best practice.
People were supported by staff who did not all have the knowledge and skills to provide safe and appropriate care and support, and safe recruitment processes were not always followed to ensure staff were suitable to work with the people who used the service. Staffing levels were not matched to the needs of people who used the service to ensure they received care and support when they needed it.
Medicines were managed safely and people lived in a clean environment. Risks to people in relation to the care and support they received from staff had improved since we last inspected.
The Care Quality Commission (CQC) monitors the use of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). We found this legislation was not always being used correctly to protect people who were not able to make their own decisions about the care they received.
People were supported to eat enough to keep them healthy and their health needs were monitored and responded to. Referrals were made to health care professionals for additional support or guidance if people’s health deteriorated. However, when people’s care and support needs changed, these were not always recorded in their care plans to ensure staff knew about the changes.
People were treated with dignity and respect and had their choices acted on. We saw staff were kind and caring when supporting people. People enjoyed the activities which had been implemented. People knew who to speak with if they had any concerns they wished to raise and they felt these would be taken seriously.
People were placed at risk due to a lack of systems in place to monitor health and safety requirements in the service. The manager had implemented audits which had led to improvements in relation to care delivery, however the provider did not have systems in place which would protect people from the risk of harm. We referred our concerns to the fire safety officer and the Health and Safety executive who both also had concerns in relation to the environment when they visited.
People were involved in giving their views on how the service was run through the systems used to monitor the quality of the service.
The overall rating for this service is ‘Inadequate’ and the service is therefore in 'Special measures'. The service 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.