There were 21 people living at Bramhall Residential Home on the day of our visit. We spoke with seven people who lived in the home, a visitor, care workers and the registered manager. We considered our inspection findings to answer questions we always ask;
' Is the service safe?
' Is the service effective?
' Is the service caring?
' Is the service responsive?
' Is the service well-led?
This is a summary of what we found-
Is the service safe?
The home had policies and procedures in relation to the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) although no applications had needed to be submitted. We saw one person may have been at risk of having more restrictions placed on them than necessary.
The MCA states that every adult has the right to make his or her own decisions and must be assumed to have capacity to make them unless it is proved otherwise. The Deprivation of Liberty Safeguards are part of the MCA. They aim to make sure that people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom.
There were no effective systems in place to ensure the provider and staff learnt from incidents. This increased the risk of harm to people and failed to ensure that lessons were learnt from incidents. We have told the provider they must meet the requirements of the law in relation to learning from incidents that affect people's safety.
People were not protected against the risks associate with medicines. We saw controlled medication was administered and recorded without being properly witnessed. Processes in place for the disposal of medication were not appropriate. We watched a medication round and saw that medication was left unsecure and that people were not always asked if they wanted medication which was prescribed to be taken as required before it was removed from the packaging. We have told the provider they must meet the requirements of the law in relation to storage, administration and disposal of medication.
People we spoke with told us they received care that met their needs. One person explained how they were able to get up and go to bed at a time that suited them and that staff were always available if they needed something. They said, 'There is always someone around. If you want anything all you have to do is press the bell and they come.' Another person told us, 'If I press my bell they are no longer than five minutes.'
Is the service effective?
People's needs were assessed but care was not fully planned or delivered in line with their individual care plans. We saw information in care plans was very brief and did not fully describe how to meet a person's needs. We found that care reviews did not always identify changes in people's needs and care plans were not updated with any new care needed. Instructions from health care professionals were not recorded in the care plan.
We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to planning and delivering care.
Is the service caring?
People were supported by kind attentive staff. We saw there was a good relationship between staff and people living at the home with much laughter. One person told us, 'It's wonderful, I enjoy it here. I like being amongst people and having a laugh.' Another person said, 'Everything is brilliant, the whole atmosphere is very friendly. It's a home from home.' A visitor told us, 'XXXX always seems cheerful when I visit.'
Care plans included life and the significant history of people .These are important to support people who have some memory loss and to ensure staff are aware of people's family, experiences and preferences. People had also completed a scrap book about their lives.
Is the service responsive?
People we spoke with told us they knew how to complain. One person said, 'If I wasn't happy I would talk to the activities lady, who would pass it on. I've no complaints, I'm well looked after.' Another person told us, 'If I had any problems I would speak to the provider, but I have not had to do that.
There was no formalised method of gathering the views of people living at the home, their relatives and friends or other healthcare professionals to see what people thought about the service they received.
Records showed the provider had not always involved other health care professionals to give advice about the care provided to people.
Is the service well-led?
There were systems in place to ensure health and safety checks were completed.
The manager had been absent from work for an extended period recently. We saw the people who managed the service in the registered managers absence did not take any action on the issues we raised at our last visit on 18 October 2013
We saw audits of care related issues had not always been completed. We saw only three care plans had been audited since our last visit and the audit did not identify the issues we found during our inspection.
The provider did not gather the views of people using the service in a systematic way that would show trends and enable an action plan to be produced. We saw the provider had made no improvements since our last inspection in gathering the views of people using the service.