Background to this inspection
Updated
30 July 2014
We visited this service on 02 April 2014. Our inspection was unannounced. The inspection team consisted of a lead inspector, a specialist advisor with expertise in the management of pressure ulcers and an expert by experience who had experience of dementia services. We were also accompanied by a pharmacist inspector.
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process, under Wave 1.
Before our inspection we looked at all the information we held about this service, including previous reports, safeguarding incidents and information sent to us by the provider.
Our inspection in 13 June 2013 found that improvements were required in several areas including the management of pressure ulcers, management of medicines, staffing, inaccurate recording and a lack of systems in place to monitor the service. We made 'compliance actions' which required the provider to create an action plan setting out how they were going to address the issues. We received this action plan and returned to re-inspect the service on 22 August 2013. Whilst we found some evidence of improvement we identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which were more serious. These related to the standards of care and welfare of people who used the service and failings in the assessing and monitoring the quality of the service which did not protect people from the risk of unsafe care and treatment.
We took action against the provider and returned to inspect this service on 25 November 2013 where we found that improvements had been made to the management of the service; however we remained concerned about the services management of pressure ulcers. Following this inspection the provider sent us action plans telling us what they were doing to put things right.
At this inspection we checked to see if the provider had made the required improvements. We did this by looking at records in relation to six people’s care, medication, staffing and the management of the service. We spoke with 11 people who used the service, and five relatives who were visiting on the day of our inspection. We also spent time observing the support provided to people during the midday meal using the Short Observational Framework Inspection (SOFI) tool which is a specific way of observing care to help us understand the experiences of people who used the service.
Updated
30 July 2014
Brandon Park Residential and Nursing Home is a care home providing short and long-term care, offering nursing, palliative, convalescence and respite care, as well as care for those diagnosed with Parkinson’s and dementia.
The service can accommodate up to 55 people. There were 25 people in residence when we visited. This was because at our previous inspections of the service on 13 June, 22 August and 25 November 2013 we identified concerns in relation to the standards of care and welfare of people who used the service. We also found that the provider did not have systems in place that assessed and monitored the quality of the service and which protected people from the risk of unsafe care and treatment. We took action against the provider and asked them to tell us what action they would take to put things right. As part of their action plan the provider agreed to voluntary suspend new admissions to the service.
At this inspection we identified further shortfalls which breached two of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.
The first breach related to the provider not having clear systems in place that assessed and monitored staffing levels and managed short notice absences. This resulted in the provider not ensuring there were sufficient staff on duty at all times.
The second breach related to people not experiencing care and support that met their needs and protected their rights. This was evidenced at the midday meal which was observed to not be a sociable experience. This was due to staff moving between dining rooms resulting in some people not receiving the support they needed to eat their meal. Additionally the records we looked at showed that not all staff had received training that ensured they were fully able to communicate with people living with dementia and understood their individualised needs.
The service has not had a registered manager in post since November 2013. The interim manager told us that they were applying to CQC to be the registered manager until a new permanent manager was recruited. Generally we found the service had improved under the leadership of the interim manager since our last inspections.
People told us that they felt safe living in the service and that staff respected their privacy and dignity at all times. They were happy with their care and said that staff were kind, caring and considerate.
The service had arrangements in place to keep people safe. Staff were knowledgeable about the procedures to take when safeguarding concerns were raised with them. People’s care records showed that staff were following effective risk management plans to protect people from the risks of harm. Appropriate arrangements were in place that ensured people who used the service received their medicines, as prescribed. Records showed that incidents and accidents that occurred in the service were fully investigated and action was taken to ensure they were less likely to happen again. Routine health and safety checks were being carried out to ensure that the environment and equipment were safe and well maintained.
People’s needs were assessed and their care and treatment was planned and delivered in line with their individual needs.
We saw that where a person lacked capacity to make decisions about their end of life care, a best interests meeting had been held in accordance with the requirements of the Mental Capacity Act (MCA) 2005. We saw that people, and those that mattered to them, had been involved in the planning for their end of life care, so that their final wishes would be respected at the time of their death.
The service was applying the Deprivation of Liberty safeguards (DoLS) appropriately. These safeguards protect the rights of adults using services by ensuring that if there are restrictions on their freedom and liberty these are assessed by professionals who are trained to assess whether the restriction is needed. Whilst no applications have needed to be submitted by the home, proper policies and procedures were in place, the manager understood when an application should be made.