Archived: Bracknell House Residential Care Home

This unannounced inspection took place on 17 and 22 December 2014. Bracknell House is a large detached property providing accommodation and personal care for up to 22 older people. The home has two small lounges, a small conservatory to the front of the property and a second and larger conservatory to the rear of the home overlooking the garden. At the time of the inspection 18 people were living at Bracknell House.

The service is run by a registered manager, who was present on the days of the inspection visits. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act and associated regulations about how the service is run. The registered manager and deputy manager are also the providers of the service.

People told us that they felt safe living at Bracknell House. One person said, “I think we’re safe here” and another person said, “I don’t have any concerns”. Relatives said that they never had any concerns about the safety or welfare of their relatives. They told us that they would be confident speaking to a member of staff or to the registered manager of the service if they had any concerns. The staff told us that they had completed training to support people safely, recognise and report abuse, and would report any concerns to the registered manager. However, we found that the safeguarding policy was out of date and the service did not have a copy of the safeguarding protocols from the local authority, to ensure that the service had the up to date guidance with regard to reporting safeguarding issues. There were no clear procedures in place to take account of relevant legislation and guidance for the management of alleged abuse.

Although people told us they felt safe we found that this service was not providing consistently safe care. One person was not being moved safely and the risk assessments in their care plan were not detailed enough, to show how the risks should be managed safely. The assessments also lacked guidance for staff to support people with their behaviour, so that these risks could be minimised. There were no environmental risk assessments in place to help make sure the premises were safe, and fire drills had not been carried out, to ensure that staff knew what to do in the event of a fire. Risk assessments to support people to bath safely did not contain sufficient information to show how these risks were being managed.

There were systems in place to review any accidents and incidents and make relevant improvements, to reduce the risk of further occurrence.

The management of the medication was not safe. There were no checks being made by the registered manager to ensure that medicines were being handled and recorded appropriately. We observed the medicines administration and found that medicines were not being recorded or given to people safely. There were no medicine risk assessments in place for people who were ‘self-administering’ some of their medicines, to ensure they were able to do this safely.

There was insufficient guidance for staff to manage medicines prescribed as "when required" , such as pain relief, to make sure people received their medicine when they needed it, or when staff should seek professional advice for their continued use.

People and relatives told us they felt there were sufficient numbers of staff on duty. However we could not always be assured that there was sufficient staff on duty at all times. On one occasion there was only two staff on duty to care for 17 people. There was no formal tool in place to assess the number of staff required to fully meet people’s care and support needs. The registered manager told us that together with the deputy manager they supported the staff to provide direct care to people, however there was no evidence on the rota to confirm this. People and staff told us that there were times when the registered manager and deputy manager supported them.

People were not protected by robust recruitment procedures. Staff records showed that not all checks had been completed, such as checking out people’s employment history and obtaining references relating to previous conduct in employment. Other checks, such as health, identification checks and evidence of a Disclosure and Barring Service (DBS) had been undertaken and were held on file.

Although staff completed an induction training programme, which included shadowing experienced staff, the induction was not competency based and in line with the recognised government training standards (Skills for Care). There were shortfalls in the training programme and records, as the registered manager told us that staff had received mental capacity training, but there was no evidence to confirm this. Specialist training had not been provided, such as epilepsy and diabetes training.

We could not be sure that people’s health care needs were met due to the lack of detail about their medical conditions, such as what symptoms and signs to look for if they needed medical attention. People had been weighed and this was recorded, but when there were concerns and action needed to be taken with regard to monitoring their food and fluid intake, this was not always in place. People with loss of appetite had been referred to dieticians, but there was no record in the care plan to show that staff were following any recommendations made.

There were insufficient details and information about obtaining people’s consent and involvement in their care planning, including assessments of people’s mental capacity and making decisions in people’s best interests.

People and relatives told us that there was a lack of choice of menu for the lunch time meal. They said that the matter of choice had been brought up at a resident’s meeting and they were asked to write down their choices, but nothing happened and there was still a lack of choice. People had not been asked, and did not know, what options were available for lunch on the first day of the inspection, and in addition the staff were unable to find the menu, to confirm that choices were offered. People told us the food was “OK” and one person felt it was a little bland.

Staff had received one to one meetings with their manager, and annual appraisals had taken place. Some staff felt overall they were supported, but at times felt that the management of the service could be improved. Staff had the opportunity to attend regular staff meetings.

People and relatives told us the staff were kind and maintained their privacy and dignity. However, staff supporting one person with their mobility did not uphold their dignity. This practice had been recorded in the care plan and had been going on since July 2014. There was no indication or evidence that this procedure had been agreed with the person and health care professionals. Staff had not raised issue that this was unacceptable practice as this person’s privacy and dignity was being compromised.

Staff were familiar with people’s likes and dislikes and supported people with their daily routines.

People were chatting to each other and staff in a relaxed and friendly manner. Different members of staff were supporting people to be involved in conversations and they took time to listen and respond to their requests. People’s independence was promoted, however this was not always recorded in the care plan. Staff supported people to go where they wished within the service. People and relatives told us that they were able to visit at any time and they had their privacy respected.

People’s needs were assessed before they came to live at the service; however there was no evidence to show how people were involved in their care planning. Some people told us that the service had been recommended to them and another person told us that they had had relatives who had used the service before and had liked what they saw when they had visited.

The format of the care plans was varied and they did not always contain details of people’s preferred daily routines, such as a step by step guide to supporting the person with their personal care. In one case the information recorded was contradictory, with inconsistent guidance for staff to follow, to make sure people’s needs were fully met. People’s assessed needs, such as information from a falls risk assessment, was not always crossed referenced with their mobility needs. Although one health care professional told us that staff acted on their guidance, this detail was not recorded in the care plans. Care plans had been reviewed, but it was not always clear how effective the reviews were as some plans just noted ‘no changes’, which would indicate that people’s needs had remained the same since the previous review, which in some cases was over a year.

People and relatives told us that they had the opportunity to voice their concerns. There were

monthly residents meetings, which also gave people the opportunity to give feedback. There were no dedicated staff hours for activities; however, people told us that some activities were provided by the staff. The local church visited the service regularly and recently school children had visited the service to sing carols.

There was a complaints procedure in place and people and their relatives were confident how to raise issues and felt that their concerns would be addressed fully.

The management of the service was not effective. The quality of care was not being checked to make sure people were safe and protected from inappropriate care and treatment. The systems in place to ensure the service was protected from the risk of fire were not adequate. Staff training was not being monitored to make sure staff had the competencies to fulfil their role. The staff were not aware of the visions and values of the organisation or involved in the continuous development of the service.

The providers were not able to produce all of the documents needed for the inspection and records were not easily accessible. Records were not robust, policies and procedures had not been reviewed, some records were not up to date, care plans were not accurate and medicine records had been changed. There were no systems in place to measure and review the delivery of care against current guidance. Due to the concerns raised in this report there was a clear indication that the management did not have an understanding of the key challenges of the service.

We found a number of breaches 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.