Archived: Brackley Lodge Nursing Home

Updated 5 May 2016

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 legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

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This inspection took place on 30 and 31 March 2016 and was unannounced. The inspection team comprised of four inspectors.

In planning for our inspection we reviewed the information that we held about the service. This included previous inspection reports, information received and assessed whether statutory notifications had been received. A notification is information about important events which the provider is required to send us by law.

We contacted the Nene Clinical Commissioning Group (NCCG). Clinical Commissioning Groups are groups of GPs who are responsible for designing local health services in England. They do this by commissioning or buying health and care services for Northamptonshire. We contacted Northamptonshire County Council Commissioners who monitor services contracted by the county council and the Safeguarding Team.

Many of the people living at Brackley Lodge were unable to recall their experiences or express their views; however we observed the care they received and the interactions they had with staff. During our inspection we talked with eight people who were able to communicate with us, three relatives and a visiting health professional. We interviewed four permanent care staff and one agency care staff, two agency nurses and three support staff.

We looked at ten peoples’ records to check whether their needs were being met. We also looked at all medicine administration records and six staff recruitment records. We made observations about the service and the way that care was provided. We also used the Short Observational Framework Inspection (SOFI); SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

Updated 5 May 2016

This was an unannounced inspection which was conducted on the 30 and 31 March 2016.

Brackley Lodge Nursing Home is registered to provide nursing and personal care for up to 30 people living with a physical disability, dementia and those who require care for adults over 65 years. At the time of this inspection there were 20 people living in the home.

In April 2015 we rated the home as providing an overall ‘Inadequate’ level of care and support to people and we placed it into special measures. This was due to serious concerns about the safety and well-being of the people who lived there. The provider agreed not to admit any new people until they had improved the care provided and also gave an undertaking to ensure that there was a registered general nurse on all of the shifts, to ensure effective clinical leadership. The service was taken out of special measures following an inspection in September 2015 which found significant improvements had been made.

However since January 2016 there had been an escalation in concerns about the safety and adequacy of the care and support provided to people living in the home. The Local Authority and health commissioners’ monitoring officers expressed particular concerns about the overall clinical oversight of the home, staff knowledge and training and a number of safeguarding issues had been raised as to potential neglect of people. In light of these concerns we brought forward a planned inspection.

The service is required to have a registered manager; there was no registered manager at the time of the inspection which has been the situation since April 2015 when the registered manager left. Attempts had been made to secure another registered manager but they had all failed.

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. The provider had employed an acting manager who was in the process of applying to be the registered manager. This person had since left and the provider had recruited another acting manager who was in the process of submitting an application to become the registered manager.

In addition to the collapse of sufficient management arrangements, there was no permanent clinical lead. The provider was relying on agency staff to take the clinical lead without the understanding and oversight of the people living in the home. Staff without managerial experience or the qualifications were left in charge. There had been a high turnover of staff which meant that people were not always being cared for by staff that knew them and understood their needs.

People were not being cared for in a safe and timely way. There was insufficient staff to meet the individual needs of people and there was no clinical oversight. The provider was failing to ensure that an RGN was on duty each shift having previously given an undertaking that this would happen to ensure that people’s physical health needs were being appropriately monitored.

Only basic care was being provided and people’s choices were being limited due to the level of staff deployed. People’s nutrition was not being consistently and accurately monitored and people were losing weight. Mental capacity assessments were not always being undertaken for people who were unable to make decisions for them self.

The systems that were in place to monitor the service and support its development were no longer being followed. Care plans and risk assessments were not being kept up to date which was putting people at unnecessary risk. Different staff were expected to monitor the administration of medicines without the knowledge and oversight of the system.

People’s choice and freedom to move around the home was impacted due to the poor staffing levels and staff were not receiving the guidance and support they needed to do their jobs well.

There had been a high turnover of staff and staff had not been given the training to equip them to meet some of the specific needs of people that lived at the home.

The leadership, quality monitoring and governance arrangements had collapsed and needed to be re-established. Records were not accurately being kept; audits had not been completed for some time so there was no steer to drive improvements. There was an absence of day to day clinical and managerial leadership.

We identified a number of areas where the provider was in breach of Regulations of the Health and Social Care Act 2008 (regulated activities) Regulations 2014 (Part 3) and you can see at the end to this report the action we have asked them to take.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC as the provider has been unable to sustain the improvements it had made following being taken out of ‘Special measure’ in September 2015.

The purpose of special measures is to:

· Ensure that providers found to be providing inadequate care significantly improve.

· Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

· Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

This is the second occasion that this service has been placed in special measures and we will be considering the action that we should take to secure the safety and well being of people living in the home. The service will be kept under review and if needed could be escalated to urgent enforcement action.