Bradbury House

Updated 31 January 2020

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

This inspection was carried out by one inspector.

Service and service type

Bradbury House is a ‘care home’ offering respite care. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

A registered manager registered with the Care Quality Commission was not in post. A registered manager and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. A manager was in post and had applied for registration.

Notice of inspection

This inspection was unannounced on the first day. The manager and staff were told about the second day of the inspection.

What we did before inspection

We reviewed information we had received about the service since the last inspection. We used all of this information to plan our inspection.

The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.

During the inspection-

The people having respite care at the time of the inspection were not able tell us about their experiences of having respite care. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We spoke with four staff including seniors, the manager and the head of care.

We reviewed a range of records. This included three people’s care records and multiple medication records. We looked at two staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records. We spoke with two professionals who regularly visit the service. We spoke to one relative.

Updated 31 January 2020

About the service

Bradbury House provides planned and emergency short term respite care for up to 10 people with a learning disability, some of whom may have additional physical care needs. All accommodation is on the ground floor and in single rooms. There are shared recreational rooms and accessible gardens.

The service was taking steps to apply the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

There was action being taken to promote choice and control, independence and inclusion to fully reflect the principles and values of Registering the Right Support. Action was being taken to focus support on people having as many opportunities as possible for them to gain new skills and become more independent.

People’s experience of using this service and what we found

There were people who at times expressed frustration and anxiety which placed them, and others at risk of harm. However, risk assessments lacked clear guidance and there were some inconsistencies with approaches from staff. The manager told us about the actions taken to ensure the safety of people and staff. They said staff had attended relevant training and referrals were made for specialist support. This included referrals to specialist nurses to update the strategies.

We responded to concerns about the food made to CQC before and during the inspection. We looked at the stocks of food and found there were adequate quantities of frozen and tinned foods. However, most food was processed and people had limited access to fresh fruit and vegetables. The manager told us they would take action to support staff to prepare fresh meals. Better cleaning routines were required to ensure the fridge was kept clean.

Risk assessments were in place for individual risks. The assessment format had been updated for staff to better detail the identified risk and the measures to minimise the risk.

Safeguarding procedures were on display at the service and staff had attended safeguarding training. The staff we spoke with knew the signs of abuse and felt confident to report their concerns.

While staff said there were staff shortages we saw staffing levels were consistent with the funders allocations of staff hours. We saw there were sufficient staff on duty when people were at the service. Some people were having one to one staff as agreed.

Medicine systems had improved. Staff were to attend training. While there had been medicine errors they were being addressed and systems had improved.

The staff were supported with their roles and responsibilities. The training matrix in place listed the mandatory and specialist training attended. Where training was overdue this was identified. The staff we asked said they had attended all training that was set as mandatory by the provider. Staff had regular one to one supervision sessions.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People's capacity was assessed, and best interest decisions reached where they lacked capacity. The manager was reviewing documentation in relation to mental capacity assessments and Deprivation Liberty Safeguards (DoLS). This will ensure a legal framework was in place to make best interest decisions for people identified to lack capacity to make specific decisions.

The staff were knowledgeable about the procedure to follow in the event people became ill during their stay at the home.

The staff were caring towards people. We saw staff use a variety of methods to engage with people. The relative we spoke with said their family member showed signs of enjoyment whenever they went for respite care. Staff told us it was important to develop relationships with people.

The existing support plans were inconsistent. The format was to change to develop more person-centred plans. People’s preferred communication methods were being developed. For example, communication passports and a Makaton board of simple signs were accessible to support people that used this method of communication.

Quality assurance systems were effective and action plans were developed in relation to any required improvements. Audits reflected the findings of the inspection. However, some systems needed to be embedded further to ensure they were effective.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 12 August 2019) and there were multiple breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been sustained and the provider was still in breach of regulations.

This service has been rated requires improvement for the second time

Why we inspected

The inspection was prompted in part due to concerns received about allegations of abuse and staffing concerns about the medicines management system. This inspection was carried out to follow up on action we told the provider to take at the last inspection. A decision was made for us to inspect and examine those risks.

You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.