Bricklehampton Hall

Bricklehampton Hall is a nursing home providing personal and nursing care to 40 people at the time of the inspection. The service can support up to 55 people in an adapted building with a purpose-built extension.

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

Improvements had been made and the provider was informing the Care Quality Commission of changes within the management arrangements and of notifiable events which had taken place.

The environment was safe. Improvements in the environment had been made and there was a scheduled of further refurbishment work.

Improvements had been made in medicine management and administration. People received there medicines as prescribed.

Staff were recruited safely. There was enough staff to meet people’s needs. There was time for social interaction and there were designated activities coordinators to assist people to follow an entertainment programme.

There were improvements in quality monitoring and oversight. Systems were in place to monitor the quality of the service and care provided. Actions were taken to continuously improve the service.

The provider had processes in place to protect people from avoidable harm and abuse. Staff had received training in safeguarding and knew how to report any concerns.

People and their relatives were happy with the care they received and felt safe because of the support provided by staff that knew their needs.

People’s care plans were personalised and reflected needs and preferences. Risks to people were identified and recorded so safety was maintained.

Processes were in place to prevent and control infection. This included enhanced cleaning schedules and safe visiting precautions.

People’s needs were assessed prior to moving into the home. Care plans reflected people’s needs and were reviewed at regular intervals.

Staff were provided with training and refresher training and received regular supervisions.

Staff were kind and caring. They respected people’s privacy and dignity and supported people to be as independent as possible.

The provider had a complaints policy in place. People and relatives were aware how to raise any concerns and felt comfortable in doing so should any arise.

People’s end of life wishes were respected. Staff worked with health professionals to ensure people were pain free and comfortable.

The registered manager worked in a transparent way with people, their relatives, staff and health and social care professionals to provide a good quality of life for people.

Staff felt supported by the management team and worked well as a team.

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.

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 14 November 2019) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was prompted by a review of the information we held about this service and to check they had followed their action plan and to confirm they now met legal requirements.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Bricklehampton Hall on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Bricklehampton Hall is a nursing home providing personal and nursing care to 54 people at the time of the inspection. The service can support up to 55 people in an adapted building with a purpose-built extension.

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

The registered provider had not always informed the Care Quality Commission of changes within the management arrangements and of notifiable events which had taken place.

During our inspection we brought to the attention of the registered manager areas of concern regarding the environment whereby people’s safety was compromised. The registered manager took immediate action in respect of these areas where possible.

Concerns were identified in the administration and management of people’s medicines. People did not consistently receive their medicines at the right times as prescribed. There were inconsistencies in the recording of people’s medicines. The recording of wound care needed to be improved to ensure the treatment required took place to meet people’s needs.

People raised concerns about staffing levels and the time taken to respond to the call bell system. Improvement was needed in relation to safe recruitment procedures.

People were supported to have maximum choice and control of their lives. However, staff did not always support them in the least restrictive way possible. This was because best interests decisions were not in place to support this practice.

Some staff were identified as requiring to undertake refresher training. Improvement was needed in one area of the home at lunch-time to ensure people received a similar choice as others. Improvement was also needed in relation to areas around recognising people’s right to privacy and dignity.

Most people believed their care and support to be safe and were satisfied with the care they received finding staff to be kind and caring. Staff were aware of their responsibility in relation to the reporting of any abuse. Newly appointed staff received induction training and worked alongside experienced members of staff.

People were able to access healthcare professionals. People were able to engage in fun and interesting activities and were able to personalise their bedroom.

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

Rating at last inspection

The last rating for this service was Good (published 11 April 2017).

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well led sections of this full report.

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

We have identified breaches in relation to safe care, safety within the environment, medicine management, consent and best interests and areas around the management of the service.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

This inspection took place on 14 March 2017 and was unannounced.

There was a registered manager (who was also referred to as matron) was in post at the time of our inspection. 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.

People told us they felt safe because of the way staff cared for them. Staff took action to care for people in ways which promoted their safety and people's care plans gave clear guidance for staff to follow in order to promote people’s well-being. Staff we spoke with were aware of how to recognise signs of abuse, and systems were in place to guide them in reporting these. They were knowledgeable about how to manage people’s individual risks, and were able to respond to people’s needs. People told us they were supported in a safe way and had their medicines as prescribed.

There were enough staff employed to care for people. Staff were recruited based upon their suitability to work with people who lived at the home. People benefited from receiving support from staff with the knowledge and skills to care for them. Staff took action to support people if they required medical assistance, and advice provided by health professionals was implemented. As a result, people were supported to maintain their health.

People were assisted in having enough to eat and drink to stay healthy. People were given choice of meals. Where necessary they were given extra help to eat and drink to stay well. People said they had access to health professionals, and there was a twice weekly visit from a local doctor. Relatives had been informed if appropriate and were confident their family member had the support they needed.

Staff knew how to support people when specific decisions needed to be made to meet their needs in their best interests. We saw people were given choices about their care and support. This enabled people to be involved in the decisions about how they would like their care and support delivered. People’s right to privacy was taken into account in the way staff cared for them.

People told us they were happy living at the home, supported by caring staff. People’s independence was promoted. Visitors were welcome to see their family members or friends when they wanted.

People were involved in deciding how their care should be planned and risks to their well-being responded to. Where people were not able to make all of their own decisions their representatives and relatives were consulted. People’s care plans and risk assessments were updated as their needs changed. People and their relatives understood how to raise any concerns or complaints about the service. Systems for managing complaints were in place, so any lessons would be learnt.

Quality audits were undertook by the registered manager and the provider to develop people’s care further. The provider and registered manager took account of people’s views and suggestions to make sure planned improvements focused on people’s experiences.

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Systems had been in place to make sure that the registered manager and staff learnt from events such as accidents and incidents. This reduced the risks to people and helped the service to continually improve.

People were protected against the risks associated with medicines because the provider had made improvements following out last inspection in December 2013. There were now appropriate arrangements in place to manage medicines.

Staff employed by the home had been recruited effectively. The provider demonstrated that appropriate checks had been obtained and that staff were trained and supported in their role.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberties Safeguards which applies to care homes. The provider had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no current applications were in place. Relevant staff had been trained to understand when an application should be made, and in how to submit one. This meant that people would be safeguarded as required.

Is the service effective?

People's health and care needs were assessed with them, but they were not always involved in writing their care plans due to their conditions. The provider had also considered information and involvement from relatives, other health professionals and staff. People told us: 'They really care for me here' and: 'I am comfortable and looked after here'.

Visitors confirmed that they were able to see people in private and that visiting times were flexible and the home were accommodating and welcoming.

The provider had been able to demonstrate that they had cooperated with other providers to ensure people received the care and treatment that met their needs. For example, we saw that people were supported with having eye and hearing tests.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People told us: 'They (staff) are helpful when I need them' and: 'They take things at my pace, I am not rushed'. A relative told us: 'I am here every afternoon, it's like I am part of a larger family now'.

Staff we spoke with had a good knowledge of people's individual needs, and knew how to support people so that their needs were met. Staff spoke about people as individuals and we observed that staff listened to people's views and opinions. One person told us: 'I have a sense of humour that the staff here now know'.

Is the service responsive?

People completed a range of activities in and outside the service regularly and the provider had staff dedicated to arranging and supporting people to attend these activities.

We saw the home had been responsive to people's changing needs and had responded to professional advice that had been provided. For example, we saw the home had requested one person to be reassessed due to their changing needs. Appropriate equipment to meet the person's needs had then been sought.

Is the service well-led?

The provider had a quality assurance system in place. We saw records that identified shortfalls and the actions that had been taken to address them. The provider listened and responded to people, staff and visitors who had left comments and suggestions. We saw that responses to the comments left had been made available for people to see.

Staff told us they were clear about their roles and responsibilities. Staff told us that they felt the home provided a good quality of service and people were well cared for. They told us that the system in place meant they felt supported in their role and where to find information when needed. For example, there was information in each person's room for the staff to follow and record the care provided.

We spoke with the registered manager, the deputy manager, three nurses, two care workers, the activities coordinator and a housekeeper. We were also able to spend some time with office and administration staff. We spoke with two people who visited people who used the service. We spoke with some people who used the service. Due to the health needs of some people who used the service we also observed the care and support provided to people.

People we spoke with were complimentary about the care provided. One person who used the service told us: 'I can't fault the place. It's my home now'. Another person commented on the staff: 'They are all wonderful.'

One visitor described the home as: 'Warm, well cared for and safe. It's all those things'. They also told us that they did not worry about their relative due to the care and support provided at the home.

We found that improvements were needed to ensure that people always received their medication as prescribed.

The registered manager told us that some improvement had been needed to ensure equipment provided within the home was checked and maintained. These improvements had already commenced to ensure equipment was safe for its intended purpose.

The provider had systems in place to enable them to monitor the quality of the service provided. These systems were in place to ensure that people received appropriate care and support. Improvements were needed to identify concerns we found regarding the management of medicines.

People were complimentary about the home and the care and support they received. One person told us: 'I love the place'. Another person said: 'This is a happy place'. Another person told us: 'Matron is a lovely person'.

We found care workers respected people's privacy and dignity when providing personal care. People were involved in decisions about their care and their day to day experiences at the home.

Staff knew about the needs of the people they were caring for. We looked at care plans for three people and found that these contained varying levels of guidance for staff on how to meet their needs. We saw that people's needs were reviewed regularly.

People told us that they felt safe living at the home and knew who to speak to if they had any concerns. Staff had received training on how to recognise signs of abuse and knew how to report concerns.

Staff told us they were supported and we saw they were trained to an appropriate standard and participated in regular supervisions and team meetings.

We looked at complaints that had been received. Those received had been dealt with to people's satisfaction.