Bradbury House

Bradbury House is a nursing home providing personal and nursing care to 47 people at the time of the inspection. The service provides support to people with physical disabilities, older people and people living with dementia. The service also supported autistic people and people with a learning disability. The service can support up to 50 people in one adapted building.

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

People and their relatives feedback about Bradbury House was mostly positive. However, we identified shortfalls relating to care planning, documentation, checks, audits and feedback from people about staffing. Although there were sufficient numbers of staff in line with the providers dependency tool, the allocation of staff did not always meet people’s needs. There was a new series of audits being completed, however they were not sufficiently embedded to provide assurances that they were identifying issues.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support: Guidance in place to inform staff how best to support people was not always detailed, however, staff we spoke with knew people well and were aware of risks to them. Staff had good knowledge of healthcare conditions and how they may affect people, for example, for people living with diabetes or people who could become distressed.

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.

Right Care: People experienced person-centred care, which promoted their dignity and privacy. Most people told us the care they received was good, but some told us staff were sometimes rushed.

Right Culture: We observed a positive culture, where staff knew people well, and adapted the support they gave to people depending on each person’s preferences. People were supported to maintain contact with their families and be involved in activities in line with their interests. The staff showed kindness and compassion and the management team demonstrated a desire to improve the service.

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 30 May 2022. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

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 to the previous breach of regulations, however new breaches of regulations were identified.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

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, which will help inform when we next inspect.

Gavin Astor House Nursing Home is a care home providing personal and nursing care to up to 50 people. The service provides support to people with physical disabilities, older people and people living with dementia. The service also supported autistic people and people with a learning disability. At the time of our inspection there were 37 people using the service. People lived over two floors, the top floor supported people with nursing needs and the ground floor supported people who were living with dementia.

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

Systems and processes to safeguard people from the risk of abuse were not effective. Incidents and allegations of abuse had not always been identified by the registered manager or reported to the local authority safeguarding team. There were enough staff to support people safely, but more staff were needed to meet people's social needs. Some people's care plans did not contain information needed to support people safely. Care plans and risk assessments were in the process of being updated.

Medicines were ordered, stored, given and disposed of safely. The home was clean and hygienic, and staff were following infection prevention and control procedures.

The provider's governance systems required improvement to be effective. Systems in place to identify incidents that should be notified to CQC had not always been effective. The home had been through a period of transition and the management team were taking steps to identify and act on issues at the service.

People were positive about their experience of living at the home. One person told us, “Staff are nice to me. I brought my own things and staff helped me put them up in my room. Staff keep me happy and cheer me up.” People’s relatives felt that they were informed of day to day incidents at the home but would like to be more involved in larger decisions around their loved one’s care.

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.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Gavin Astor House Nursing Home had one autistic person using the service. Based on our review of safe and well-led, the service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support: Guidance for how to support the person to maximise their choice control and independence was clear. Staff were knowledgeable about how to offer the person choices and support them to make their own decisions.

Right care: Staff knew the person well and how the person wanted to be supported. We saw that the person enjoyed the company of staff and staff spoke to the person with respect.

Right culture: Staff spoke to people kindly and we observed staff making people laugh. Staff were positive about the management team and the support they provided.

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 12 June 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Gavin Astor House Nursing Home on our website at www.cqc.org.uk.

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.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified a breach in relation to safeguarding people from the risk of abuse at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Gavin Astor House Nursing Home is a ‘care home’. 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.

Gavin Astor House is a purpose built care home registered to provide accommodation and nursing care to up to 50 adults. The service provides nursing care to adults over age 18 with physical disabilities as well as to older people. Gavin Astor House is owned by the Royal British Legion Industries. The home is situated in grounds within the Royal British Legion village, there is ample parking. All rooms are single with en-suite facilities. There were 42 people living there at the time of our inspection; 40 people on a permanent basis and two people staying for a period of respite.

At the last inspection on 7 and 8 December 2016, the service was rated Requires Improvement. At this inspection the service was rated Good.

At our last inspection in December 2016, we found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breach related to the people’s care plans not being updated to ensure they contained the relevant information to inform staff how to meet people’s assessed needs, in particular information pertaining to nutrition and hydration. This inspection took place to check that the registered provider had made improvements to meet the regulation. We found that improvements had been made and the breach had been met.

The service had a registered manager in post who had worked for the organisation for a number of years. The registered manager was moving to a new role within the organisation and a new manager had been recruited. At the time of our inspection the new manager was working alongside the registered manager whilst they were in the process of completing the provider’s induction. 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.

There were mixed views regarding the deployment of staff. Some people told us their calls bells took a long time to be answered by staff whereas relatives told us they felt there were enough staff. People’s needs had been assessed and recorded; the registered manager used an assessment tool to monitor the number of staff required to meet people’s assessed needs. Observations and records showed there were enough staff to meet people's needs.

People felt safe and were protected from the potential risk of harm and abuse. Staff understood their responsibilities for safeguarding people and followed the provider’s policy and procedure. Potential risks to people had been assessed and steps were taken to reduce any risks. The premises were well maintained and equipment had been regularly serviced to ensure it was in good working order.

The provider operated safe and robust recruitment and selection procedures to make sure staff were suitable and safe to work with people.

People received their medicines safely as prescribed by their GP. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed regularly. People were protected by the prevention and control of infection where possible, with systems in place to ensure the risks of contamination were minimised. Accidents and incidents were monitored and managed effectively.

People received a personalised service which was responsive to their needs. People and/or their relatives were involved in the development and review of their care plan. Guidance was in place to inform staff of how to meet people’s needs whilst encouraging and promoting their independence.

People’s nutrition and hydration needs were assessed and recorded. People received food they enjoyed and specific dietary requirements were catered for. Staff worked with health care professionals to ensure people remained as healthy as possible.

People were treated as individuals, their equality, diversity and human rights were promoted and protected.

Staff at all levels were given the training, skills and confidence to meet people’s needs. Staff were supported in their role by a member of the management team, this included clinical support and supervision for the registered nurses.

People were encouraged to make their own choices about their lives. People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service supported this practice. The provider supported staff’s rights and made adaptations to the service to meet people’s needs.

Effective systems were in place to enable the provider and the management team to assess, monitor and improve the quality and safety of the service. Records were maintained adequately and kept securely.

Staff respected people’s privacy and dignity. Interactions between staff and people were caring and kind. Staff were patient, compassionate and they demonstrated affection and warmth in their discussions with people. Staff knew people well and had knowledge about people’s histories, likes and dislikes.

People were offered the opportunity to participate in a range of activities to meet their needs and interests. The views of people and others were sought and acted on. People knew who to speak to if they were unhappy. Complaints were managed in line with the provider’s policy; complaints were used as a way to learn and improve the service that was provided to people.

The management team worked in partnership with external organisations to promote best practice and to develop and promote a positive culture between the staff, supporting people that had dementia.

The registered manager and the management team understood their responsibility of registration with us and notified us of important events that occurred at the service; this meant we could check appropriate action had been taken.

Further information is in the detailed findings below.

Gavin Astor House is a purpose built care home registered to provide accommodation and nursing care to up to 50 adults. The service provides nursing care to adults over age 18 with physical disabilities as well as to older people. Gavin Astor House is owned by the Royal British Legion Industries. The home is situated in grounds within the Royal British Legion village. All bedrooms are single with en-suite facilities. There was a passenger lift to assist people to move between floors. At the time of our inspection 42 people lived at the service.

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.

At our previous inspection on 28 July 2015, we found a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found that people had not received their medicines as required or as prescribed. The provider had systems in place to make sure there were enough staff employed and rostered. However, the way staff were deployed needed to be reviewed to ensure there were sufficient staff available at key time during the day. We made a recommendation about this. Safe recruitment procedures were being followed to make sure staff were suitable to work with people. Staff members past employment history was not being explored when there were gaps in their employment. We made a recommendation about this. Quality assurance systems were in place to assess the level of quality provision with the service but they had not identified the issues we found at the inspection. We made a recommendation about this. We asked the provider to take action to meet the regulations.

We received an action plan on 27 November 2015 which stated that the provider had met the regulation on 20 November 2015.

People and their relatives told us that they received safe, effective, caring and responsive care and the service was well led.

Some people received their nutrition and hydration through percutaneous endoscopic gastrostomy (PEG). Records did not always evidence that they had received the right amount of food and fluid to maintain good health.

Medicines had been generally well managed, stored securely and records showed that tablets had been administered as they had been prescribed. Medicines records in relation to pain patches were not clear or consistent with the manufacturer’s information. We made a recommendation about this.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager understood when an application should be made and how to submit one when required. However, robust systems were not in place to track, monitor and report DoLS authorisations. We made a recommendation about this.

People did not all have care plans that detailed how staff should meet their care needs in all of the areas they had been assessed as requiring help and assistance. The registered manager had introduced a new care planning system in June 2016 which was still being embedded.

Records were not always complete or accurate. We made a recommendation about this.

Staff had received training about protecting people from abuse and showed a good understanding of what their roles and responsibilities were in preventing abuse.

People’s safety had been appropriately assessed and monitored. Each person’s care plan contained individual risk assessments in which risks to their safety were identified, such as falls, mobility and skin integrity.

The service was suitably decorated, adequately heated and was clean. There was a relaxed atmosphere.

There were enough staff on duty to meet people’s needs. Recruitment policies were in place. Safe recruitment practices had been followed before staff started working at the service. Staff had undertaken training relevant to their roles and said that they received good levels of hands on support from the management team.

There were procedures in place and guidance was clear in relation to Mental Capacity Act 2005 (MCA) that included steps that staff should take to comply with legal requirements. Staff had a good understanding of the MCA 2005 to enable them to protect people’s rights.

People had choices of food at each meal time. People were offered more food if they wanted it and people who did not want to eat what had been cooked were offered alternatives.

People’s information was treated confidentially. Personal records were stored securely. Staff were careful to protect people’s privacy and dignity and people told us they were treated with dignity and respect, for example staff made sure that doors were closed when personal care was given.

People and their relatives described a service that was welcoming and friendly. Staff provided friendly compassionate care and support. People were encouraged to get involved in how their care was planned and delivered.

People were supported to maintain their relationships with people who mattered to them. Relatives and visitors were welcomed at the service at any reasonable time and were complimentary about the care their family member’s received.

Staff upheld people’s right to choose who was involved in their care and people’s right to do things for themselves was respected. People’s care was responsive and recorded.

People were engaged with activities when they wanted to be. The activities plan for the service showed that activities took place most days of the week. If people complained, they were listened to and the registered manager made changes or suggested solutions that people were happy with.

People told us that the registered manager and staff were approachable and listened to their views.

There were effective quality assurance systems and the registered manager carried out regular checks on the service to make sure people received a good service.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

People experienced person centred care which met their individual needs. People said that they received the help they needed when they needed it. One person said 'They are very good, you never have to wait long for help'. One person told us 'I like to get up late and stay up late, and they let me do what I want'.

Medication was managed appropriately and people received the medication they needed at the times they needed them.

The premises were safe and well maintained.

People using the service benefited from equipment that was comfortable and met their needs.

Peoples complaints and comments were listened to, and action was taken to resolve any complaints made.