The Care Quality Commission
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Archived: Begbrook House Care Home

Overall: Requires improvement read more about inspection ratings

Sterncourt Road, Frenchay, Bristol, BS16 1LB (0117) 956 8800

Provided and run by:
Grandcross Limited

Important: This service is now registered at a different address - see new profile

All Inspections

13 December 2016

During a routine inspection

This inspection took place on 13 December 2016 and was unannounced. Since the previous inspection conducted in November 2015 the registration status of the service has changed to a new legal entity, but has remained with the same provider organisation.

Begbrook House Care Home is registered to provide personal or nursing care for up to 32 people. At the time of our inspection there were 30 people living in the service.

There was a registered manager in place on the day 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's records were not always completed consistently or correctly to monitor and manage their health conditions. Some people were having their food and fluid intake monitored because they had been assessed as being at risk of dehydration or malnutrition. Their food and fluid charts were not adequately completed.

The service was not consistently responsive to people’s needs. The quality and content of care plans was variable. People were not consistently involved in the decision making process regarding their care plans or in the reviews.

People told us that the staff were kind, caring and respectful. Concerns were expressed regarding the communication levels of some staff where English was not their first language. Staff were knowledgeable about people’s needs and were aware of their life histories and background. Staff told us how people preferred to be cared for and demonstrated they understood the people they cared for. Staff felt well supported by the deputy and registered manager.

Care plans contained risk assessments. These included risk assessments for falls, moving and handling, skin integrity and bed rails. The assessments had been reviewed monthly and when risks to people had been identified, there were generally comprehensive plans in for place for staff to follow in order to reduce the risks.

Records showed that a range of checks had been carried out on staff to determine their suitability for work. Staffing levels were maintained in accordance with the assessed dependency needs of the people who used the service. Staff demonstrated a good awareness and understood their responsibilities with regard to safeguarding people from abuse.

People's rights were in the main being upheld in line with the Mental Capacity Act (MCA) 2005. This is a legal framework to protect people who are unable to make certain decisions themselves. In people's support plans we saw information about their mental capacity and Deprivation of Liberty Safeguards (DoLS) being applied for. These safeguards aim to protect people living in care homes from being inappropriately deprived of their liberty.

People spoke positively about the activities offered and told us the programme was varied and enjoyable. Relatives were welcomed to the service and could visit people at times that were convenient to them.

People and their relatives spoke highly of the deputy and registered manager. They found them to be very helpful and approachable. They acknowledged that they had made improvements to the service in the short time they had been in post. They felt the atmosphere at the service had improved and described it as a happy friendly place. A recent external report by a health professional team stated; 'At present the new home manager is making excellent progress. Her leadership is palpable and the staff are responding to her style and consistency.'

We found two breaches 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.

20 November 2015

During a routine inspection

This inspection took place on 20 November 2015 and was unannounced. The last full inspection took place in January 2015 and, at that time, four breaches of the Health and Social Care (Regulated Activities) Regulations 2010 were found in relation to safeguarding, supporting staff, records and assessing and monitoring the quality of service provision. We also found a breach of Regulation 18 of the CQC (Registration) Regulations 2009 relating to the failure of the provider to notify the Commission of an important incident. These breaches were followed up as part of our inspection.

Begbrook House Care Home is registered to provide personal or nursing care for up to 32 people. At the time of our inspection there were 27 people living in the service.

There was no registered manager in place. 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. A manager has been in post since September 2015. They have yet to submit their registered manager’s application form.

In January 2015, we found that staff were not consistently supported through an effective training programme. At this inspection we found that insufficient improvements had been made.

In January 2015, we were not satisfied that records were accurate and reflected the current needs and care people were receiving. Although work had been progressed since our previous inspection, care plans did not always consistently reflect people’s individualised needs. Care plans were not consistently written in conjunction with people or their representative.

In January 2015, we found that the provider had not responded to a safeguarding incident appropriately. They had not followed their own safeguarding policy and procedures and those of the local authority safeguarding team. At this inspection we found that sufficient improvements had been made.

At our last inspection in January 2015, we found that the management arrangement in place to assess and monitor the level of service were not always effective. The previous registered manager had not notified the Commission of an incident when someone came to significant harm. At this inspection sufficient improvements had been made.

People’s rights were not always being upheld in line with the Mental Capacity Act (MCA) 2005. This provides a legal framework to protect people who are unable to make certain decisions themselves.

The majority of staff demonstrated kind and compassionate behaviour towards the people they were caring for. During the lunchtime service we observed staff treating people with kindness, but there was limited social interaction with people. Staff focussed on their tasks and did not spend time talking with people, even when they were assisting people to eat.

The staffing levels were sufficient to support people safely. Staffing levels were assessed by following the Care Home Equation for Safe Staffing (CHESS) dependency tool. The tool determines the level of staffing required whilst taking into account the dependency needs of the people who lived at the home.

People had their physical and mental health needs monitored. All care records that we viewed showed people had access to healthcare professionals according to their specific needs.

A dedicated activities coordinator was employed by the service. There was a structured weekly activities programme. This included pampering sessions, quizzes, bingo, arts and crafts, film shows and gentle exercises.

People and relatives had told us that that service had gone through a difficult time and had experienced changes in management and loss of staff. However, positive feedback was received about the new manager from people and their relatives and they acknowledged that things were improving.

We found three breaches 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.

27 and 28 January 2015

During a routine inspection

This inspection took place on 27 and 28 January 2015 and was unannounced. There were no concerns at the last inspection of June 2014. Begbrook House provides a service for up to 32 older people. At the time of the inspection there were 30 people living at the service.

There was not a registered manager in post. 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.

Whilst the provider was recruiting a permanent manager the deputy had agreed to carry out the role of interim manager from July 2014. A manager had been appointed in December 2014 however due to unforeseen circumstances they were unable to take up the post.

The provision of interim manager had not been effectively implemented. This was because the deputy who had agreed to cover this role had not been given supernumerary hours to accommodate this. This meant they were working 30 hours per week as a nurse in addition to managing the service. Subsequently we found there were areas requiring improvement. This included, staff training and care documentation.

Staff said they had found the last six months “difficult” with the inconsistent management arrangements, however they did feel the interim manager had been “very supportive”. People and relatives were very positive about the staff and said they “provide a very good service” and “do a sterling job”. They felt the lack of a permanent manager had had an impact on communication.

Although there were some safe practices being followed at the service at the time of our inspection there was an ongoing safeguarding investigation by external agencies. This was following a serious incident that took place at the service. They had failed to recognise and identify that a person was at significant risk of serious harm.

Medicines policies and procedures were followed and medicines were managed safely. There were enough staff to meet people's needs and the service recognised where a change in circumstances may require a short term increase in staffing levels. Suitable recruitment procedures ensured staff were safe to work in the service.

Staff did not have the knowledge and skills they needed to carry out their roles effectively. Some training updates had lapsed and not all staff had received training that was relevant to people’s needs. Staff said they felt supported on a day to day basis and received regular formal supervisions.

People were supported to eat and drink sufficient amounts. Where people were at risk of poor nutrition or hydration, measures were in place to monitor this. Arrangements were made for people to access healthcare services.

Staff had a good awareness of individuals' needs and treated people in a warm and respectful manner. Although people and staff confirmed care and support was personalised, care plans did not always capture this. Audits in care documentation had already identified where improvements were needed.

We found 5 breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We completed this inspection at a time when the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations 2009 were in force. However, the regulations changed on 1 April 2015; therefore this is what we have reported on. You can see what action we told the provider to take at the back of the full version of this report.

7 May 2014

During a routine inspection

Begbrook House Care Home provides accommodation and nursing care for up to 32 older people. An adult social care inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led? Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at. If you want to see the evidence that supports our summary, please read the full report. This is a summary of what we found.

Is the service safe?

People had been cared for in an environment that was safe. Staff had received appropriate training including basic life support for qualified staff. Staff knew the needs of all the people who used the service very well. The provider had systems in place to reduce the risks of any infections spreading. The home had a regular audit programme in place and made sure actions were completed.

Is the service effective?

We spoke with people who used the service and saw compliments from their relatives. This feedback was very positive about the care people received. It was clear from what we saw and from speaking with staff that they understood people's care and support needs.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff were patient and encouraged the people who used the service, especially to join in activities and socialise. This was supported by the feedback we received from people who used the service and their relatives.

Is the service responsive?

People's needs had been assessed and care had been provided to meet their needs. People who used the service told us they did not have enough activities to do. We saw that the provider had listened to this and brought in a new activities co-ordinator who was providing more activities based on people's preferences. The people we spoke to confimed this and were happy with the changes.

Is the service well-led?

Staff had a good understanding of the home and the people who used the service. Relatives told us that they felt comfortable approaching any member of staff if there was any problems. The people who used the service and staff told us they could approach the manager at any time with concerns and have confidence they would be resolved. We were infomred that the current registered manager at the time of our inspection was moving to another home but was overseeing Begbrook until the deputy manager registers with us as a registered manager.

18 April 2013

During a routine inspection

Since the inspection of August 2012 there had been a newly appointed manager and deputy. We received positive comments about the subsequent changes that had been implemented and the positive impact that this had on the service overall.

Comments from people living in the home, relatives and staff included, 'The new management structure and leadership has improved the whole atmosphere', 'You can see how things have moved forward on a daily basis', 'There is less sickness absence and more team working' and 'The manger is very proactive and is seen around the home everyday, they are approachable and act on things quickly'.

The manager was available throughout the day and they were knowledgeable about people in their care, policies, procedures and systems in place to ensure the continued smooth running of the home.

There was a happy, relaxed atmosphere in the home. We spent some time in the company of people living in the home and spoke with them individually. We saw that staff interacted in a caring way and people responded to this.

8 August 2012

During a routine inspection

The manager was on leave on the day of our visit and the inspection was assisted by the area manager. We spoke with the manager the following day for three hours to gather further evidence and to provide feedback to the manager about the inspection overall. We spoke with six staff members at length.

We were introduced to people throughout the day and they welcomed us to their home. We spent time in various parts of the home, including communal areas and individual bedrooms so that we could observe the direct care, attention and support that people who lived at this home received. People were happy to speak with us about their experiences in the home.

People looked well and were relaxed and happy when we visited. People were spending time in the lounge with visitors, some were enjoying the privacy of being in their own rooms and people were walking freely around parts of the home and the gardens.

1 March 2012

During an inspection looking at part of the service

We carried out this review to follow up the compliance actions served following our last visit. This report should be read in conjunction with our report of October 2011.

We spent some time in the company of people living in the home and spoke with them individually. This information is detailed throughout the report. We saw staff interacted in a caring way and people responded to this.

We found that actions had been taken to resolve the areas of non-compliance following our last visit.

30 August 2011

During an inspection in response to concerns

We spoke with six people who use the service.

One person told us that they would like to be told a little bit more about the events that were going on within the home. They went on to say that they would like to know more about their health and care.

We were told that people did not feel that they were involved in the development of their care plan. One person said "[I] can't complain as I feel I get the care that I need".

We asked people who live at the home about support and assistance they received from staff. One person told us; 'staff don't help me when I need it. I do use the call bell to ask for help but they (staff) take ages to come'. This person further went on to say; 'you just have to wait, they don't care'. This same person told us; 'some staff here just ignore you, I know that they have heard me but they pretend they haven't'.

Another person we spoke to told us; 'most of the time, they (staff) are very good, however, if you ring the bell for help there is no guarantee they will come, this is particularly the case at night, I find it's better to shout out, they do come then'.

When we asked people if they knew how to raise concerns or complaints about the service provided a Begbrook House, people we spoke to told us; 'If I have any complaints or worries I would tell my family', another person told us; 'I would not know who to tell, there have been so many managers and under managers, I am not sure'.

One person told us that they were happy living in Begbrook House. They said that they were happy with the services provided.

Another person said that generally staff were good and that their care needs were met.

A fourth person told us that they were not involved in making decisions about the care that they receive and that they had not participated in residents meetings.

We asked people about how easy it was to communicate with staff. One person told us; 'I find it really hard to understand some of the staff, I think it's their accents, I am hard of hearing so I guess that doesn't help'.

Another person told us; 'staff don't always understand what it is I want when I am asking for help, this morning I was in a lot of pain. I told the staff member this and they said there was nothing they could do for me, they did go and get another member of staff, but this person came back to me with a commode, I didn't even want the toilet, I wanted some pain relief, but it didn't come, I don't like to make a fuss'.

We asked people about the activities within the home. One person told us; 'people here don't mix very well, I did go up to the lounge once, for a party, it was fun, but people here just seem to want to stay in their rooms, it's a shame, I would like to do more'.