Archived: Burton, Bridge and Trent Court Care Centre

We undertook a focused inspection visit on 19 July 2016. This visit was unannounced and was required to check that the provider had addressed the areas identified as requiring improvement at our last comprehensive inspection visit on the 29 February 2016.

At our last visit we identified that improvements were needed to ensure safe medicine practices were always followed and that people's creams were available to them as prescribed. The quality monitoring systems in place required further development and improvements were needed to the recruitment checks and staffing levels.

The provider sent us a report on the 21 June 2018 to address the areas of concern we had identified. The provider and registered manager have continued to inform us on a regular basis of the improvements being made at Burton, Bridge and Trent Court Care Centre.

The areas that required improvement at our last visit were under the two key questions; is the service safe and is the service well led. This report covers the areas that required improvements and all key lines of enquiry (KLOEs) under these two questions. The KLOEs are a set of questions we use that directly relate to the five key questions we ask of all services.You can read the report from our last comprehensive inspection visit, by selecting the ‘all reports’ link for Burton, Bridge and Trent Court Care Centre on our website at www.cqc.org.uk

Burton, Bridge and Trent Care Centre is registered to provide accommodation for up to 99 people. They can offer support to people with dementia and mental health related conditions. Bridge Court, Burton Court and Trent Court are three separate buildings but are registered with us as one location. Bridge Court provides nursing, residential and dementia care to older people. Burton Court provides nursing care to women with mental health related conditions and Trent Court provides nursing care to men with mental health related conditions. All three units are allocated a unit manager.

At the time of our inspection visit 58 people were using the service. On Bridge Court there were 16 people, on Trent Court there were 27 people and on Burton Court there were 15 people.

There was a registered manager in post at the time of this inspection visit. This 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.

We saw that improvements had been made to medicines practice, discussions with nursing staff and records seen, demonstrated that improvements had been made to ensure medicines were available to people as prescribed. However nurses were not always given protected time to ensure they were not disturbed or distracted when administering medicines, therefore we could not be sure people would receive their medicines safety.

Staffing levels had improved since our last visit. However the deployment of staff on Burton Court over the lunch time period did not ensure people were supported in a timely way.

The recruitment checks undertaken at the service had been improved. Staff spoken with and records seen demonstrated that all of the required checks were undertaken before staff commenced employment.

We saw that the provider had made improvements to the environment. New furniture and equipment had been purchased, some redecoration had been undertaken and further environmental improvements were planned.

The recording of the support people received had improved. We saw that these records were completed and this enabled the management team to monitor the care people received and to address any identified concerns.

The provider had made improvements in the auditing process relating to the management of medicines. The records confirmed medicine audits were in place and undertaken each month. Any areas for improvement were identified and actions taken as required.

The staff understood how to protect people from abuse and had clear direction on how to support people who demonstrated behaviours that put themselves or others at risk; this ensured the support people received met their needs and kept them safe.

Assessments were in place that identified risks to people’s health and safety and care plans directed staff on how to minimise identified risks. Plans were in place to respond to emergencies to ensure people were supported in accordance with their needs. Care staff told us they had all the equipment they needed to assist people safely and understood about people’s individual risks. The provider checked that the equipment was regularly serviced to ensure it was safe to use.

There was clear leadership and direction for staff to ensure people's needs were met. Staff told us they were comfortable raising concerns which demonstrated that a transparent and open management approach was in place.

Quality monitoring checks were completed by the provider and registered manager and when needed action was taken to make improvements. The registered manager understood their responsibilities around registration with us.

Burton, Bridge and Trent Care centre is registered to provide accommodation for 99 people. They can offer support to people with dementia and mental health related conditions. Bridge Court, Burton Court and Trent Court are three separate buildings but are registered with us as one location. Bridge Court provides nursing, residential and dementia care to older people. Burton Court provides nursing care to women with mental health related conditions and Trent Court provides nursing care to men with mental health related conditions. All three units are allocated a unit manager.

At the time of our inspection 47 people used the service. On Bridge Court there were 13 people, on Trent Court there were 22 people and on Burton Court there were 12 people.

There was no registered manager at the time of this inspection. However, we had been informed by the consultants overseeing the running of the home that an application to register a manager had been made. 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.’

Improvements had been made in the management of medicines but further improvements were needed to ensure safe medicine practices were always followed and that people’s creams were available to them as prescribed.

Quality monitoring systems were in place to enable managers to make improvements where needed but they required further development to ensure the staff team consistently recorded the daily care they provided to people.

Improvements were needed to the recruitment checks undertaken to ensure staff’s suitability before they started work. Improvements were needed to the staffing levels on Bridge Court to ensure staff were available to meet people’s needs in a timely way and meet their social and recreational needs. People’s living at Burton Court and Trent Court were provided with sufficient opportunities to have their social needs met.

Improvements had been made to ensure people were supported in safe way; this was because staff had the skills and competence to support people safely. We saw that the staff supported people to move safely and used equipment that had been maintained and was safe for use. We saw that staff followed risk assessments to ensure people received safe care. The staff understood how to protect people from abuse. Staff had clear direction on how to support people who demonstrated behaviours that put themselves or others at risk; this ensured the support people received met their needs and kept them safe. People who required physical intervention to keep them safe had their rights protected, as information regarding these interventions was recorded.

People were supported to make important decisions about their care. Where people were unable to consent, mental capacity assessments and best interest decision had been completed and we saw that people’s consent was sought before care interventions were delivered. Where people were deprived of their liberty applications to ensure this was done legally had been made to protect people’s rights.

People’s nutritional needs were met because staff had a good understanding of people’s nutritional requirements and any risks associated with eating and drinking. People were supported to eat their meals and these were provided to people at a suitable temperature to be enjoyed. People were referred to healthcare professionals when needed to ensure their health care needs were met. We saw that staff were caring towards people and the needs and wishes of people were respected and their dignity maintained.

People knew how to make a complaint and we saw these were investigated. The leadership and direction for staff had improved to ensure people’s needs were met. Staff told us they were comfortable raising concerns which demonstrated that a transparent and open management approach was in place.

This visit to Burton Bridge and Trent Court Care Centre was an unannounced inspection. Bridge Court, Burton Court and Trent Court are three separate buildings but are registered with the Care Quality Commission as one location. We spent time in each building and looked at people's care records and other records. We spoke to people using the service to get their views on the quality of support they received. As some people were unable to give us their views on the quality of care they received, we also spent time observing the care and support people provided. We spoke to the staff that were supporting people and spoke to people's visitors.

The inspection team consisted of three inspectors and an expert by experience. This is a person who has personal experience of using or caring for someone who uses this type of care service. The expert by experience spoke to people using the service and observed the care and support provided and spoke to some of the staff team. The information provided by the expert by experience is included within this report.

Is the service safe?

We saw that on Trent Court and Burton Court people were supported in a safe way. Areas of identified risk had been assessed and provided staff with information on how to support people. We saw that care plans and risk assessments were followed. This ensured people were supported in a safe way. We saw that staff had a good understanding of people's support needs and this enabled them to support people safely.

On Bridge Court we saw occasions when risks were posed to people's health and wellbeing; this was because care plans and risk assessments were not always followed in practice.

We saw that in Trent Court and Burton Court Capacity assessments had been undertaken for people that were unable to make decisions independently; however the assessments seen on Trent Court made a generic statement about the person's ability to make decisions which was not reflective of their ability to make decisions in all areas.

During the first two days of our visit on Bridge Court we did not observe staff gaining verbal consent to people prior to undertaking any care or support. Staff were observed gaining verbal consent from people and explaining care practices on the third day of our visit. Information in care records on Bridge Court did not reflect special arrangements for people without capacity.

A system was in place within all three buildings to manage people's medication and we saw that in general these systems were followed to ensure people received their medication in a safe way. However we identified that the stock balance of some medications did not correspond with medications administered and we found a few gaps on Burton, Bridge and Trent Court where medication had not been signed for after administration.

Is the service effective?

We saw that in Trent Court and Burton Court the support provided to people achieved good outcomes that promoted their quality of life. The care plans seen were clear and comprehensive and reflected the support that people received.

People living in Trent Court told us they liked living there and confirmed that the support provided by staff was good. One person said; 'It's very nice here, the staff are all nice, very friendly and they know when I need some support.' Another person said; 'I'm happy here, I go out regularly and I get on with all the staff.'

One person's visitor on Burton Court told us they were happy with the care their relative received. They said that their relative had been in other homes and felt that Burton Court was the best. This visitor told us; 'They resolve issues quickly, I don't worry about my Mum.'

On Bridge Court our observations of the support provided varied over the three days we visited. We saw that on the first two days the support provided did not always achieve good outcomes for the people using the service; staff appeared to lack direction and leadership. We observed a clear improvement on the third day of our visit and saw the staff team were organised and had a clear understanding regarding the support each person needed to promote their quality of life.

One person's visitors in Bridge Court raised several concerns regarding the support their relative received. We discussed these concerns with the manager, who contacted the family and arranged a meeting with them.

Is the service caring?

In Trent Court and Burton Court we observed a positive working relationship between the care staff and the people they supported. Some people required one to one support throughout the day and staff treated people with courtesy and respect. For people that did not require one to one support we saw staff took the time to check that people were alright and they were supported and encouraged to participate in activities of their choice.

In Bridge Court during the first two days of our visit staff did not always demonstrate a caring or respectful approach towards people. Staff interactions with people living at Bridge Court were limited and the interactions we did see appeared to be task orientated.

Is the service responsive?

We found that Trent Court and Bridge Court were well organised and staff understood their roles and responsibilities. People's daily routines were followed which ensured the support they received was consistent.

Over the first two days of our visit in Bridge Court we saw limited interactions between staff and people using the service. Although staff were present in communal areas for the majority of time people were not always attended to in a timely way to ensure their needs were met. However on the third day of our visit in Bridge Court we saw a marked improvement in the interactions between staff and people using the service. Staff were attentive to people's needs and took the time to sit and chat with them.

Is the service well-led?

Since our last visit in January 2014 there had been changes to the management team at the service. Although we identified some positive improvements within Trent Court and Burton Court, this was not reflected in Bridge Court.

We found that the unit managers on Trent Court and Burton Court provided positive leadership to the staff they supported and this was reflected in our observations and from discussions with staff.

The changes at Bridge Court over recent months did not promote a stable and effective environment for the staff team. Although we acknowledge that the manager in post at Burton Bridge and Trent Court Care Centre was quite new to the service, our observations of leadership throughout our three days at the Bridge Court demonstrated there was a distinctive difference in the quality of support provided between the two staff teams that were on duty during our visit which had impacted on the quality of support provided to people.

During this inspection, we only inspected Trent Court as we had received information of concern about the care and welfare of people and how the service was managed within this unit.

Some people using the service had complex communication needs. Where people were not able to express their views verbally we observed their interaction with staff. We saw staff providing support in the home and people were treated with respect. People who visited the service told us they were happy with the support provided for their relatives. One person told us, 'The staff couldn't do any more. They have a difficult job which they do very well.'

Information within care records was not accurate or up to date. This meant people were at risk of receiving inappropriate care.

Where people did not have capacity, a suitable assessment had not been carried out. This meant that the provider could not demonstrate that decisions had been made in people's best interest.

We saw the provider did not have systems in place to maintain the service. Some areas of the home needed to be upgraded to ensure people lived in a comfortable and safe environment.

The provider sent us an action plan, detailing how they would improve the medication systems to ensure people could be confident they received their medicines as prescribed. We saw systems were in place to record when medicines were received into the service, when they were given to people and when they were disposed of. However, the new systems had not identified some omissions or concerns. This meant possible medication errors were not addressed promptly and people may not have received all their medicines as prescribed.

The temperatures of the area where medicines were stored was now monitored and recorded to ensure the quality of the medicines used. This meant medicines were stored safely and within the correct temperature range.

We spoke with one person whose medicines we reviewed. They told us they knew what medicines they took and when they should have them. This meant the person was informed about their medicines to maintain their wellbeing.

We will continue to monitor the service to ensure the systems are developed so people can be confident they receive all their medicines as prescribed.

We found that people were treated with dignity and respect. Their individuality was recognised and they were supported to make their own choices about how they spent their time and how they were supported. One person told us, 'The staff always ask me what I want and they always listen to me.'

We found the staff understood people's needs and knew how to support them. One person using the service said, 'Nothing is ever too much trouble. The staff here can't do enough for you. I'm very happy.'

Medication was not always recorded correctly to demonstrate the quantity of medicines in the service. This meant systems were not in place to ensure people had what had been prescribed to them.

We saw complaints information was available and people confirmed they felt able to raise a concern.

On this inspection we needed to check that improvements had been made. We also looked at other areas of care to complete our unannounced scheduled inspection which is presently required on an annual basis.

The inspection was unannounced, which meant the registered provider and the staff did not know we were coming. We looked at the evidence available following the action plan we received from the provider, and we spoke with people using the service, visitors and some of the staff on duty. Three inspectors, a pharmacist inspector, a specialist in mental health and an expert by experience accompanied us on our inspection. This ensured we had a wide range of evidence to support our judgements.

We found improvements had been made and people using the service received appropriate care, treatment, nutrition and support.

We looked at the way medication was managed and saw that medication systems and practices were safe and suitable.

We looked at the recruitment procedures for staff and found that appropriate systems were in place to protect people using the service.

We saw suitable systems were in place to manage the service and ensure people's views were listened to.

There were 93 people in residence; the home can accommodate 99 people in total.

When we arrived people were receiving a hot meal, although this was not what was on the menu because the necessary food stock for the stated meals were not available. Staff sometimes supplemented or purchased foods for people using the service. Fresh produce was not always available for people to support a healthy diet. This meant people were not always provided with nutritional food to keep well.

The staff on duty told us the home had been without continence aids earlier in the day. One the day of our inspection we saw continence aids had been delivered at 11am but people had not been provided with suitable aids earlier that day. This meant people were not supported in line with their assessed needs to keep well and maintain their dignity.

We looked at the care records for three people and talked to the staff about the care that was provided. We found information was conflicting and some staff told us they had not read the care records. This meant the provider could not ensure people had their needs met in a consistent and safe way.