Britten Court

Britten Court is a residential care home providing accommodation and personal care to up to 80 people. The service provides support to adults who may be living with dementia, mental health and/or a physical disability. At the time of our inspection there were 80 people using the service. The service was an adapted building with 4 suites accommodating 20 people in each, 2 providing nursing care and the other 2 providing residential and dementia care.

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

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. We considered this guidance as there were people using the service who have a learning disability.

There were systems in place to reduce the risks of abuse and avoidable harm. Where incidents happened, the management learned lessons and implemented actions to reduce them happening again. Staff were available when people needed support and staff were recruited safely. The service was clean and hygienic. People were supported to have visits from their family and friends.

People received their medicines when they needed them. Staff had been trained and their competency assessed to ensure medicines administration was undertaken safely.

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 received positive feedback from people using the service and relatives about the care provided, the management and staff. The registered manager understood their roles and responsibilities in managing the service and staff told us they felt the service was well-led. The registered manager had a good oversight of the service and the people who used it. Where we had identified improvements needed in the records, this was immediately addressed by the registered manager and their team.

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 10 November 2017).

Why we inspected

The inspection was prompted in part due to concerns received about the care provided and a notification received from the service regarding moving and handling. A decision was made for us to inspect and examine those risks. We undertook a focused inspection to review the key questions of safe and well-led only. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this full report.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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 read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Britten Court 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.

At the last inspection on 19 May 2016, we asked the provider to take action to make improvements to the service. These included improvements to the staffing level, the personalisation of care records and the way the service monitored the quality and safety of the care people received. At this inspection we found that these actions had been completed.

At this inspection the service had made significant improvements and was no longer in breach of any Regulations. The rating for this service is now ‘good’.

The service had a 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.

People and their relatives told us they felt safe and secure living in the service. Staff knew how to keep people safe and plans were in place to reduce risks to people.

Medicines were managed, stored and administered safely.

People and their relatives told us there was enough competent staff to provide them with support when they required it. The service was working on strategies to reduce the use of agency staff and increase the number of permanent care staff.

Staff had received appropriate training and support to carry out their role effectively. Staff were given opportunities to develop and improve upon their skills.

People received appropriate support to maintain healthy nutrition and hydration. They told us they had appropriate access to support from other health professionals such as GP’s, chiropodists and dentists.

The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLs). People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Some improvements were required to ensure that capacity assessments and best interest’s paperwork were completed consistently.

People and their relatives told us the staff were kind, caring and respectful towards them. This was confirmed by our observations. People and their relatives were given the opportunity to feed back on the service and their views were acted on. However, some improvements were needed to ensure that people’s views on their care were documented in care planning and review records.

Staff we spoke with knew people on an individual basis. Care records contained enough information about people for staff to fully understand them. People had access to meaningful activities and were supported to follow their interests.

People and their relatives told us they knew how to complain and felt they would be listened to if they wished to make a complaint.

The registered manager, deputy manager and senior management team created an open, transparent and honest atmosphere within the service. People, relatives, staff and other professionals were invited to take part in discussions about the service and feed back their views.

There was a thorough and robust quality assurance system in place and shortfalls identified were promptly acted on to improve the service.

Further information is in the detailed findings below.

Britten Court provides accommodation, nursing and personal care for up to 80 people, some living with dementia. At the time of our inspection, there were 78 people living in the service.

There was 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.

At the last inspection on 30 April 2015, we asked the provider to make improvements in how the service protects people in relation to medicines management, and this action has been completed. Despite this there were still some areas in the management of medication that could be improved.

There was an open culture in the service, which ensured that staff were able to speak up, however, some staff lacked confidence in the registered manager and their ability to take action when needed. The management team were implementing new systems and processes to improve care, but this was being undertaken too quickly, leaving some staff feeling uncertain of their roles and responsibilities. Although there was a registered manager in post the provider had put in a relief manager to ensure that changes were implemented effectively.

During this inspection we found there were significant variations in the quality of the care being provided across the service. Whilst in some areas the service was actively improving, in others people received inconsistent care which did not always consider or fully meet their needs. The registered provider was in breach of three regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to ensuring people throughout the service were consistently supported by the skills and deployment of sufficient numbers of staff, providing care which was individualised, and ensuring that the governance and oversight was effective at improving the overall quality of the service. Governance systems were being improved, but they were still not robust enough to demonstrate how they supported the leadership to make improvements needed to provide a consistent service.

People did not always receive the time and attention they needed to fully meet their needs. At times care was task focussed and hurried with staff unable to respond to people as quickly as they would like or perform their role effectively. This also had an impact on staff’s ability to provide care which was consistently dignified and respectful.

Staff were not always sure how to support people with when they were anxious, and further training was needed to help staff be more confident when supporting people with specific needs. Care records did not always provide appropriate guidance to support staff in how their needs should be met. We have made a recommendation about the specialist needs of people living with dementia.

Care records did not reflect people’s personal preferences and were incomplete in some areas. Risk assessments also contained contradictory or incomplete information, putting people at risk of harm.

Though improvements were seen in the way the service managed medicine systems and processes, people did not always receive their medications in a timely manner due to staff being interrupted on medicine rounds.

Activity provision was not consistent throughout the service, and we observed that it was difficult for care workers to find the time to provide this in addition to their other duties.

Staff were able to recognise abuse and knew how to report concerns if they suspected a person was being abused. Systems were in place to discuss potential safeguarding issues so they were escalated appropriately.