Bradbury Grange

Updated 8 October 2022

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection team consisted of two inspectors.

Service and service type

Bradbury Grange 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.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. At the time of our inspection there was not a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

Before the inspection, we reviewed information we had received about the service. This included details about incidents the provider must notify us about, such as abuse, serious injuries and deaths. We reviewed the last inspection report and the action plan. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with eight people who used the service about their experience of the care provided. We spoke with ten relatives, nine members of staff including the deputy manager, operations manager, an area manager, care staff, the laundry person, cook, activities co-ordinator. We also received feed back from a visiting professional.

We reviewed a range of records. This included six people’s care records and multiple medication records. We looked at three staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

Updated 8 October 2022

About the service

Bradbury Grange is a residential care home providing personal care to older people and people living with dementia. At the time of the inspection, 47 people were living at the service. Accommodation is spread over two floors in a large detached property. On each floor there was a large communal lounge and dining room where people could choose to spend their time. The service can support up to 50 people.

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

People, staff and relatives told us there were not enough staff deployed to ensure people received the care and support they needed when they needed it. There were days when there was not enough staff. Agency staff covered some shortfalls, but people told us that agency staff did not know them and how they liked to be cared for.

Staff said they were demoralised and felt unsupported and not listened to by the management team. At the time of the inspection there was no registered manager in post. The registered manager had recently left the service. The provider was trying to recruit a new manager. People told us that they were bored, there was nothing to do. People, relatives and staff said they had reported this to management, but little action had been taken. Staff were recruited safely. Safety checks had been completed before staff started working with people.

Some people had medical conditions. Staff had not received specialist training in these areas like diabetes, catheter and stoma care. Risks to people’s health and wellbeing had been assessed and there was guidance in place on how to mitigate these risks. However, risk assessments gave little guidance on how to support people consistently and in a way that suited them best when they became upset and distressed.

Medicines were managed safely. Some people were supported to take their medicines independently and this was assessed and monitored. However, when people were prescribed ‘as and when’ medicines when they were distressed there was no guidance in place to make sure these medicines were given consistently and safely.

Safety checks and risks within the environment were checked and action taken if any shortfalls or concerns were identified. Fire exits were accessible for people in the event of an evacuation. The environment was clean and safe. There were procedures to protect people from the risk of infection. Some areas of the service were in need of redecorating and improvements to support people living with dementia.

People were protected from abuse and avoidable harm and were treated with respect and dignity. People were supported to have day to day choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. Staff helped to maintain people's independence by encouraging them to do as much as possible for themselves.

People's needs were assessed and reviewed to ensure care being delivered was up to date and reflective of their needs. People had care plans that provided guidance for staff on the support and care that they needed on a daily basis. People received a healthy, balanced and nutritious diet that supported their health and wellbeing.

The service worked with healthcare professionals to ensure people's health needs were met. People and relatives said GP’s and other specialists were contacted when needed. When health care professionals had raised concerns, these had been responded to and action taken. Visiting professionals told us they thought the service had improved over the past couple of years, but they were concerned this may not continue due to the registered manager leaving. When accidents or incidents occurred, learning was identified to reduce the risk of them happening again.

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 31 January 2020).

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 the provider had made improvements regarding the previous breach of regulations, however we found breaches of the regulations in regard to staffing levels, staff training and the quality and safety of the service. The provider remained in breach of regulations.

At our last inspection we recommended that the provider follows good practice guidance in relation to working with other agencies to provide consistent and effective support. At this inspection we found the provider was working with other agencies to ensure people received effective and safe care.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

The inspection was also prompted in part due to concerns received about the care and support people received and staffing levels at the service. A decision was made for us to inspect and examine those risks.

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.

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

The overall rating for the service has not changed from requires improvement based on the findings of this inspection.

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

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

Enforcement and Recommendations

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 breaches in relation to staffing, staff training and the quality and management at this inspection.

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

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.