De Bruce Court

About the service

De Bruce Court is a residential care home providing personal and nursing care to 18 people at the time of the inspection. Care is provided to younger adults and older people, some of whom have a dementia, physical disabilities, learning disabilities or mental health needs. The service can support up to 46 people.

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

Right Support

The provider did not always support people to have the maximum possible choice, control and independence. Staff did not always act in accordance with the requirements of the Mental Capacity Act 2005 and associated code of practice. Staff did not always adhere to safe practices when wearing personal protective equipment (PPE).

Staff did not always support people to achieve their aspirations and goals. When goal care plans were in place, relatives told us these were not always followed, and records confirmed this.

Healthcare professionals worked in partnership with the provider when people moved to the home, professionals told us this was managed successfully.

Right Care

People were not receiving person-centred and safe care. The ability to provide person-centred care was compromised due to low staffing levels. People could not always take part in activities and interests that were tailored to them. Some people told us they were bored and had nothing to do or could not go out as no staff were available to support them in the community.

Healthcare professionals gave mixed comments regarding staff interventions with people. One healthcare professional complimented staff on following guidance. Whilst others described the lack of support offered.

Right Culture

People's quality of support was not always enhanced by the provider’s quality assurance systems. People did not always lead inclusive and empowered lives. People were not encouraged to be involved in the organisation of the home, including menu planning and recruitment. Staff did not always focus on people’s strengths or promote what they could do. People were not always supported in line with their cultural and religious needs.

For more details, please see the full report which is on the Care Quality Commission website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 27 July 2021).

Why we inspected

The inspection was prompted by concerns regarding how the service was applying the principles of right support, right care, right culture. We assessed the application of these principles during this inspection.

Initially the inspection was a targeted inspection focusing on Safe and Well-led. However, after some concerns were identified, we widened the scope of the inspection to include all five key questions.

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 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 safe care and treatment, staffing, consent, dignity and respect and good governance at this inspection.

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 return to visit as per our re-inspection programme. If we receive any concerning information, we may inspect

sooner.

De Bruce Court is a residential care home providing personal and nursing care to 30 people at the time of the inspection. Care is provided to younger adults and older people, some of whom have dementia, physical disabilities, learning disabilities or mental health needs. The service can support up to 46 people.

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

People told us they felt safe at De Bruce Court. Procedures were in place to protect people from the risk of abuse. There were enough staff deployed to meet people's needs. Risks associated with people's care were properly assessed and control measures to reduce such risks were in place. When incidents occurred, these were reviewed during de-brief sessions and any lessons learnt were shared with the staff team. The premises were well maintained, clean and tidy. There were effective infection control measures in place.

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.

The service was able to demonstrate how they were meeting the underpinning principles of right support, right care, right culture. People were provided with the right support which enabled them to make choices and promoted their independence. People received the right care that was provided in a person-centred way which promoted their dignity. The service provided the right culture for people in an environment where they were included and empowered by care staff.

People were treated with kindness and compassion. Staff respected people's privacy and dignity and people were supported to be as independent as possible, without compromising their safety. Most relatives told us they had positive relationships with staff.

People’s care plans were person-centred and reflected current needs and preferences. Staff we spoke with knew people's needs well. People and relatives knew how to make a complaint. Complaints we reviewed had been handled appropriately. People had access to a range of activities which reduced the risk of isolation.

Since the last inspection the manager had registered with CQC.

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 requires improvement (report published 15 January 2021). At that inspection we found improvements had been made and the provider was no longer in breach of regulations, but some improvements were still needed, and the rating remained requires improvement.

Why we inspected

This was a planned inspection based on the previous rating.

This report only covers our findings in relation to the Key Questions Safe, Caring and Responsive as these areas were previously rated requires improvement. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for De Bruce Court 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.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

De Bruce Court is a residential care home providing personal and nursing care to 25 people at the time of the inspection. Care is provided to younger adults and older people, some of whom have dementia, physical disabilities or mental health needs. The service can support up to 46 people.

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

During the inspection there were two occasions when staff did not wear appropriate personal protective equipment. When we mentioned this to the manager, they took immediate action. After the inspection, we received information from the local infection prevention and control team that additional PPE was needed in order to support a person who required a specific intervention safely. The manager was able to demonstrate that appropriate action had been taken to mitigate the risks associated with this.

People said they felt safe. Staff received safeguarding training and knew how to recognise and report any concerns.

There were enough staff to meet people's needs and staff were deployed appropriately. Medicines were managed safely and effectively. The premises were well maintained, clean and tidy. Recruitment procedures were robust and appropriate checks were carried out on agency staff.

Staff training was up to date and staff reported they felt well supported.

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. Improvements had been made to best interest records.

People and staff felt the service was well managed. An effective quality assurance process was in place. Care records were complete and up to date.

Staff said the management team had made lots of improvements and things had improved significantly. The atmosphere of the service had improved and things appeared to be much more settled.

The service did not have a manager registered with the Care Quality Commission (CQC) at the time of this inspection, although an application had been submitted.

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 4 December 2019) and we found multiple breaches of regulation. There were breaches of regulations 11 (need for consent), 12 (safe care and treatment), 17 (good governance), 18 (staffing) and 19 (fit and proper persons employed) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We last inspected this service on 10 March 2020 when we completed a targeted inspection to check whether the warning notice we previously served in relation to a breach of regulation 17 had been met. We found some of the requirements of the warning notice had been met, but not all. The overall rating for the service did not change following this targeted inspection and remained requires improvement.

At this inspection on 1 October 2020 we found further improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 13 August 2019. Several breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve arrangements around consent, medicines management, governance arrangements, staff training and staff recruitment.

We undertook this focused inspection on 1 October 2020 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 ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service remains requires improvement.

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 coronavirus and other infection outbreaks effectively.

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

De Bruce Court is a residential care home providing personal and nursing care to 21 people at the time of the inspection. Care is provided to younger adults and older people, some of whom have dementia, physical disabilities or mental health needs. The service can support up to 46 people.

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

The provider and the management team had taken steps to improve the service and ensured people received safer care. An action plan to address the warning notice issued by CQC had been developed and was being completed. Some of the requirements of the warning notice had been met, but not all.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Decisions made in people's best interests had not always been recorded appropriately.

Quality assurance systems to measure the effectiveness of the service had improved, but further improvements were still needed. The management team had a better oversight of the service and this needed to be sustained.

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 requires improvement (published 29 November 2019) when there were five breaches of regulation. Following our previous inspection, we served a warning notice on the provider. We required them to be compliant with Regulation 17 (good governance) of the Health and Social Care Act 2008 Regulations 2014 by 30 November 2019.

Why we inspected

We undertook this targeted inspection to check whether the warning notice we previously served in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

CQC have introduced targeted inspections to follow up on warning notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

De Bruce Court is a residential care home providing personal and nursing care to 23 people at the time of the inspection. Care is provided to younger adults and older people, some of whom have dementia, physical disabilities or mental health needs. The service can support up to 46 people.

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

The service was not well led. The provider failed to have enough oversight of the home and on-going breaches of regulations were identified. The areas for improvement we identified at our last comprehensive inspection had not been addressed which affected the safety and experiences of people living at the home. Systems to monitor the quality and safety of the service and support continuous improvement were not effective. People’s care records were not always complete or accurate. Agency staff records were not complete and appropriate checks on nursing staff were not in place.

Most staff worked hard to meet people's needs, however staff deployment required improvement and we have made a recommendation about this. Staff had little time to meet people’s emotional needs as care was often focused on completing tasks quickly. Care staff were expected to carry out additional tasks which resulted in less time to spend on care and support. People said delays in care sometimes affected their dignity.

People did not receive consistently safe care and medicines were not always managed safely. Staff recruitment procedures were not always thorough and identity checks had not been carried out on agency staff.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Some people had not had their ability to consent to the care they received assessed. Decisions made in people’s best interests had not always been recorded appropriately.

People had mixed views about whether they were treated with dignity and respect and whether they were involved in decisions about their care. Whilst most staff had completed training in quality and diversity we did not always see this reflected in practice. Some staff had a caring approach, but other were task-focused.

There was a lack of activities to keep people engaged and people told us they felt under stimulated. People and relatives knew how to complain, but they said complaints had not always been handled appropriately or to their satisfaction. We have made a recommendation about complaints.

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 1 November 2018) and there were two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

We carried out a focused inspection on 13 March 2019 to see if improvements had been made and whether regulations were met. We found improvements had been made so there was no longer a breach of Regulation 18. However, there was an ongoing breach of Regulation 17 as the provider did not have accurate and complete records for each service user.

The provider completed an action plan after our focused inspection in March 2019 to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was in breach of five regulations. We have made recommendations about staff deployment, activities and complaints.

Why we inspected

The inspection was prompted in part due to concerns we received about staffing levels, staff deployment, medicines and staff turnover. A decision was made for us to inspect and examine those risks.

We began our inspection by carrying out a night visit to check staffing levels on 13 August 2019. We returned on 14 and 15 August 2019 to undertake a focused inspection to review the key questions of safe and well-led. Whilst doing so we found areas of concern in the other key questions, so we reviewed all the key questions, which meant we carried out a comprehensive inspection of this service.

The overall rating for the service remains requires improvement. This is based on the findings at this inspection.

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

Enforcement

At this inspection we identified five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, relating to the need for consent, safe care and treatment, good governance, staff training and fit and proper persons employed. Please see the action we have told the provider to take at the end of this report.

We issued a warning notice relating to the breach of regulation 17 (good governance).

Since the last inspection we recognised that the provider had failed to display their CQC rating on their website. This was a breach of regulation and we issued a fixed penalty notice. The provider accepted a fixed penalty and paid this in full.

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

the time of our inspection there were 21 people living at the home, some of whom were living with a dementia.

People’s experience of using this service: Medicines were not always managed safely. Improvements had been made to the recording of topical medicines and guidance on ‘when required’ medicines, but further improvements were needed.

Staff training and supervisions had improved. Staff turnover remains a concern; plans were in place to address this.

Care plans had improved but further improvements were needed to ensure staff had sufficient information about people’s specific needs.

Issues the provider had identified through checks on the quality and safety of the service were

being addressed at the time of this inspection.

At this focused inspection we found some improvements had been made but further improvements were needed. There is no longer a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, but there is an ongoing breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. While some improvements had been made we could not improve the overall rating from requires improvement because to do so requires consistent good practice over time. We will check this during our next planned comprehensive inspection.

Rating at last inspection: Requires Improvement (report published 1 November 2018).

Why we inspected: At the previous inspection we found breaches of Regulations 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because: medicine records for 'when required' medicines lacked detail; records relating to the administration of topical creams were not always accurate; care records were not always clear and up to date; staff had not completed training specific to people's individual needs; staff supervisions were not up to date; and the provider did not have effective quality assurance processes to monitor the quality and safety of the service provided and to ensure people received appropriate care and support.

Following the previous inspection we asked the provider for an action plan which said what they would do to meet legal requirements in relation to the above issues. We undertook this focused inspection to check they had met legal requirements and to confirm they had followed their action plan and made improvements to the service. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for De Bruce Court on our website at www.cqc.org.uk.

Follow up: We will monitor all intelligence received about the service to inform the assessment of the risk profile of the service and to ensure the next planned inspection is scheduled accordingly.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

De Bruce Court is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. De Bruce Court provides personal and nursing care for up to 46 people. At the time of our inspection there were 15 people living at the home who received personal or nursing care, some of whom were living with a dementia.

A registered manager was not in place at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

This service first registered with the Care Quality Commission on 9 October 2017; this was the first inspection of this service.

During this inspection we found breaches of Regulations 17 (good governance) and 18 (staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Regulation 18 of the Care Quality Commission (Registration) Regulations 2009. This was because: medicine records for 'when required' medicines lacked detail; records relating to the administration of topical creams were not always accurate; care records were not always clear and up to date; staff had not completed training specific to people’s individual needs; staff supervisions were not up to date; the provider did not have effective quality assurance processes to monitor the quality and safety of the service provided and to ensure people received appropriate care and support; and the provider had failed to notify the Commission about significant events in a timely manner.

You can see what action we told the provider to take at the back of the full version of the report.

People had mixed views whether they felt safe or not. Most people said they felt more staff were needed but we saw people’s needs were attended to in a timely way, which meant there were enough staff. However, we did notice call bells continued to ring when staff were already in attendance, which could cause some people to become anxious or upset.

A high number of agency staff were being used daily due to the number of staff vacancies. People tended to speak more positively about the permanent staff and less positively about the agency staff.

A thorough recruitment and selection process was in place which ensured staff had the right skills and experience to support people who used the service. Identity and background checks had been completed which included references from previous employers and a Disclosure and Barring Service (DBS) check.

Accidents and incidents were recorded and dealt with appropriately, but there was no regular analysis to look for trends which may have reduced the risk of future accidents and incidents.

The environment was clean and well-furnished but it was not consistently dementia friendly.

People had 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.

People told us they enjoyed the food available. The meal time experience needed improving to make it more pleasant.

Staff were not always caring as sometimes they concentrated more on the task rather than the individual they were supporting. People gave us mixed feedback about the standard of care provided.

People did not always have access to important information about the service, including how to complain and how to access independent advice and assistance such as an advocate.

People's risk of social isolation was increased as they did not have frequent access to meaningful

activities.

The provider’s quality monitoring system was ineffective at identifying and generating improvements within the service.

People and staff said the service needed a permanent manager and stable staff team to make the necessary improvements.