Archived: Bronswick House

Bronswick House is registered to provide personal care for fourteen people whose needs are associated with their mental health. It is set on two floors with three bedrooms on the ground floor and ten on the first floor. At the time of the inspection there were 10 people living at the home.

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

A system for staff recruitment was in place and one staff member said, “All the checks on me were completed before starting work at Bronswick House.” The building was clean and hygienic, and staff were seen to wear appropriate personal protective equipment (PPE). There were sufficient staff to meet people’s care and support needs. People’s safety was at the centre of care delivery. One person said, “I do get a little nervous, but staff are always around and it makes me feel safe here.” Risks were assessed and carefully monitored to ensure individuals safety. People received their medicines safely.

The management team had auditing systems to maintain ongoing oversight of the service and make improvements where necessary. Quality assurance processes ensured people were able to give their views of the service. Responses we looked at were positive. We found the management team acted upon suggestions or ideas that were made to ensure the service continued to develop and improve the lives of people.

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 30 August 2018).

Why we inspected

We undertook this inspection as part of a random selection of services rated good and outstanding to test the reliability of our new monitoring approach.

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.

Bronswick House is registered to provide personal care for fourteen people whose needs are associated with their mental health. The home offers support for life and does not offer rehabilitation services. It is set on two floors with three bedrooms on the ground floor and ten on the first floor. There is one shared bedroom. Bronswick House is situated in a residential area and is close to public transport.

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

People told us they felt safe and supported by the staff team. Staff assessed and managed risks so people were able to be as independent as possible but remain safe. The registered manager had robust system for recruitment and there were enough staff to meet people’s care and support needs. Staff supported people with their medicines as they needed. The home was clean with satisfactory infection control.

Staff supported people to see healthcare professionals promptly to help their health and wellbeing. People had sufficient food and drink and staff were familiar with their dietary needs. People were helped 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. Staff assessed people's capacity to make decisions. The provider had made improvements to the home environment. However, this would benefit from further attention to make the décor pleasant and appealing. Staff had been suitably trained and supported and had the skills, knowledge and experience to provide good care.

Staff provided care that met people’s needs and preferences and respected their diversity. People, and if appropriate their relatives, were involved in planning their care and encouraged to make decisions. People told us they enjoyed living at Bronswick House and were treated with respect and consideration.

Staff had assessed and were familiar with people’s specific communication needs. People were involved in a variety of activities independently or with staff support. Staff encouraged people or their families to tell them about any concerns or complaints. People could remain at Bronswick House, with familiar people to support them, when needing end of life care.

People said they were encouraged to make decisions about their lives. They said staff listened to and acted on these. The registered manager monitored the service to check on the quality and to make sure staff were providing good care. They understood and acted on legal obligations, including conditions of CQC registration and those of other organisations. They worked in partnership with other services and organisations to make sure they followed good practice and people in their care were safe.

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

Rating at last inspection:

At the last inspection the service was rated good (published 27 July 2017).

Why we inspected

This was a planned inspection based on the rating at the last inspection.

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.

At the last comprehensive inspection in 12 April 2016 and 18 April 2016 the registered provider did not meet the requirements of the regulations of the Health and Social Care Act 2008 (Regulated Activities) 2014 and breaches were found for safe care and treatment, management of medicines and governance of the home. It was rated as Requires Improvement.

Our regulatory response to these breaches in relation to the unsafe care and treatment and management of medicines was a warning notice informing the provider of the actions they had to take to meet the regulations. In relation to good governance we asked the provider to send us a report that said what action they were going to take to make improvements.

On the comprehensive inspection In April 2016, in addition to the breaches we made a recommendation about staff providing more frequent person-centred activities in the home and community. We also made a recommendation about staff supporting people who lacked capacity to make decisions in a timely way. People told us some staff restricted them from having drinks or snacks at night. Also several bedrooms, corridors, furniture and furnishings were unclean and unhygienic.

We carried out a focused inspection visit on 31 January 2017 and checked what progress had been made in relation to the breaches. We saw during the focused inspection, the service had made improvements and were no longer in breach of the regulations. People received safe care, medicines were managed safely and governance of the home had improved. However we needed to see these improvements were sustained so the rating was not changed on the focused inspection. Neither did we look at the recommendations from the April 2016 inspection.

There had been a change of manager since the last comprehensive inspection. They were registered with the commission just after this inspection visit. 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.

Bronswick House is registered to provide personal care for fourteen people whose needs are associated with their mental health. The home offers support for life and does not offer rehabilitation services. It is set on two floors with three bedrooms on the ground floor and ten on the first floor. It is situated in a residential area, and is close to the public transport.

Although a small number of people had limited verbal communication and were unable to converse with us, we were able to speak with six people who lived at the home. People told us they felt safe at the home. They said staff were friendly and supportive and looked after them. Procedures were in place and risk assessments had been modified and improved and reduced the risks of unsafe care or actions. People told us they were treated with kindness and respect. We observed staff provided supportive and sensitive care during the inspection.

People said there were enough staff to give them the support they wanted. We saw there were enough staff to provide safe care and supervision and for people to receive support to go out in the local area.

Staff had acted on the recommendation made at the last comprehensive inspection to provide more activities and introduced various games, gardening and walks. We had also made a recommendation about staff supporting people who lacked capacity to make decisions in a timely way. We saw this had been acted upon and best interest meetings held. At the last comprehensive inspection people told us some staff restricted them from having drinks or snacks at night. The registered manager had provided people with facilities for drinks whenever they wanted them.

At the last comprehensive inspection, several bedrooms, corridors, furniture and furnishings were unclean and unhygienic. On this inspection infection control practice had improved. The home was clean and hygienic. The décor of the home and the environment had started to improve. The registered manager had arranged for several rooms to be painted and maintenance work to be completed. However, a rolling programme of redecoration and maintenance was needed to continue to improve the quality of the environment.

We looked at the recruitment of two recently appointed members of staff. We found appropriate checks had been undertaken before they had commenced their employment. This reduced the risk of appointing unsuitable staff. Staff had been trained and had the skills and knowledge to provide appropriate care to the people they supported. We saw regular support and supervision was provided to staff.

Medicines were managed safely. People said staff supported them with their medicines correctly and when they needed them. We saw they were given as prescribed and stored and disposed of correctly.

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.

People told us the meals had improved and they enjoyed them. People were offered a choice of nutritious meals. One person said, “The meals have improved so much since [registered manager] came. We get home made rice pudding now, which I love.”

We saw staff were knowledgeable about and acted promptly to support people with their health care needs. Care plans had been developed to be more informative and personalised, involved people and where appropriate their relatives and were regularly reviewed.

People said they knew how to complain if they needed to. They said they had opportunities to express any comments or complaints and were listened to and action taken.

People told us the registered manager and staff team were approachable and supportive and listened to them. They said they felt the home had improved and they were more involved in decisions since the registered manager’s arrival. Staff said the registered manager was supportive and encouraging.

We found systems and procedures were in place to monitor and assess the quality of the service. These included seeking views of people they supported through informal discussions, formal meetings and satisfaction surveys.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We undertook a focused inspection on 31 January 2017 to check they had followed their plan and to confirm they now met legal requirements.

This report only covers our findings in relation to the latest inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Bronswick House on our website at www.cqc.org.uk.

Bronswick House is registered to provide personal care for fourteen people whose needs are associated with their mental health. The home offers support for life and does not offer rehabilitation services. It is set on two floors with three bedrooms on the ground floor and ten on the first floor. It is situated in a residential area, and is close to public transport. At the time of the inspection visit fourteen people lived at the home.

There was a registered manager in place. However, although they were overseeing the service, they had withdrawn from the day to day management of Bronswick House. A new manager had day to day responsibility for Bronswick House and had started the process to apply to become registered manager. 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 our focused inspection on 31 January 2017, we found that the provider met the warning notice regarding safe care. They had followed their plan which they had told us would be completed by August 2016 and legal requirements had been met.

Risk assessments were in place, reviewed and informative to reduce any potential risks of harm to people. They were dated and signed by the person who completed them. Staff were observant and provided safe care and supervision to people, particularly those who were most vulnerable.

Risk assessments had been amended and improved and were dated and signed so staff had clear guidance on the care and support people needed. This helped keep people safe.

Staff managed medicines safely with appropriate gaps between the times of administering them. They were stored securely and not left unattended.

Care records had been amended and developed so they were informative, personalised and involved people in their care.

People were encouraged to discuss any improvements they wanted in the home. Audits and checks were carried out frequently and findings promptly acted upon.

We could not improve the rating for safe, responsive or well led from requires improvement because to do so requires consistent good practice over time. We will check this during our next planned comprehensive inspection.

On the day of inspection there were twelve people who lived at the home.

Bronswick House is registered to provide personal care for fourteen people whose needs are associated with their mental health. The home offers support for life and does not offer rehabilitation services. It is set on two floors with three bedrooms on the ground floor and ten on the first floor. It is situated in a residential area, and is close to the public transport.

A scheduled inspection of the service was last carried out in August 2013. The service was not meeting the requirements of the regulations inspected at that time. There were breaches in nutrition, staffing, safety and suitability of premises and assessing and monitoring the service. A follow up inspection was carried out in November 2013 to check if the home had become compliant with those regulations. On that inspection they were meeting the assessed regulations.

At this inspection in April 2016 we noted a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Breaches were found for safe care and treatment, management of medicines, accurate records and quality assurance.

You can see what actions we have asked the provider to take at the back of the full version of the report.

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

There was 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. The registered manager was responsible for Bronswick house and another care home in the town.

People told us they felt safe living at Bronswick House. There were risk assessments for some risks but other risks were not assessed. This reduced people’s safety and people were not always kept safe. A serious incident showed staff had not kept a person safe or ensured the safety of other people. Staff did not carry out checks over a long period to make sure the person was safe and in the home. The person had left the home unnoticed. During this time the person had been agitated, distressed and unsafe.

Risk assessments were not always in place or informative. They highlighted risks but did not give staff guidance on how to reduce any risks. Where people had behaviour that challenged the service, there was no guidance for staff or strategies to reduce behaviours or diffuse situations

Staff were aware of how to raise a safeguarding concern and told us the steps they would take if they became aware of abuse. The registered manager reported safeguarding concerns, accidents and incidents to CQC and where appropriate to the local authority.

Care records were not always dated and signed so it was not clear whether they were current or older.

There were procedures in place to monitor the quality of the service and audits were being completed regularly. However these were not effective as the issues we raised on the inspection had not been identified by the home’s audits

Medicines procedures were not always followed or medicines given as prescribed.

We looked at the environment on the first day of the inspection. Several rooms, corridors, furniture and furnishings were unclean and unhygienic. Bedding was worn and stained. On the second day there was some improvement. Painting had started in some rooms, the home was cleaner and new bedding was in place.

There were some social and leisure activities available and staff engaged with people.

We have made a recommendation about staff providing more frequent person-centred activities in the home and community.

Staff understood the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS). By the end of the inspection they were working within the law to support people who may lack capacity to make their own decisions.

We have made a recommendation about staff working in a timely way to support people who may lack capacity to make decisions.

People told us staff were respectful and caring and respected their privacy. Staff were available when people needed them to assist with people’s personal care needs.

People told us the meals were good and varied and they had plenty to eat.

People we spoke with told us they had no complaints, and knew how to make a complaint if they needed to.

Staff had been trained to provide support to people they cared for. Most staff had completed or were working towards national qualifications in care.

Outcome 5 ' Meeting nutritional needs

Outcome 10 ' Safety and suitability of premises

Outcome 13 ' Staffing

Outcome 16 ' Assessing and monitoring the quality of service provision

This was because the home was not compliant at the previous inspection.

We spoke with a range of people about the home. They included the manager, staff and people who lived at the home. We also had responses from external agencies including the local authority contracts team. This helped us to gain a balanced overview of what people experienced living at Bronswick House.

We saw that people were relaxed and happy during engagements with staff. Service users were supported with their nutritional needs and offered menu options. Food hygiene and safety had improved.

The provider had developed maintenance systems and addressed issues we found with the environment. Additionally, the manager had addressed our concerns with staffing levels. New auditing systems had been introduced to regularly monitor the quality of service provision.

The service ensured that people were cared for in a supportive and dignified manner. One person told us, 'I've been here a long time and I'm happy living here'. There were environmental issues, some of which were addressed at the time of completing this report.

Meals were nutritious, but there was no choice offered to residents on a daily basis. There was an issue with a cat having access to the small kitchen where snacks were prepared. Although staff had adequate training and supervision, we had concerns about staffing levels. These were not always adequate in meeting people's needs whilst continuously monitoring all service users.

Care records were of a good standard. Care plans and risk assessments were in-depth, signed and regularly reviewed. However, Bronswick House did not have appropriate processes in place to monitor the quality and environmental safety of its service.