Background to this inspection
Updated
29 February 2024
The inspection
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 was carried out by 2 inspectors. An Expert by Experienced supported by speaking with people living in the care home.
An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
Old Rectory (Bramshall) is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Old Rectory (Bramshall) is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Registered Manager
This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.
At the time of our inspection there was a registered manager in post.
Notice of inspection
This inspection was unannounced.
Inspection activity started on 14 November 2023 and ended on 6 December 2023. We visited the care home on 14 and 17 November 2023.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used all this information to plan our inspection.
During the inspection
We spoke with 10 people living in the service and 3 relatives. We spoke with 9 members of staff including a director, the registered manager, the deputy manager, senior care staff and care staff. We looked at 4 people's care records and multiple medicine records. We looked at how medicines were stored, administered and recorded. We looked at 4 staff files in relation to recruitment. A variety of records relating to the management of the service, including building safety records, audits and accident and incident records were also reviewed.
After the inspection we continued to seek clarification from the provider to validate evidence found. We held a virtual meeting with the manager to ask further questions.
Updated
29 February 2024
About the service
Old Rectory (Bramshall) is a residential care home providing personal care to up to 30 people. The service provides support to younger and older adults with physical disabilities, sensory impairments and people living with dementia. At the time of our inspection there were 24 people using the service. The care home accommodates people in 1 adapted building.
People’s experience of using this service and what we found
The provider had not identified and addressed all environmental risks to people. People’s medicines were not always well managed. Staff were not always recruited safely, there were gaps in recruitment records and recruitment records were not effectivity audited. The provider’s quality assurance systems and processes were not always effective in identifying risks to people and in driving improvements in the service.
People’s care and support needs had not always been fully assessed when their needs had changed and there were some inconsistencies and inaccuracies people’s care folders. Staff were supported and received training, supervisions and team meetings, however, some training was not always effective.
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. However, the policies and systems in the service did not always support this practice and improvements were needed in relation to the Mental Capacity Act.
People, relatives, and staff felt able to make suggestions and raise concerns with management, who were visible and accessible. There were enough staff on duty to support people safely. Infection prevention and control was well managed. Visitors were able to visit people living in the service without restrictions.
People were treated with dignity and respect and staff promoted people’s independence. People, relatives and staff were consulted, and their views were considered and acted on where appropriate and possible. People’s care plans were personalised and activities were arranged and took place in the home. People’s communication needs had been considered as part of their care planning.
Lessons were learned following accidents and incidents. The registered manager understood their duty of candour and worked in partnership with other health and social care professionals.
There were enough staff to support people and the provider explained they were continuing with on-going recruitment of staff. Infection prevention and control was well managed. Visitors were able to visit people living in the service without restrictions and the provider learned lessons when things went wrong.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
This service was registered with us on 26 November 2020 under a new provider and this is the first inspection.
The last rating for the service, under the previous provider (Tudor Care Limited) was requires improvement published on 16 January 2020.
Why we inspected
The inspection was prompted in part due to concerns received about medicines, environmental risks, staffing levels etc. A decision was made for us to inspect and examine those risks.
We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report.
You can see what action we have asked the provider to take at the end of this full report.
The provider has taken some action in response to risks identified.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Old Rectory (Bramshall) on our website at www.cqc.org.uk.
Enforcement
We have identified breaches in relation to the building and the environment safety, medicines management, systems and processes and overall governance of the home at this inspection.
Please see the action we have told the provider to take at the end of this report.
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.