About the service:

Bournbrook Manor Home is a residential care home that provides accommodation and personal care and support to a maximum of 23 older people and for some older people living with dementia. At the time of our inspection 15 people were living at the service.

People’s experience of using this service:

¿ People told us they felt safe. Safeguarding systems and practices protected people from abuse.

¿ However, people were not always kept safe because risks were not always assessed, monitored or mitigated.

¿ People shared mixed feedback in relation to staffing levels. However, staff told us there were enough staff available to meet people’s needs.

¿ Systems and practices required improving in relation to the safe management of medicines.

¿ Accidents and incidents were not always followed through with the appropriate action to minimise the risk of re-occurrence. Where lessons could be learned to improve the service, and make the care people received safer; these were not always identified and addressed.

¿ People received care from staff who had not always completed mandatory training the provider had required.

¿ Staff involved and consulted a range of health and social care professionals to ensure people's healthcare needs were met.

¿ People told us they enjoyed their meals but were not enabled or involved in the planning of their meals.

¿ Although staff knowledge of Mental Capacity Act (2005) had improved people did not always have their legal rights protected as the staff did not know which people had Deprivation of Liberty Safeguards authorisations in place or how to support people in the least restrictive way.

¿ People said staff were kind and caring but interactions between staff and people were generally task orientated with limited sustained interaction.

¿ People’s dignity, privacy and confidentiality were compromised on occasions

¿ There were limited opportunities for engagement and stimulation for people living with dementia.

¿ People did not always receive care and treatment that was responsive to their needs or provided in a person-centred way. People's care plans were not consistently being followed and some were not current or reflective of people’s needs.

¿ People were not consistently supported to be involved in the planning or reviewing of the care they received.

¿ Relevant care documents were not accessible to meet people’s individual communication needs.

¿ People told us they felt confident to raise a complaint. However, Information about how to raise concerns had not been produced in an accessible format for people who had a visual or cognitive impairment.

¿The provider had developed systems for identifying, assessing and mitigating risks, however, these had not always been operated effectively. The registered manager carried out audits of the service but these had failed to ensure that people were always safe and that their needs were being met.

¿ The providers systems had not been effective at improving the quality of the service and the service had failed to achieve and sustain a minimum overall rating of ‘Good’ at three consecutive inspections.

¿ A new management team had been introduced and they were very committed to driving improvement to enhance the quality of the care and support delivered to people.

Rating at last inspection:

The service was rated Requires Improvement overall. Our last report was published on 02 May 2017.

Why we inspected:

This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received. At this inspection on 05 March 2019, we found the provider had failed to sustain and build on improvements and the service had deteriorated.

Enforcement:

We found that the provider was not meeting all of the requirements of the law. We found multiple breaches in regulations. You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC's regulatory response

We carried out this unannounced inspection on the 2 May 2017. Bournbrook Manor care home is registered to provide care to 23 older people with a variety of needs including the care of people living with dementia. At the time of our inspection 18 people were residing at the home.

At our last comprehensive inspection in April 2016 we found that the registered provider was in breach of regulations. This was because the provider did not have effective systems in place to assess and monitor risks relating to the health, safety and welfare of people using the service. The provider did not have robust systems in place to monitor the quality of the service. In addition the provider did not ensure that the care and treatment of service users was provided with the consent of the relevant person. Following the inspection the registered provider submitted an action plan detailing how they would improve to ensure they met the needs of the people they were supporting and the legal requirements.

We undertook this unannounced inspection on the 2 May 2017 to check that the registered provider had followed their own plans to meet the breaches of regulations and legal requirements.

We found that the registered provider had addressed some of the concerns that we had identified at our last inspection and had met their action plan and the breaches of regulation. We found that the provider had further improvements to make in respect of enhancing the knowledge of the Mental Capacity Act (MCA) within the staff team and to improve auditing processes.

The registered manager was present during our inspection. 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 that could tell us said that they felt safe living at the home. People were supported by staff who had received training on how to protect people from abuse. There were enough staff on duty to meet people’s needs and recruitment checks on new staff had been completed before they started to work. People received their medicines as prescribed.

People’s consent was sought, but staff had limited knowledge of the MCA and the Deprivation of Liberty Safeguards (Dols). Staff told us they had the knowledge and skills to support people to meet their individual needs. People’s nutritional and dietary needs were assessed and people were supported to eat and drink sufficient amounts to maintain their health. People were supported to access a number of healthcare services.

Staff demonstrated some caring and compassionate practice and staff demonstrated a positive regard for the people they supported. People received care and support from staff who knew and understood their individual preferences and needs. People’s privacy and dignity was respected.

People’s needs had been assessed and most care plans developed to inform staff how to support people appropriately. Activities were provided but improvements were planned to ensure people had the opportunity to participate in activities of interest to them. People felt able to complain and were confident concerns raised would be addressed.

People had confidence that the registered manager was improving the service they received. People and staff consistently told us that the registered manager was approachable. We found that although there were some systems in place to monitor and improve the quality of the service provided, these were not always effective in ensuring the home was consistently well-led.

We inspected this home on 5 and 6 April 2016. This was an unannounced inspection. The home was last inspected in May 2013 and was meeting all the regulations. The home is registered to provide personal care and accommodation for up to 21 older people. The home provides care to older people with a variety of needs including the care of people living with dementia. At the time of our inspection 20 people were living at the home. We observed how care was provided to people and whether people were happy living at the home.

The registered manager was present during our inspection. 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 told us that they felt safe living at the home. Relatives confirmed that they thought the home kept people safe. Staff were able to demonstrate a good understanding of procedures to follow to keep people protected from abuse and harm. We found that the registered providers systems and processes had not always ensured the risk to people was minimised. Although there had been no medication errors in the last twelve months, systems were not robust enough to ensure that medications were safely administered.

Staff we spoke with told us training was provided, however training to develop staff’s knowledge in relation to specific health conditions was not provided. Care plans did not reflect people’s level of capacity. Staff lacked the understanding of the Mental Capacity Act (2005) and what it meant for people living in the home. People’s rights had not been supported in line with the legislation.

The home did not always have effective systems to monitor and improve the quality and safety of the care provided to people. People, their relatives and staff consistently told us that the registered manager was kind and approachable. People’s views had been sought but not consistently acted upon.

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

People were supported to have food and drink in sufficient quantities to meet their needs and help maintain good health. People’s health was supported by access to appropriate health professionals.

We saw interactions between staff and people living at the home which were kind and compassionate. People gave us mixed feedback about the staff. Some people said staff were kind and did all they could to help them, others told us some staff were not caring.

People were enabled and encouraged to make decisions about their care. People told us that they had been involved in planning and agreeing to the care provided. People and those that mattered to them did not always contribute to the reviewing of care plans. Staff knew people well and could describe individual preferences of the people they were supporting.

We saw that some arrangements had been made to provide people with interesting things to do. However activities were not always person centred to meet people’s individual choices.

There was a complaints process that people and their relatives knew about. People told us that they felt comfortable to raise concerns and told us staff would listen and support them. Systems were not in place to record complaints and concerns that would help the provider to learn and to improve the home.

At our last inspection in January 2013, we found that the management of records needed improvement. We followed up these concerns at this scheduled inspection and found that suitable records were now being maintained and that these were easily located when requested.

At this inspection we spoke with five people who lived in the home. All of them confirmed that the staff were caring, they were given choices about how they were supported and that they felt safe. Included in their comments were: "I can tell staff how I want things doing and they ask me if they are doing it right," "The staff are little angels, they treat me with respect," and "The manager (and deputy manager) controls the staff properly."

We saw that staff treated people with respect and responded when people asked for assistance. People were not overly restricted by routines or regimes within the home; for example they could choose where to spend time in their room or in the communal areas, and exercised choice about when, where and what to eat.

Staff at the home were knowledgeable about people's health conditions and the care and support people needed. People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

Although some people who lived at the home had dementia we were able to speak with other people that lived there. We spent two hours in a communal area observing care being provided. We spoke with eight people and all but one of those we spoke with were positive about the care and treatment they received in the home. One person was concerned about the facilities but did not want to tell us anything more. We also spoke with one person's relatives, three staff, the manager and one of the owners of the home.

Staff spoken with were able to tell us about people's needs so that they received care in a way that they preferred. The relatives spoken with told us they were consulted about their relative’s care and kept informed about their health so they felt involved in their care. One of the relatives told us “I know that my relative is truly loved by the staff here, they let her be who she is and has always been."

People received there medication as it was prescribed.

There were enough care staff to ensure that people had the care and support they needed. Care staff were knowledgeable about people's care needs.

There were systems in place to monitor how the service was provided. Records needed to be improved so that important information about people's health and well being could be retrieved quickly.

We carried out this review to check on the care and welfare of people using this service as we had not visited it for some time and had limited information on the quality and safety of the service being provided.

Eighteen people were living in the home when we visited and we talked with six of them and a relative of another person about their experience of living there.

The people living in the home and the relatives we talked with were happy with the quality of the care provided. They said things like “They look after me well” and “The staff are very good and very helpful.” One person who had moved in recently said their relatives had found the home for them and they were pleased with their choice.

People and their relatives told us staff treated them with respect and helped them to be as independent as possible. One person said “Staff help you with what you want.”

People and their relatives told us they were happy with the meals provided at the home. They said “They’ve got a nice cook.”

People and their relatives told us that, if they needed extra support or if they needed to see a doctor, staff arranged this. One person said they had not needed a doctor but “I’m sure they’d call one if necessary.” One relative explained that, when the person living in the home was very unwell, staff had worked hard to look after them in the home, so they did not have to go to hospital.

People and their relatives told us they could raise concerns if they were not happy with the care being provided and they were confident they would be taken seriously. They said “If I’ve got any problems, (the manager) sees about it.”