Britannia Care Home is a purpose built facility in Girlington, Bradford close to local amenities. The home provides accommodation for a maximum of 39 people who have mental health needs.

Accommodation is provided across three floors. There is clear access to all floors for wheelchair users with a passenger lift and a ramp for wheelchair access at the front of the home.

The inspection was carried out on 14 September 2017 and was unannounced.

At the time of the inspection there were 38 people living in the home.

A registered manager was 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.

At the last comprehensive inspection in August 2016 we identified one breach of regulation in relation to the safe management of medicines (Regulation 12). During this inspection we found the required improvements had been made.

People told us they liked living at Britannia and felt safe. Staff were aware of how to identify and report any concerns about people’s safety and welfare.

There were enough staff available to ensure people received appropriate support. The required checks were completed before new staff started work and this helped to protect people. Staff were trained and supported to carry out their duties.

The home was clean and maintained in a safe condition. People told us they liked their rooms.

Risks to people’s safety and welfare were identified and managed. Within people’s care records there was some duplication of the information recorded in their care plans and risk assessments. The registered manager had already identified this and was dealing with it.

Incidents and accidents were recorded and investigated and action was taken to reduce the risk of reoccurrence. The records showed physical restraint was only used when it was in people’s best interests and necessary to prevent harm.

We found improvements had been made to the way peoples medicines were managed and people told us they received their medicines at the right times.

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We found the service was acting within the legal framework of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) which helped to make sure people’s rights were protected and promoted.

People had access to advocates to help ensure their views were represented.

Everyone told us they enjoyed the food. People were offered an excellent choice of food which reflected their preferences and cultural needs. Appropriate action was taken to support people who were at risk of poor nutrition.

Within the care records we saw evidence people had access to a range of health and social care professionals. The feedback we received from other agencies involved with service was positive. They all told us they felt the registered manager and staff worked well with them for the benefit of people who used the service.

People told us staff were kind and treated them with dignity and respect. This was confirmed by our observations of care and support. People were supported to maintain their independence. Equality and diversity was promoted, for example, people were supported to celebrate a diverse range of religious festivals.

People were supported to take part in a range of activities. The registered manager was eager to recruit a dedicated activities coordinator to improve people’s access to social activities.

There was a system in place to log, investigate and respond to any complaints received. People told us they were confident the registered manager would listen to them and take appropriate action if they had any concerns.

There was an open and inclusive culture within the home. The registered manager provided strong leadership and a good role model for staff. We found t

Britannia Care Home is a purpose built facility in Girlington, Bradford close to local amenities. The home provides accommodation for a maximum of 35 people who have mental health needs. Accommodation is provided across three floors. There is clear access to all floors for wheelchair users with a passenger lift and a ramp for wheelchair access at the front of the home.

We inspected the service on 16 August 2016. This was an unannounced inspection which meant we did not give the provider notice of our visit. At the time of the inspection there were 31 people living in the home.

A registered manager was 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.’

At the last comprehensive inspection in December 2015 we identified numerous breaches of regulation, rated the service as’ inadequate’ overall and placed it in special measures. At this inspection we found improvements had been made driven by a service improvement plan. Increased management support had been provided. As a result we withdrew the service from special measures.

People and staff we spoke with told us the service had improved and they were satisfied that good quality care and support was now provided to people.

However we identified some concerns regarding the way medicines were managed. One person had not been taking their evening medicines and satisfactory steps had not been taken by the service to protect this person from harm. We found other people’s medicines were better managed.

People told us they felt safe whilst using the service. Risks to people’s health and safety had been assessed and clear and person centred risk assessments put in place which were well understood by staff.

Sufficient staff were deployed to help ensure safe care. Additional staff were deployed if required to manage distressed behaviour. Robust recruitment procedures were in place to help ensure staff were of suitable character to work with vulnerable people.

The premises was suitably maintained and checks were regularly undertaken to ensure it was in a safe condition.

People told us staff were suitably skilled to care for them. Staff had received a range of training with further training planned over the coming months to address identified shortfalls.

A range of food was provided to people based on their individual likes, dislikes and cultural preferences. The risks associated with malnutrition were appropriately managed by the service.

People had access to a range of health professionals. However the recording of health professional visits needed to be made more robust to make clear the outcome of appointments and visits.

The service was acting within the legal framework of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS).

People told us staff were kind and treated them with dignity and respect. This was confirmed by our observations of care and support.

Information on people’s likes, dislikes and histories had been obtained by the service. Staff demonstrated a good understanding of people they were caring for. This helped ensure personalised care was provided that met people’s individual needs.

Care records demonstrated that people’s needs had been assessed and clear and person centred plans of care put in place. These were well understood by staff, giving us assurance that appropriate care was being provided.

An improved provision of activities had been put in place. A new activities room had been set up and regular trips out into the community took place.

A system was in place to log, investigate and respond to any complaints received.

Since the last inspection, improvement plans had been effective in raising the overal

This inspection took place on 21 December 2015 and was unannounced.

During our previous inspection on the 29 April 2015 we identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to make improvements in relation to; the management of medicines, governance systems and processes, and the safety and suitability of the premises. During this inspection we checked improvements had been made in these areas and re-rated the quality of the service provided.

Britannia Care Home provides accommodation, personal care and support for a maximum of 35 people. On the day of our inspection 31 people used the service. Most people who use the service have enduring mental health needs. The service is situated in Girlington, Bradford close to local amenities. The bedroom accommodation is a mixture of single and shared rooms, many with en-suite facilities. Communal space includes a dining room and two lounges.

The service has two registered managers. 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.

We identified a number of areas where potential risks to people’s health and safety had not been appropriately assessed, monitored and mitigated. There was a lack of robust information to assist staff in managing this risk, and where information and guidance was provided this was not always being followed.

We noted an improvement in some aspects of the premises. However, appropriate assessments were not being completed to ensure that people’s bedrooms and the overall environment was safe and appropriate to people’s specific needs.

We found recruitment procedures were not robust and consistent. This placed people at risk of harm as the suitability of staff had not been thoroughly checked before they commenced work.

No concerns were raised by people who used the service, relatives or staff about the staffing levels. We observed staff were available to respond to people’s needs. However, we found improvements were needed to ensure the staffing levels were robustly reviewed and assessed as people’s needs changed.

The staff were confident about how to identify and act upon any allegations of abuse or if they were concerned about people’s wellbeing. Procedures were in place to monitor and respond to safeguarding incidents and allegations. Improvements had been made to how money was managed.

Overall we found medicines were now managed more safe and robust way. Some minor improvements were still on-going, however the registered manager had plans in place to address these areas.

People told us the food was good. However we identified concerns about how staff monitored people’s weight and ensured their nutritional intake was sufficient.

Staff worked closely with other healthcare professionals to ensure people’s physical and mental health needs were met. However, improvements were needed to ensure any advice was translated into the care planning system to ensure staff could evidence they had taken appropriate action.

Staff acted within the legal framework Deprivation of Liberty Safeguards and the Mental Capacity Act 2005.

Most people and relatives we spoke with said they were happy with the care provided and praised the staff. People told us staff treated them with respect and were polite. However improvements were needed to ensure the care people received was consistently good and person centred.

Care records were not always complete, accurate and person centred. This risked that people would not always be provided with appropriate care and support.

Although many people who used the service accessed the community independently, some improvements were needed to ensure activities were planned more effectively, particularly for those people who did not have the confidence or ability to leave the home without staff’s support.

A complaints procedure was in place and the registered manager operated an open door policy to encourage people to come to them directly with any concerns or issues. It was not always clear that lessons had been learned from the complaints people had made.

Although some improvements had been made to some audits. Overall the systems and processes in place to monitor, assess and improve the quality of service provided were not sufficiently robust. We were concerned that the registered managers and provider did not have the knowledge and understanding to develop, implement and maintain robust governance systems.

We identified four breaches of legal requirements. You can see what action we have asked the provider to take at the back of the full version of the inspection report.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We inspected the service on 29 April 2015. The inspection was unannounced.

We previously inspected this service on 4 August 2014 and found legal requirements had been breached in relation to; records and assessing and monitoring the quality of service. We asked the provider to make improvements and they wrote to us to say they would take action to ensure they met legal requirements in these areas by the 31 October 2014. During this inspection we checked these areas and found there had been some improvements and therefore the risk to people had been reduced. However, further improvements were still required to ensure legal requirements were fully met.

Britannia Care Home provides accommodation, personal care and support for a maximum of 35 people. On the day of our inspection 32 people used the service. Most people who use the service have enduring mental health needs. The service is situated in Girlington, Bradford close to local amenities. The bedroom accommodation is a mixture of single and shared rooms, many with en-suite facilities. Communal space includes a dining room and two lounges.

The service has two registered managers. 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. Feedback from people and staff about the registered managers was positive. However, we noted it was sometimes unclear which manager held responsibility for specific areas of the service. This was being addressed by the provider.

We found some improvements had been made in relation to the processes in place to assess and monitor the quality of the service. However, it was too early to be assured that these improvements could be sustained and to demonstrate that the processes were fully embedded, refined and robust. We also found additional systems were required to ensure the service could demonstrate when and how improvements to the service were made.

We found appropriate arrangements were not always in place to ensure the proper and safe management of medicines.

At the time of the inspection the home was undergoing renovation work. We found the provider had not taken appropriate action to ensure people’s safety by ensuring the security of the areas being worked on. We also found other areas of building were not secure, properly maintained and suitable for the purpose for which they were intended to be used.

People told us they felt safe. Staff had a good awareness of the action they would take to keep people safe, such as in the event of an emergency or if they suspected someone was at risk of abuse. However, this was not always supported by functional and appropriate procedures and protocols.

We found improvements had been made to the organisation of records kept in relation to the running and management of the service. However, care records were not always complete, accurate and did not always provide appropriate guidance for staff to follow. We also found there was a lot of duplicated information in people’s care records which made reviewing the person’s current needs difficult.

Overall people told us the food was good. However, we saw that people’s preferences were not consistently taken into account in relation to the food and drink on offer. We also found there was a lack of attention to detail to ensure mealtimes were a positive experience for people.

We found there were sufficient numbers of staff to meet the needs of the people who used the service. Staff were subject to a thorough recruitment process and received ongoing training to ensure they had the skills required to support people.

Staff demonstrated a good understanding of the people they cared for and what each individual liked and disliked. Staff treated people with respect and dignity and helped to support people’s cultural and religious beliefs. We also found staff had a good understanding of the Deprivation of Liberty Safeguards and the Mental Capacity Act 2005 and understood their role in protecting the rights of people with limited mental capacity.

People were involved in six monthly reviews of their care and told us they felt involved in making decisions about the care and support they received. However people were not supported to pursue their interests, find new interests or develop their life skills. We found an absence of activities to ensure people were stimulated and there was no structured activities programme available.

We identified that three legal requirements had been breached. You can see what action we told the provider to take at the back of the full version of the report.

We have considered all the evidence we gathered during our inspection. We used the information to answer the five key questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

This is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, and the staff told us.

Is the service safe?

At the time of our visit there were 25 people who lived at the home. We spoke with five people. They raised no concerns about their safety with us during our visit and said if they had concerns they would discuss them with the manager

Each person's care file had risk assessments which covered areas of potential risk. When people were identified as being at risk, their plans showed the actions required to manage these risks.

Safeguarding procedures were in place to protect people from the risk of abuse and we found staff understood their roles and responsibilities in safeguarding the people they supported.

From our review of care records we found evidence that people were not always protected from the risks of unsafe or inappropriate care and treatment as the care provider did not maintain accurate and relevant records in relation to the care and treatment provided to people. We have asked the provider to tell us how they will make improvements to meet the requirements of the law in relation to records.

Is the service effective?

People were being cared for by staff with the appropriate skills and who were supported to deliver care and treatment safely and to an appropriate standard.

The home worked closely with community based services in specific areas of people’s care which included both their physical and mental health. The input of other healthcare professionals involved in people's care and treatment was recorded in care records.

Is the service caring?

The people we spoke with told us they were happy with the care and support provided. One person said “It’s really good here, I like it a lot. Staff help me to remember when I need to go to my hospital appointments which is important for me”. Another person said “You won’t find anything wrong here; it’s alright, I am happy”. Someone else said “It’s nice here, I have lots of friends. Staff are kind and take me to the doctors if I feel unwell”.

Staff were aware of people’s preferences, interests, aspirations and diverse needs. Our observations of the care provided, discussions with people and records we looked at told us that individual wishes for care and support were taken into account and respected.

Is the service responsive?

People’s needs had been assessed before they began to use the service. Care plans were also reviewed each month or sooner if there was a change to people’s needs. However, we found care records did not always reflect people’s current needs. We also found the manager was not able to produce all of the records requested during the inspection. This showed us the service did not have appropriate systems in place to store records in a secure but accessible way which maintained confidentiality and ensured they could be located promptly when required. We have asked the provider to tell us how they will make improvements to meet the requirements of the law in relation to records.

Is the service well-led?

We found the provider did not have a robust quality assurance monitoring system in place that was designed to continually monitor and identify shortfalls in the service and any non-compliance with the essential standards of quality and safety. We have asked the provider to tell us how they will make improvements to meet the requirements of the law in relation to how they assess and monitor the quality of service people receive.

Our inspection on the 13 June 2013 found the provider had not carried out the appropriate checks before staff were recruited and financial and staff records had not been correctly maintained. Following the inspection the provider wrote to us and told us they would take action to ensure they were compliant with these essential standards.

At this inspection we found improvements had been made and the provider had followed a more robust recruitment process and the staff and financial records were appropriately maintained.

Four people who used the service told us they “Liked the staff” and they were “Very good”.

We spoke with three people who used the service and they told us they were happy at Britannia Care Home. One person told us, "I like it here” and another person said, "it's lovely here I have a care plan and they review it with me." We spoke with another person who told us there were activities for them to take part in on a daily basis.

Everyone said the staff were wonderful and the owners, who worked in the home every day, were very approachable and supportive. People said the food was very good and the home was clean and comfortable.

However we found that staff recruitment processes were not robust and records were not maintained appropriately

We spoke with four people using the service and they told us they were happy at Britannia Care Home. One person told us, "All the staff look after me well." And another person said, "The staff helped me to have a bubble bath this morning, it was good, it relaxed me."

We spoke with one person who told us there were activities for them to take part in however, they also told us they chose to watch the television, listen to music and read. They told us they played chess with other service users and members of staff. These are examples that people are able to take part in activities they enjoy doing and there are organised activities taking place.

Another person said, “I would not want to live anywhere else it’s very good here.”

We were also told by people using the service they were looking forward to a visit to Blackpool to see the ‘Lights’ in September.

One person we spoke with told us they thought there were enough staff to look after them.