Bramcote Hills Care Home

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

We identified one breach of the legal regulations relating to this key question. We assessed 5 quality statements in the caring key question and found areas of concern. The scores for these areas have been combined with scores based on the rating from the last inspection. People were not supported to have choice and control and were not provided with opportunities to make decisions about how their support was provided. People were not encouraged and helped by staff to do as much as they could for themselves to maintain their independence. People were not supported to understand their rights and how the service would make sure these were respected. People’s friends and families were free to visit them with no restrictions. People were not provided with opportunities to take part in a wide range of activities.

This service scored 25 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People were not always treated with compassion and dignity with their care and support. One person told us, “When I call for someone to help me get the sides of my bed up – it’s like a cot – sometimes I have to wait. It can be a long time. There’s not enough staff sometimes to stop the screaming.” People told us staff were kind, one person told us, “On the whole they are very gentle. Utmost politeness. 99% are kind.” However, staff were not provided with time to ensure people’s wellbeing needs were always met such as having a chat and responding to peoples care and support needs in a person-centred way.

Staff were able to explain how they treated people with compassion and understood how to ensure peoples dignity was respected. Staff told us they could not always do this due to insufficient staffing. One staff member told us, “When short staffed the amount of compassion and dignity when caring is lessened. For example, if a resident in the lounge can’t settle and they need extra attention, often we can’t give it as have to go back to another resident ASAP. Pressure from the bosses to get them out of their rooms quickly. So, it’s not often that easy.”

Partners had visited the care home after our visit and told they also found people did not always receive compassionate and dignified care due to insufficient staffing levels at the care home.

We observed staff to be rushed and did not always have enough time to provide dignified and compassionate care to people. People’s dignity was not always protected. We observed one person who was living with dementia walking with purpose and had lifted their dress up exposing their incontinence pad, staff had not recognised this and the inspector had to step in to ensure action was taken to protect this persons’ dignity. Staff carried out inappropriate pressure relieving techniques on people within the communal lounge in front of all staff, people and visitors. The staff team failed to ensure they were protecting service users’ privacy and dignity. As stated in the safe part of this report, we observed a number of incidents such as a person being ignored when they shouted out for help and people were asked to wait when they alerted staff for help. This meant people were not always treated with kindness, compassion and dignity. Staff were observed to be kind to people when they were providing care and support.

People were not always treated as an individual. Staff provided task focused care, rather than individual care to people. A person told us “They know I stay awake until very late. People still open my door too early in the morning.” People we spoke with could not explain how they were treated as an individual, people told us they were not sure if staff were aware of their likes, dislikes or preferences.

Staff could explain people’s care and support needs but did not know people as individuals such as their life history. Staff were not provided with personalised care plans regarding people’s preferences, likes and choices. Staff told us they had did not always have time to talk to people to find out about them as an individual. One staff member told us, “Not really enough time to talk and listen to residents, as when we are done with one, we are on to another resident. If had more staff would have time for that”.

We did not observe people being treated as individuals. Throughout our onsite visits, care and support was task focused. For example, once morning personal care support was completed, some people were supported to the lounge to wait for their lunch time meal. There was no meaningful support provided in between mealtimes, so people sat for long periods of time having nothing to do.

The provider did not have a process or system to allow people to be involved in decisions regarding their care and support. Staff wrote care plans that were not shared with people to ensure the information regarding them was correct. This meant people were not provided an opportunity to discuss their likes, dislikes and preferences meaning staff did not have clear guidance on how to treat people as an individual. We found people had not had care and support as an individual.

People were not empowered to have choice and control their care and support needs. People were not given the opportunity to be involved with the care planning records to ensure staff had correct information regarding how they wanted to be supported. Staff were not provided with time to allow people to be as independent as they possibly could be. People told us they did have some choices. One person told us, ‘I can choose what time to get up and where to have breakfast. There are 2 choices at dinner. You can have anything you want for breakfast.” People did not have choices or control regarding activities. A person told us, “There used to be something to do, but now there are not so many activities. They changed the member of staff and put her on other jobs. We used to get an information sheet with activities, we don’t get that now.”

Staff told us people do get choices on what they would like to drink, eat and wear. Staff were able to explain people who lived at the care home who could do their own care tasks such as personal care. However, we were not assured that all the people living at the care home were provided sufficient time with care staff to be encouraged to do as much as they could for themselves because there were not enough staff to provide this support.

We observed staff did not always promote people’s independence. For example, one person’s care plan stated they were diagnosed with dementia and that they were independent with eating and drinking requiring minimal supervision. However, we observed staff fully supporting the person to eat without the opportunity to allow the person to try for themselves. This meant people were at risk of losing their skills and independence. We observed there were no choices for people on how they wanted to spend their time. There were no activities or other opportunities for people to be involved in during the day or night. We observed a person who showed distressed behaviour repeatedly due to not having the opportunity to be stimulated with meaningful activities. This meant people were at risk of having a negative impact on their wellbeing and mental health.

The provider had not provided enough staff on shifts to ensure people could be as independent as possible. People who displayed distressed behaviour were not supported to remain stimulated to ensure they did not become distressed due to boredom. There was no clear guidance on the person’s preferred routines. The guidance also promoted the person’s independence as much as possible. People could not easily access their friends and family. One relative told us, “at the weekend there are not so many staff. Not easy to get in touch by phone, and you have to attract someone’s attention to get into the home by knocking at a window to get in.” There was no system or process in place for people to be involved in meaningful activities. People told us they did not have access to activities within the care home.

Due to insufficient staffing levels, we found staff were not always able to respond to people’s immediate needs. People and relatives told us when they press their call bell for staff support, they do have to wait a long time before staff respond. One relative told us, “Sometimes there aren’t enough staff. Buzzers are always going off and they are not answered for ages.” A person told us, “They don’t come straightaway if they are busy. There are never enough staff. It’s the evenings and night when you have to wait longer.”

The management team told us their policy was for call bells to be answered within 3 minutes. However, throughout our onsite assessment the call bell response time would go over 3 minutes. This meant staff did not always respond to people’s immediate needs. Staff told us they tried their best to respond to people’s needs immediately but this was not always possible. One staff member told us, “The call bell response time can vary. After a time, the sound changes to emergency and then managers are on the walkie talkies tell someone to go to the emergency. It is not always possible to go right away if in with another resident, the sound and the walkie talkie add to the pressure, we are all rushing about. Could be supporting a resident who needs 2 staff and then, one of you has to go and leave your colleague with them on their own, when you know they there should be two staff. It’s not right. This is a daily occurrence and multiple times a day.”

We observed staff were not always responsive to people’s needs ensuring they were safe. For example, there were not always enough staff available in the communal areas when there were people present. One person had identified risks of verbal and physical abuse towards staff and service users. We found there were not sufficient staff on duty to supervise this person ensuring other people were safe. This placed people at risk of physical and verbal abuse. We found people who were assessed as a falls risk and required supervision to be left unsupervised. This placed people at risk of harm. We also observed a person had a large skin tear on their right arm. We observed it to be red, weeping, sore and not treated. We asked staff who were supporting this person and they told us they did not know it was weeping and the nurse in charge told us it had healed and had not been made aware of any changes. The person required full staff support for all areas of their care and none of the staff had noticed the skin tear scabbing had come off. This meant the person was placed at a heightened risk of developing further pressure damage and unnecessary pain and suffering.

Staff told us their wellbeing was not considered and that they were consistently under pressure to get tasks done with a level of staff that made it extremely hard. One staff member told us, “It is exhausting, it’s like, where do the management want us to go, what do they want us to do, because we can’t be everywhere.” Staff told us there was no staff facilities and they work 12 hours shifts. One staff member told us, “There was an area for staff that had a fridge and microwave, these have been condemned and removed with no indication that they will be replaced. Staff cannot use fridges etc that are used for residents so there is nowhere for staff to store food especially in hot conditions, it’s not good, or to warm up hot meal. We work long hours and are intitled to breaks and should have an area that is suitable. Staff have raised concerns and have been told that there isn’t a room for them. They (management) want any rooms to be filled with residents.”

The provider had provided staff with a break during their shifts, however the provider failed to ensure there was a safe system and process. For example, during the three breaks provided throughout the day shift, 3 staff went on their break at the same time without being replaced, leaving the care home understaffed.