Bramcote Hills Care Home

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We assessed 2 quality statements in the effective 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. Peoples needs and rights were not supported. Peoples care and treatment was not effective due to their health, care, well-being, and communication needs not being assessed with them. Peoples care plans were not kept up to date and assessments were not completed in a timely manner. Staff were not aware of people’s preferences and people were not supported in a person-centred way. People were not aware of their rights around care and treatment. Staff did not have good knowledge of the mental capacity act, including capacity and consent. Staff were not aware of how to support someone with fluctuating capacity.

This service scored 58 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People did not have their assessed needs always met. People who required positive behaviour support to manage behaviour of distress did not have good outcomes from their support. One person had one to one staff support in place to support them. This support was ineffective. We observed the staff member not engaging or interacting with the person to provide any positive behaviour support. No effort was made to look out for early warning signs to ensure positive techniques could be used before the person showed distressed behaviour. This meant the person went from one incident to another and was at risk of further distress. People were not provided with an opportunity to be part of their assessment to assess their own care and support needs. People told us that they were not aware they had a care plan. People were not confident that their needs were understood by the staff team, to ensure they were supported in a person-centred way. One person said, ‘I don’t think they[staff] know what I like or what I’m interested in.”

The management team were not always aware of people’s risk assessments and care plans did not reflect people’s current needs. The care planning records did not provide staff with clear guidance to ensure peoples assessed needs were appropriately met. Staff did not have good knowledge of how to support people’s needs, and what action to take if the person’s needs appeared to have changed. One staff member told us, “I know where the Care plans are. I don’t check them every time because I am working, I’m not sure if they are up to date.”

During the onsite assessments, we found serious shortfalls in risk management, placing people at risk of harm. We found a lack of meaningful or appropriate risk assessments for service users who had identified risks. People’s needs were not always assessed. There was no system in place to ensure people’s risks were assessed or reviewed as needs changed. There was no system to ensure staff had all the information required to provide care that met people’s needs. A range of national assessment tools were not always used to understand people’s needs and how best to support them. For example, people who were supported in bed did not always have a waterlow risk assessment completed. A water low risk assessment is a vital tool in identifying and/or managing pressure ulcers. There were people living at the care home who displayed behaviours of distress and verbal abuse towards others. However, staff were not provided with care plans or risk assessment on how to best support people when they showed these behaviours. Staff were not aware how to respond. We observed a person who was distressed, and staff did not know how to respond so left their bedroom. Staff were not provided with reflective information and guidance on peoples assessed needs. Where people’s needs changed, their care planning documents were not updated so staff understood people’s changes in needs. For example, a person had a speech and language assessment completed on 10 April 2024 and it clearly stated for staff to use a teaspoon for supporting with meals. However, we observed a staff member supporting the person with a tablespoon. The person was showing signs of coughing and the staff member did not recognise this response as a risk of choking. The staff member told us they had not been made aware of the change to the person support. People’s communication needs were recorded and understood by staff. This allowed staff to communicate with people to have a clear understanding of the person’s needs.

People’s dining experience was poorly managed. We observed people were seated over 40 minutes before a meal was served. Some people had finished their pudding while others were waiting for their meals. Due to insufficient staffing levels, we were not assured people had their nutritional and hydration needs met. During our onsite visit we did not see any hydration stations where people could help themselves to a drink. People were reliant on staff asking them and staff having time to make individuals a drink. People who required support with incontinence pads told us they had to wait to have their support. One person told us, “If you want a pad changing you can wait for hours. They say, ‘It’s lunchtime you will have to wait.”

Staff were able to explain who required full staff support with their food and drinks. However, they explained that some people would need to wait while a staff member become available to offer this support. Staff told us incontinence care was done at set times as most people needed a pad change every 4 hours. This meant people did not always have care and support around personal care needs. Kitchen staff were able to explain people’s specific dietary needs. They told us how they were working to ensure people who required a modified diet had their needs met, for example, people who had lost weight required a fortified diet.

People did not have their nutrition and hydration care and support needs met. People who were cared for in bed and required full support from staff to eat and drink were left to wait for their drinks and meals until staff were available. We observed a person’s lunch meal was brought to them at 12:00. However, they were not supported till 13:02 because there was not sufficient staff. Staff had not considered the time the food had been sat there and if was safe to eat and if the food was still hot. People’s nutrition and hydration needs were not always supported in line with current standards. Staff had identified people at risk of weight loss and implemented monitoring records to show how much food people were consuming. However, the records lacked detail to enable effective monitoring to take place. This increased the risk of people becoming dehydrated or poor malnutrition. Peoples care records did not include people’s preferences of food and drink. We found a person had been given a drink without their prescribed thickener. This placed them at risk of harm due to having a drink at the wrong texture which would place them at risk of choking.

We did not look at How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Monitoring and improving outcomes during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Consent to care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.