Bramcote Hills Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – We looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question inadequate. At this assessment the rating has changed to requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed. We identified two breaches of the legal regulation to this key question.

This service scored 53 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People living at Bramcote Hills Care Home continued to not be involved in any learning. People told us they had not been involved in any discussions or meetings about safety. This meant there was not always an effective learning culture.

Learning from incidents did not take place in order to reduce the risk of incidents reoccurring. Staff were unable to explain what learning they had been involved in. The staff told us a lot of changes had been made since the last CQC visit and felt the management team had learnt and are making the required changes to ensure the service is safe. The manager was able to explain their system and process at management level regarding a learning culture. For example, they told us they reviewed all incidents and accidents to look for themes and trends. However, they could not demonstrate how staff and people were involved with any learning.

The provider did have a process in place for the management team to review incidents and accidents. Records demonstrated they were reviewing incidents to learn from. However, staff and people living at the care home were not provided with the opportunity to reflect after incidents to ensure learning and improvement could effectively occur.

People told us that communication between the care home staff and other health providers was good quality. One person told us they have a person visit them for rehabilitation and it’s been working well.

Clinical staff had good knowledge of which health and social care professionals supported which people. Staff were able to explain when these professionals visited and what type of support they offered. However, the clinical staff continued to provide staff with poor information regarding people’s care because care plans were not reflective of the feedback health professionals had provided.

Since our previous visit we received further concerns from a health partner who continued to tell us that the communication between staff and health professionals was poor. For example, emergency services attended the home and staff lacked knowledge regarding the persons care and health needs. Another health visitor told us they had seen an improvement, and this impacted positively on the person they visited as staff were following the guidance they provide.

Staff did not keep clear summary documentation on people’s holistic needs. If the person required a hospital admission and information was shared, the information would have been incorrect. This meant hospital staff would not have clear guidance on how the person liked to be supported.

People were not always protected from harm, during our assessment we observed care and treatment that had potential risk of harm. We observed choking risks and risks of neglect, and we saw evidence of when people did not receive continence care, despite when people had told staff they needed help with care. People told us they had seen improvement, and they felt safe from abuse. One person said “I do feel safe now, the staff are much more visible.” People told us that there were no unlawful restrictions imposed on them. They were free to complete their own routines and live their lives as they wished. Some people would be at risk if they did not have continuous supervision and control. Where this was the case, we saw staff had applied the suitable Deprivation of Liberty Safeguards. These safeguards ensure people who cannot consent to their care arrangements in a care home or hospital are protected if those arrangements deprive them of their liberty.

Staff understood how to respond to allegations of abuse. Staff told us that they had no concerns, but if they did, they were now confident the new management team would act appropriately. Staff were confident in using whistleblowing processes if they felt concerns were not being responded to. Staff told us if action was not taken, they knew they could raise concern to the CQC. Staff had completed safeguarding training. However, we were not assured staff were always able to put this training into practice. The new manager understood how to respond to allegations of abuse. They had a clear process of how to investigate and keep people safe.

We saw that people and staff had positive relationships. We saw no evidence that people were fearful of the staff team. However, a person had raised concerns regarding a staff member that “huffed” when they request something.

The new manager had a system and process to audit incident and accidents. If an allegation of abuse was made, there were appropriate policies in place to guide the staff team. Records showed that incidents were quickly investigated and referred to the local authority safeguarding team if needed. We continued to find poor progression in ensuring The Mental Capacity Act 2005 (MCA) was followed. The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. We found assessments were not always completed or lacked the key principles of the Act to make best interest decisions. The management team have told us since our visit they have taken action and completed the required assessments to ensure they meet The Mental Capacity Act.

The service continued to not work well with people to understand and manage risks. People told us they had not been involved in their risk assessments. This meant we were not assured staff had accurate information and guidance on how people wanted to be supported with their known risks. One person told us, “Occasionally they [staff] have forgotten to switch my buzzer on and that worries me as I can’t get out of bed and ask for help by myself.”

The management team told us they had asked people if they wanted to be involved in their risk assessments but they had declined. However, people told us they had not been asked and would like to be involved. The manager could not demonstrate when people had been asked.

We saw people were not always supported safely. We observed a person being supported to eat while they were in a deep sleep. The staff member supporting them did not recognise the risks this posed especially in relation to choking. Inspectors intervened, and the staff member did not recognise the concerns and told us it was ok to continue. A senior staff member then intervened and asked the staff member to stop supporting them to eat. We observed one person who became distressed and staff were quick to respond and offer support that reduced their agitation. This meant the person was kept safe as their distress did not escalate.

The provider did not have systems in place to ensure people were involved to manage risks and ensure staff were provided with reflective guidance on how to support people with risks. People’s care plan demonstrated people were not involved in managing risks. The new manager was in the process of making contact with relatives and inviting them to be involved in care plans. People’s needs were not clearly documented in their care plans so staff did not always have clear guidance on a person’s mental, physical, health and social needs. For example, we found all diabetes care plans to not be reflective to people’s needs. This meant staff were not provided with clear information and guidance regarding how to support people with their glucose levels. The management team told us they had worked with the NHS diabetes nurse to ensure their care plans are person centred and provide staff with clear information and guidance. Where incidents had occurred, there were not opportunities for staff and people to review what had happened and ensure measures were put in place to prevent this reoccurring. Staff did not always keep clear records on how they had supported people and at what time. This meant there were missed opportunities to allow changes in a person’s needs to be identified and improvements made to their planned care. Staff had received training on how to support people’s individual needs. Some people at the service could become distressed due to their mental health diagnosis. Staff had received training on how to support people when they became agitated.

People felt the environment was managed safely. A person showed the inspection team their bedroom. They explained that they felt their bedroom felt safe to them. People told us that the call bells in their bedrooms were always working and accessible. This meant they could request staff support if needed.

The management team described a clear process for monitoring the safety of the environment. For example, the new manager documented their regular checks around the building and explained how they passed concerns to the maintenance team to resolve. We saw that any areas they had picked up, had been resolved to keep people safe.

Some people at the care home used equipment (like walking frames or hoists). We saw these pieces of equipment were well maintained and stored appropriately. The home was safe in the event of a fire. Corridors were clear of any blockages, allowing people to follow easy to read escape routes. Staff had access to firefighting equipment. Windows were unable to be opened wide. This safety feature prevents people from falling or climbing out and is in line with guidance from the health and social care executive.

The environment was kept safe, by regular checks and maintenance. We saw there had been regular checks to ensure the home was safe in the event of a fire for example, by checking the alarm systems. People had access to call bells to call for support if needed. Documentation showed these call bells were regularly checked, ensuring that they were working and effective.

We received mix feedback from people regarding staffing. Some people told us there were improvements made to the staffing levels and there was enough staff, and any needs were responded to quickly. One person said, “before no one use to come and now it’s like Piccadilly Circus. It is much better.” People felt staff were well trained and knew how to meet their needs. However, another person told us that there is “Not sometimes enough staff. No. Sometimes I think there aren’t enough at nighttime. I’m not sure if this is because they are coming in late.”

Staff told us they had been provided with more training and they explained how it had supported them to be more effective in their roles. For example, staff had completed refresher positive behaviour training. Staff told us they now have sufficient staffing to enable them to do their role and meet people’s care and support needs and keep people safe. Staff told us they had regular opportunities to meet their manager. These meetings gave them the opportunity to feedback about their experiences and request further guidance/training if needed.

We saw there were enough staff to provide support to people safely. Staff were deployed effectively around the building to provide timely support to people. However, our observations, as stated within this report, meant we were not assured staff were competent at always providing safe care and treatment.

There were clear processes to ensure there were enough staff. The provider had used a calculation tool to assess how many staff were needed to meet people’s needs. The rota’s suggested these staffing levels had then been arranged according to this calculation. Staff had received suitable training to do their role. However, we were not assured staff were competent in following their training for clinical decisions, risk management and safeguarding. This meant people were at potential risk of harm.

People told us that the home was always kept clean. We found people’s bedrooms and communal areas were kept clean and tidy. One person told us, “They seem to clean my room regularly and the toilets are clean.”

Staff had completed infection prevention and control training. Staff knew what personal protective equipment they should wear and when. Staff knew how to put on and remove this equipment in a safe way. This protected people from the spread of infection.

The ground floor of the home had a strong smell of urine. On the day of our visit the provider did have contractors in the home change a person’s flooring to reduce or mitigate the smell. Improvements had been made and we saw how the kitchen was managed in a hygienic way to ensure people did not get food bourne infections. Since our last visit the food standards agency had completed a visit and had rated the service 5 stars on the 19 August 2024.

There were clear processes and policies, to ensure the environment was kept clean and hygienic. This protected people from the spread of infection. Staff had received training in infection control, how to put on protective equipment and how to keep people safe in the event of an infection outbreak.

People still had not been provided with the opportunity to be part of their medicines management care planning. This meant people were not provided with an opportunity to understand their medicines support and care. People told us that they had ‘as needed’ medicines like paracetamol for occasional pain relief. They explained that staff supported them to take these ‘as needed’ medicines in line with their changing symptoms.

Staff were able to explain their processes and system for medicine management. However, clinical staff lacked competencies to ensure medication care plans and records were completed accurately. For example, we found a poor medicine care plan that did not provide clear and accurate information regarding people’s medicines and could place people at risk of harm. The clinical staff did not have a good understanding of medicines. We found where variable dose medications were prescribed, it wasn’t always clear if 1 or 2 tablets were administered. Without this key information it would be difficult to understand if medication was effective or required an increased dose. Furthermore, clinical staff were unable to explain when there was evidence that people had missed medications, if the medication was offered again and if the person was monitored. For example, a person refused Metformin 500mg on 31st and 5th November (prescribed for diabetes) and all bedtime medications were refused on 4th and 5th at bedtime. There was no records to demonstrate if any action was taken.

Medicines were not managed safely. We continued to find poor guidance for people diagnosed with diabetes. We found all four people who required insulin did not have sufficient guidance in place for staff to follow to ensure people received support appropriately and safely. People's care plans did not have accurate or person-centred information regarding their glucose levels and ranges. There was not clear guidance on action staff needed to take if glucose levels were not within the person’s normal range. There was blanket information stating what action to take if a person's glucose level drops below 4. However, some people's normal ranges where significantly higher than 4 so if staff did wait until they dropped to 4 before taking any action, people would be at risk of harm. The manager told us they had acted and made contact with a diabetic nurse to support with care planning around this. Some people required ‘as needed’ medicine and staff were not always provided with clear written guidance on how this should be administered. For example, a person was prescribed a medicine, and the prescriber had stated take one or two capsules. However, staff did not have any guidance to follow when one should be given and when to increase to two capsules. Staff continued to fail to ensure topical medicines were stored safely. We found topical medications that were accessible and unsecured in people’s bedrooms. This increased the risk of harm to people if used or ingested. Staff had received training on how to administer medicines safely. The management team had regularly assessed the staff’s competency, ensuring they were following best practice. Medicines were stored in a locked area, to prevent people accessing them unsafely. Some people at the service were prescribed controlled drugs. These are subject to enhanced restrictions due to the addictive nature of these medicines. Staff had followed national legal requirements by storing these medicines in an extra secure place.