About the service: Brackenbridge House is a care home without nursing and is part of GCH (South) Ltd. It provides accommodation for up to 36 older people in single rooms. The home is situated within a residential area of the London Borough of Hillingdon. At the time of our visit there were 32 people using the service but three of them were in hospital when we inspected the service.

People’s experience of using this service:

• During the inspection we found, there had been improvements in the recording of incidents and accidents, but this information and the actions taken were not always being added to people’s care plans or risk assessments. This meant the provider could not ensure the learning from the investigation into incidents and accidents was used to reduce the risk of reoccurrence.

• The provider had a range of audits in place but those in relation to checking incidents and accident records, care plans and risk assessment were not effective and did not provide appropriate information to enable them to identify relevant issues.

• There were improvements in relation to the activities provided at the home. An activities coordinator was in post and a range of activities were being provided including regular visits to a memory café.

• Improvements had been made to the administration and recording of medicines. We saw senior care workers had completed training to support them in administering medicines in an appropriate manner.

• People told us they felt safe living in Brackenbridge House. There was a procedure in place to investigate and respond to any concerns raised regarding the care provided. We saw risk assessments and risk management plans had been completed where a possible risk to a person’s health and wellbeing had been identified.

• There were appropriate numbers of care workers deployed around the home to ensure people’s support needs were met.

• People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

• The provider had an appropriate recruitment process in place. Care workers completed training identified as mandatory by the provider with regular supervision and an annual appraisal.

• People were able to access a range of healthcare professionals to support their healthcare needs.

• People commented they were happy with the care they received, and their privacy and dignity were respected, and they were encouraged to be as independent as possible.

• People’s care plans identified how they wished their care to be provided.

• The provider responded to complaints in an appropriate manner.

• People using the service and staff felt the service was well-led.

Rating at last inspection: At the last inspection the service was rated Requires Improvement. We issued two Warning Notices in relation to safe care and treatment and good governance. (Report published 1 September 2018) The location was also rated as Requires Improvement following inspections in September 2017 and September 2016. The location as rated as Inadequate following an inspection in January 2016.

Why we inspected: The inspection was scheduled in line with our enforcement processes as we issued the provider two warning notices following the inspection in July 2018 and we wanted to make sure the provider had made the necessary improvements at the service.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. We may inspect sooner if we receive any concerning information regarding the safety and quality of the care being provided.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

We undertook an unannounced inspection of Brackenbridge House on 3 and 4 July 2018.

Brackenbridge House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Brackenbridge House is part of GCH (South) Ltd. It provides accommodation for up to 36 older people in single rooms. The home is situated within a residential area of the London Borough of Hillingdon. At the time of our visit there were 33 people using the service.

The registered manager had joined the home at the end of April 2018 and had been registered with the CQC shortly before the 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.

We previously inspected Brackenbridge House on 5, 6 and 11 September 2017 and rated it Requires Improvement. We identified breaches of Regulations in relation to safe care and treatment (Regulation 12), safeguarding service users from abuse and improper treatment (Regulation 13), good governance (Regulation 17) and staffing (Regulation 18).

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions ‘Is the service safe?’, ’Is the service effective?’, ‘Is the service responsive?’ and ‘Is the service well-led?’ to at least good.

During this inspection we found improvements had been made in relation to safeguarding service users from abuse and improper treatment (Regulation 13) and staffing (Regulation 18). Improvements had not been made in relation to safe care and treatment (Regulation 12) and good governance (Regulation 17).

The provider had a policy and procedure in place for the administration of medicines but this was not always followed by care workers to ensure people always received their medicines safely.

The provider did not have an effective system to review Incident and accident records and did not always identify actions to reduce potential risks to people using the service. Risk assessments were not updated to indicate if there was a change in the person’s support needs. This meant the provider could not ensure the learning from the investigation into incidents and accidents was used to reduce the risk of reoccurrence.

The provider had a range of audits in place but some of these were not effective and did not provide appropriate information to enable them to identify any issues with the service and take action to make improvements.

In general people felt safe when they received support but they gave examples of times when they had not always felt safe. The provider had a process for responding to safeguarding concerns which had not always been followed previously but records were now being maintained.

People and staff told us additional staff were required to provide support at the home and the registered manager confirmed they had considered the staffing levels and care worker numbers were being increased. The provider had a robust recruitment process in place to ensure only suitable staff worked at the home.

The registered manager had identified which care workers were not up to date with their training and had arranged for this training to be completed as soon as possible. Regular supervision sessions with line management were now being scheduled.

The registered manager had reviewed everyone living at the home and ensured Deprivation of Liberty Safeguards (DoLS) applications had been made when appropriate to ensure people were supported to have maximum choice and control of their lives, and in the least restrictive way possible. The p

We undertook an unannounced inspection of Brackenbridge House on 5, 6 and 11 September 2017.

Brackenbridge House is a residential home and is part of GCH (South) Ltd. It provides accommodation for up to 36 older people in single rooms. The home is situated within a residential area of the London Borough of Hillingdon. At the time of our visit there were 28 people using the service.

The provider transferred and re-registered Brackenbridge House under a new limited company in May 2017. The location had previously been inspected but this is the first rating for the service since the change in registration.

At the time of the inspection the service did not have a registered manager in place. The previous manager joined the service in January 2017, registered with the CQC in May 2017 and left the service in July 2017. An interim manager had been in place for three weeks before the inspection but their contract ended on the second day of the inspection. The regional manager explained the provider had arranged for a new manager, from another part of the organisation, to start working at the service shortly after the inspection and would be in post for one year.

The provider had a policy and procedure in place for the administration of medicines but this was not always followed by care workers. Records did not accurately show when medicines were administered and if people received all their medicines as prescribed.

Incident and accident records were not reviewed and actions were not identified to reduce potential risks to people using the service.

Care workers had not completed training identified as mandatory by the provider or received supervision and appraisal from their manager to support them to provide safe and appropriate care.

The provider had a policy in relation to the Mental Capacity Act 2005 but was not always working within the principles of the Act to ensure people’s care was provided in their best interests and safeguards were in place if required to protect their rights.

The provider had a range of audits in place but some of them were not effective and did not provide appropriate information to enable them to identify any issues with the service and take action to make improvements.

Records relating to care and people using the service did not provide an accurate and complete picture of their support needs which meant care workers were not given accurate information regarding people’s care needs.

People had access to a range of healthcare professionals but the outcomes of the referrals and instructions from the healthcare professionals were not always recorded appropriately to provide an audit trail.

People using the service felt the care workers were caring and treated them with dignity and respect while providing care.

The care plans identified the person’s cultural and religious needs as well as the name they preferred the care workers to call them by. People could take part in a range of activities.

People knew how to make a complaint if they had any issues in relation to the care received but complaints had not always been dealt with in line with the provider’s policy..

People using the service, relatives and care workers felt the lack of a long term registered manager had affected how the service was managed in relation to service delivery and staff support.

We found a number of breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches relate to safe care and treatment of people using the service (Regulation 12), safeguarding service users from abuse and improper treatment (Regulation 13), good governance of the service (Regulation 17) and staffing (Regulation 18). You can see what action we told the provider to take at the back of the full version of this report.