CQC report explained · a nursing home
What the CQC found at Bradwell Hall Nursing Home
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- People's risks were assessed and reviewed. Inspectors found improvements in safeguarding, staffing, medicines and infection control.
- Effective?
- Requires improvement
- The report does not give a separate Effective rating. This question was not covered by this focused inspection.
- Caring?
- Good
- People and relatives spoke positively about the care. Inspectors observed staff supporting people calmly, kindly and respectfully.
- Responsive?
- Good
- Care planning had improved and recorded people's needs, choices and preferences. People were supported with communication, activities and contact with relatives.
- Well-led?
- Good
- Inspectors found stronger leadership, clearer responsibilities and effective quality checks. Staff, people and relatives described better communication and a more positive culture.
What inspectors found, April 2021
Bradwell Hall Nursing Home was rated Good after major improvements, and is no longer in Special Measures.
Inspectors made an unannounced focused inspection visit on 29 March 2021. They spoke with four people, 13 relatives and 21 staff. They reviewed care records, medicine records, training information and quality checks.
They found that care had improved significantly since the previous inspection. Risks were assessed, medicines were managed safely, staff recruitment and training had improved, and people were treated with kindness, dignity and respect.
Care plans contained more information about people's needs and preferences. The home had improved its systems for handling concerns, monitoring quality and learning from incidents. All four areas inspected were rated Good.
The previous rating was Inadequate and the home had been in Special Measures since September 2020. The provider was no longer in breach of the regulations checked during this inspection, so the home left Special Measures.
Better safety systems
Risks were reviewed and staff were better able to recognise changes in people's health and needs. Inspectors also found a significant reduction in risk-related incidents.
“People's risks were assessed and reviewed to keep people safe and well.” from the report
Safer medicines
Medicine practices had been reviewed. Staff were trained and assessed, records provided an audit trail, and the use of a particular calming medicine had reduced significantly.
“Medicine management had been reviewed and changes implemented to ensure people received their medicines safely and in line with their needs.” from the report
Kind and respectful care
People and relatives described caring staff. Inspectors saw staff communicate in a friendly and compassionate way and offer people choices.
“We observed staff engaging with people in an environment which was calm and relaxed.” from the report
More personalised support
Care plans recorded people's needs, choices and preferences more clearly. Activities and communication support were adapted to individuals.
“People's needs, choices and preferences were recorded in their care plans to support staff to meet their needs in line with these.” from the report
Stronger leadership
The management team had improved oversight, communication and quality monitoring. Staff said managers were visible, supportive and approachable.
“There were effective quality assurance systems in place and the registered manager continued to carry out a programme of audits to assess the safety and quality of the service and identify issues.” from the report
Serious recent history
seriousThe previous inspection had found breaches involving safe care, safeguarding and governance. This inspection found enough improvement and confirmed that the provider was no longer in breach of those regulations.
“Breaches of legal requirements were found in regulation 12 (Safe Care and Treatment), regulation 13 (Safeguarding Service Users from Abuse and Improper Treatment) and regulation 17 (Governance).” from the report
- 01How will you make sure the improvements found at this inspection are sustained?
- 02How many agency staff are currently being used, and how do you make sure staffing remains sufficient and suitably skilled?
- 03How are changes in a person's health, risks and care needs recorded and acted on each day?
- 04How do you review whether alternative approaches are working before using as-required calming medicines?
- 05How are people and relatives involved in reviewing care plans, preferences and activities?
This was a focused inspection of Safe, Caring, Responsive and Well-led; the report does not give a separate Effective rating and says ratings for key questions not looked at were carried over from the previous comprehensive inspection. This explanation was written from the published report of 21 April 2021 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, February 2021
Rated Inadequate and placed in special measures; inspectors found people were at risk of harm and the home was not well-led.
This was an unannounced focused inspection on 29 and 30 September 2020. Inspectors looked only at whether people were safe and whether the home was well-led. They spoke with people, staff and health professionals, observed care, and checked care, medicine and management records.
Inspectors found serious problems. Safeguarding concerns included possible abuse, poor responses when people were distressed and the use of holding without a proper assessment. Staff did not always follow care plans, manage medicines safely, report health concerns or prevent infection. Three safeguarding referrals were made during and after the inspection.
The home had enough staff and a safe building, and people and staff were tested for COVID-19. However, management checks did not reliably find or correct unsafe care. The overall rating fell from Requires Improvement to Inadequate. The other three areas were not inspected and kept their previous Requires Improvement ratings.
Safe building
The building and equipment were kept in good repair through safety checks and maintenance.
“The provider ensured people lived in a safe environment.” from the report
COVID-19 testing
People and staff were tested in line with government guidance, and the home kept its pandemic contingency plans under review.
“The provider ensured people and staff were tested in line with government guidance.” from the report
Staff recruitment
The provider completed the required recruitment and identity checks before new staff started.
“The provider followed safe recruitment practices to ensure staff were suitable to work with people at the home.” from the report
Contact with relatives
The home provided COVID-19 information and helped people keep in touch with relatives through bulletins and emails.
“People had access to easy read materials about COVID-19 and were supported to keep in touch with their relatives.” from the report
Safeguarding risks
seriousPeople were not always protected from possible abuse. Inspectors identified three incidents where abuse may have occurred and made safeguarding referrals.
“During our inspection we identified three incidents where abuse may have occurred.” from the report
Unsafe care and treatment
seriousStaff did not always follow care plans or act on health risks. Some people did not have their bowels open for several days without the required contact with a GP.
“Staff had not always followed these instructions and for three people, had not contacted the person's GP for between five to nine days.” from the report
Medicines
seriousProtocols for medicines used when people were agitated or distressed were too general. Records did not always explain why the medicine was given or whether other calming approaches had been tried.
“This placed people at risk of receiving medicine which was not needed.” from the report
Infection control
seriousSome staff did not use masks and hand hygiene consistently. This placed people at risk of cross infection.
“The application of these measures by staff was not always consistent.” from the report
Weak management checks
seriousAudits and daily reviews did not identify important risks, including long periods without bowel movements and errors in care and medicine records.
“Quality systems were not robust enough to demonstrate safety was effectively managed.” from the report
Dignity and consistency
needs fixingInspectors found different experiences across units. Some staff used inappropriate terms and referred to people by room number rather than by name.
“People were referred to by their room number, rather than their name by some staff.” from the report
- 01What has changed to prevent safeguarding incidents, including people entering other people's bedrooms and becoming involved in conflict?
- 02How do you now make sure staff follow bowel-care instructions and contact GPs within the times stated in care plans?
- 03How are medicines for agitation or distress tailored to each person, and how do you record whether other calming approaches were tried?
- 04What checks now make sure staff use PPE and hand hygiene correctly on every unit?
- 05What evidence can you show of progress against the registration conditions and the required 14-day updates?
This was a focused inspection of Safe and Well-led only; Effective, Caring and Responsive were not inspected and retained their previous Requires Improvement ratings. This explanation was written from the published report of 11 February 2021 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Bradwell Hall Nursing Home
8 rated inspections over 6 years: the service has improved, from Requires improvement to Good.
- April 2021Goodcurrent ratingup from InadequateSafe: GoodEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Good
- February 2021Inadequatedown from Requires improvementSafe: InadequateWell-led: Inadequate
- March 2020Requires improvementstayed Requires improvementSafe: Requires improvementWell-led: Requires improvement
- November 2019Requires improvementstayed Requires improvementSafe: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- October 2018Requires improvementdown from GoodSafe: Requires improvementWell-led: Requires improvement
- July 2017Goodup from Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- May 2016Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- March 2015Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- October 2013
Report published without a new overall rating.
- September 2012
Report published without a new overall rating.
- October 2011
Report published without a new overall rating.
- July 2011
Report published without a new overall rating.
- December 2010
Registered with the Care Quality Commission on 6 December 2010.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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