CQC report explained · a nursing home
What the CQC found at Old Rectory (Bramshall) Limited
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- People were not always safely supported with mobility. Inspectors also found environmental risks, incomplete topical cream records and gaps in legionella checks.
- Effective?
- Good
- Staff had suitable training and knew people's needs. People received appropriate support with food, healthcare, consent and daily choices.
- Caring?
- Good
- People described staff as kind, friendly and helpful. Inspectors saw respectful relationships and support for people's dignity, confidence and independence.
- Responsive?
- Good
- Care plans reflected people's needs, preferences and changes in health. People were supported with activities, communication, relationships, complaints and end-of-life wishes.
- Well-led?
- Requires improvement
- The manager was not yet registered with the CQC, and quality checks had failed to identify several safety and care-record problems. People and staff nevertheless described the management team as approachable and supportive.
What inspectors found, January 2020
Old Rectory (Bramshall) Limited was rated Requires Improvement; inspectors found kind, responsive care but safety and management checks were not reliable.
This was an unannounced planned inspection on 4 December 2019. Inspectors spoke with people, a relative and staff, observed care, and checked care plans, medicines records, recruitment files and management records.
The home provided caring and responsive support. People were treated with kindness, had choices about their care, received suitable food and healthcare, and were supported with activities and relationships.
There were important safety problems. Staff did not always use safe mobility techniques, parts of the building were unsafe, topical cream records were incomplete, and quality checks had not found these issues. The home was rated Requires Improvement overall, with Safe and Well-led also rated Requires Improvement.
Kind relationships
People received compassionate support from staff who knew them well and treated them with dignity.
“People received help and support from a kind and compassionate staff team with whom they had developed positive relationships.” from the report
Personalised care
Care plans gave staff useful information about people's needs, preferences and how they wanted to be supported.
“People's care and support plans gave staff the necessary information to effectively respond to their needs and preferences.” from the report
Training and staffing
Staff had the training needed for their roles, and inspectors found enough staff available to support people promptly.
“People were supported by enough staff who were available to safely support them.” from the report
Unsafe mobility support
seriousInspectors saw a transfer carried out in a way that put a person at risk of injury and did not follow recognised best practice.
“The technique used by the staff members put this person at risk of injury and did not follow recognised best practice.” from the report
Unsafe environment
seriousInspectors found missing fire-door seals, a damaged fire-door frame, exposed hot pipework, damaged furniture, missing fittings and unattended cleaning products.
“The physical environment was not always maintained to a standard which was safe for people to live in.” from the report
Incomplete cream records
needs fixingThe home could not show that prescribed topical creams had always been given as directed because recording charts were incomplete.
“The provider could not demonstrate people received their prescribed topical creams as directed.” from the report
Weak quality checks
needs fixingThe home's monitoring systems did not identify several problems with safety, infection prevention, topical cream records or legionella prevention.
“These systems were ineffectively applied as they didn't identify and correct the issues we found at this inspection.” from the report
Manager not registered
needs fixingA manager was in post but had not completed registration with the CQC. The previous registered manager had left in January 2019.
“The last registered manager deregistered in January 2019. This means the provider was not meeting this requirement of their registration with us.” from the report
- 01What action has been taken to make transfers and other mobility support safe?
- 02Have all fire doors, exposed hot pipes, damaged furniture, missing fittings and unattended cleaning products been checked and repaired or removed?
- 03How are topical creams now recorded and checked to make sure they are given as prescribed?
- 04What legionella checks and water-flushing arrangements are now in place?
- 05Has the manager completed registration with the CQC, and how are quality checks now identifying problems?
This was an unannounced planned inspection covering all five CQC questions; it included observations, conversations and checks of care, medicines, recruitment, maintenance and management records. This explanation was written from the published report of 16 January 2020 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, June 2017
Rated Good overall; inspectors found safe, kind and personalised care, but legal decision-making processes needed improvement.
Inspectors visited without warning on 23 May 2017. They spoke with people living at the home, relatives, staff and a visiting health professional. They observed care and checked care records, staff records and quality checks.
The home was rated Good overall. Safe, caring, responsive and well-led were rated Good. Inspectors found that medicines were now stored, given and recorded safely, after concerns at the previous inspection.
Effective care was rated Requires Improvement. Mental capacity assessments were not always linked to specific decisions. In one case, the manager had not checked whether a representative was legally authorised to make a decision about bedrails. Some staff also needed better knowledge of decision-making safeguards.
Inspectors found enough suitably recruited staff, caring relationships, personalised support, activities and good links with health professionals. The home had an open atmosphere and used audits and people's feedback to make improvements.
Enough staff
People did not have to wait long for help, and inspectors saw staff respond promptly to call bells and provide support at mealtimes.
“We saw that people did not have to wait when they asked for support and staff had time to sit and chat with people.” from the report
Kind and respectful care
Staff knew people well, treated them with respect and supported privacy, dignity and independence.
“We saw that staff treated people with respect and promoted their dignity.” from the report
Personalised support and activities
Care plans recorded people's preferences, and people could join activities or follow their own interests. Their care was reviewed regularly.
“We saw that staff knew people well and provided care that was responsive to people's individual needs.” from the report
Quality was monitored
The manager and provider used audits, action plans and feedback to identify and complete improvements.
“This showed the provider had effective systems in place to continually assess monitor and improve the quality and safety of the service people received.” from the report
Decision-making records
needs fixingCapacity assessments were not always specific to the decision being made. The home also needed to check legal authority for decisions made on behalf of people, and update some staff training.
“At this inspection, we found mental capacity assessments had been carried out but these were not always decision specific and in some cases they had been carried out for people who had capacity.” from the report
Staff knowledge of safeguards
needs fixingSome staff could not explain how a person may be lawfully restricted in their best interests. Updated training had been arranged for June 2017.
“However, some staff could not tell us how people could be deprived of their liberty when it was in their best interests, which meant they may not recognise when someone was being unlawfully restricted.” from the report
- 01How do you now make sure every mental capacity assessment relates to the specific decision being considered?
- 02How do you record best-interest decisions and check that a representative has legal authority to make decisions?
- 03What training have staff completed on the Mental Capacity Act and Deprivation of Liberty Safeguards since this inspection?
- 04How do you check that medicines remain safely stored, administered and recorded?
- 05What improvements have been made since the 2017 inspection, and what was the outcome of the planned action on decision-making?
This was an unannounced inspection on 23 May 2017 that assessed the overall service and all five CQC questions. This explanation was written from the published report of 23 June 2017 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 Old Rectory (Bramshall) Limited
5 rated inspections over 5 years: the service has improved, from Inadequate to Requires improvement.
- January 2020Requires improvementcurrent ratingdown from GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
Read what inspectors found at Old Rectory (Bramshall) Limited →
- June 2017Goodup from Requires improvementSafe: GoodEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Good
Read what inspectors found at Old Rectory (Bramshall) Limited →
- August 2016Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- November 2015Requires improvementup from InadequateSafe: GoodEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- June 2015InadequateSafe: Requires improvementEffective: InadequateCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate
- October 2014
Report published without a new overall rating.
- February 2014
Report published without a new overall rating.
- March 2013
Report published without a new overall rating.
- October 2012
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 25 January 2011.
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.
Weigh the report against the rest
Fees, photos and reviews from families
How to read CQC ratings and reports
What to check when you visit
At least 100 live-in carers within about an hour of Staffordshire
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
Most charge £980 to £1,230 a week. 85 can care for a couple. 10 years' experience on average.
“We particularly appreciate the companionship Dawn gives in the evenings when she plays cards and Scrabble with my mother.”
Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.