Wright Watson Enterprise Centre (Bradnet) improved from Inadequate to Requires Improvement overall, exiting Special Measures after resolving four of five previous regulatory breaches. A continued breach of Regulation 12 regarding incomplete and unreviewed risk assessments, and governance systems requiring further formalisation, prevented a Good rating.
Concerns (10)
critical
Record keeping
: “Some risk assessments had been in place for an extended period without being reviewed.”
moderateCare planning: “There was a lack of environmental risk assessments included in people's care plans.”
moderateMedication management: “There was a lack of information about medicines prescribed for 'as required' use.”
moderateConsent / capacity: “Where care records were kept electronically there was not always strong evidence to show how people's consent to their care had been obtained.”
moderateGovernance: “Some systems needed to be made more formal to ensure they were sufficiently robust should the service increase the number of people it supported.”
moderateStaff training: “There were no records of how competence and confidence had been assessed during this [induction] period.”
minorIncident learning: “The systems for ensuring lessons could be learnt were informal because the service was small and there were very few incidents.”
minorSafeguarding: “We talked with the manager about the need to improve staff confidence in this area [safeguarding awareness].”
minorEnd-of-life care: “There was a lack of information relating to their preferences for the kind of care they wished to receive as they approached the end of their life.”
minorRecord keeping: “Staff made records about each visit, however these were often functional and lacking in information about peoples' overall well-being.”
Strengths
· Staff were caring, respectful and promoted people's privacy, dignity and independence.
· Medicines management had improved with systems in place and relatives confirming accurate recording.
· Call planning and staffing deployment had improved; staff arrived on time and stayed for full call duration.
· Recruitment checks were now consistently safe following an audit of employment records.
· Supervision and appraisal activity had been introduced, with staff feeling well-supported.
Quality-Statement breakdown (22)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Staffing and recruitmentGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Using medicines safelyGood
safe: Learning lessons when things go wrongRequires improvement
safe: Preventing and controlling infectionGood
effective: Staff support: induction, training, skills and experienceGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Staff working with other agencies to provide consistent, effective, timely careGood
caring: Ensuring people are well treated and supported; respecting equality and diversityGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
caring: Respecting and promoting people's privacy, dignity and independenceGood
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesGood
responsive: Meeting people's communication needsGood
responsive: End of life care and supportGood
responsive: Improving care quality in response to complaints or concernsGood
well-led: Managers and staff being clear about their roles, understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: Engaging and involving people using the service, the public and staffGood
Wright Watson Enterprise Centre (Bradnet) improved from Requires Improvement to Good across both inspected key questions (Safe and Well-Led), having addressed all previous breaches and recommendations. The service demonstrated safe risk management, medicines handling, consistent staffing, and strong leadership with a person-centred, open culture.
Strengths
· Significant improvements made since last inspection, with provider no longer in breach of regulations
· Risks assessed, monitored and regularly reviewed with comprehensive checklists including high-risk frequent reviews
· Medicines managed safely with detailed care plans, staff competency assessments and weekly quality checks
· Safe and consistent staffing levels with electronic call monitoring checked daily
· Strong culture of learning lessons when things go wrong, including near-miss events