High Brake House

We found the following examples of good practice.

The registered manager had established effective infection prevention and control procedures which were understood and followed by the staff. A screening process had been implemented for all visitors entering the building, which included health and temperature checks as well as lateral flow device tests. Visiting professional staff were also asked for proof of COVID-19 vaccinations.

Admission to the home was completed in line with COVID-19 guidance. People were only admitted following a negative COVID-19 test result and supported to self-isolate in line with current guidance to reduce the risk of introducing infection. People’s health and well-being was carefully monitored during this time. A regular programme of testing for COVID-19 was in place for staff and people living in the home. This meant swift action could be taken when any positive results were received.

There were plentiful supplies of Personal Protective Equipment (PPE) and stocks were carefully monitored. PPE was available at stations throughout the home for staff to access when they were supporting people with personal care. PPE was disposed of safely to help reduce the risk of cross contamination. Staff had been trained in infection control practices and posters were displayed around the home to reinforce procedures. We observed staff were using PPE appropriately.

The layout of the service and the communal areas were suitable to support social distancing. The premises had a good level of cleanliness and was hygienic throughout. Housekeeping and care staff were following an enhanced cleaning schedule and there was good ventilation. The atmosphere of the home was cheerful and calm. We observed staff were attending to people’s needs throughout our visit.

Comprehensive policies and procedures were in place to manage any risks associated with the COVID-19 pandemic. The policies and procedures were updated regularly following any changes in national guidance. Detailed infection prevention and control audits were carried out on a regular basis.

High Brake House is a care home which is registered to provide care and accommodation for up to 35 older people, including older people living with a dementia. The service does not provide nursing care. People in care homes receive accommodation and 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. High Brake House is an adapted building in a residential area in Clitheroe. At the time of the inspection there were 34 people accommodated at the service.

The service was managed by a registered manager. 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.

At our last inspection on the 4 and 5 May 2016 the overall rating of the service was ‘Good’. However there were breaches of the regulations relating to staff recruitment and medicines management. We asked the provider to make improvements on these matters. We received an action plan from the provider on 19 June 2016 indicating how and when they would meet the relevant legal requirements. At this inspection we found sufficient improvements had been made and the service remained Good.

During this inspection we found there were no breaches of the regulations of the Health and Social Care Act (Regulated Activities) Regulations 2014. However we found there were some shortfalls with the management of complaints. We have therefore made a recommendation about improving complaints processes.

There was a warm and friendly atmosphere at the service. We found there were good management and leadership arrangements in place to support the day to day running of the service.

Arrangements were in place to promote the safety of the premises, this included maintenance, servicing and checking systems. We found the service to be clean in the areas we looked at.

People were happy with the accommodation. We found there was a good standard of décor and furnishings to provide for people’s comfort and wellbeing. People had personalised their rooms and had been asked for their choice of colour schemes.

People told us they felt safe at the service. Staff were aware of the signs and indicators of abuse and they knew what to do if they had any concerns about people’s wellbeing and safety.

Arrangements were in place to ensure staff were checked before working at the service. We found some checks had not been properly completed. But the registered manager took swift action to make improvements. There were enough staff available to provide care and support. There were systems in place to ensure all staff received regular training and supervision.

People’s needs were being assessed and planned for before they moved into the service. People were supported with their healthcare needs and received appropriate medical attention. Changes in people’s health and well-being were monitored and responded to.

Each person had a care plan, describing their individual needs, preferences and routines. This provided guidance for staff on how to provide support. People’s needs and choices were kept under review.

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

There were some good processes in place to manage and store people’s medicines safely. We found some improvements were needed and these were put right during the inspection.

People made positive comments about the caring attitude of staff. During the inspection we observed staff interacting with people in a kind, friendly and respectful manner.

There were opportunities for people to engage in a range of group and individual activities. Progress was ongoing to provide more meaningful activities and engagement. People were keeping in contact with families and friends. We found visiting arrangements were flexible.

People were happy with the variety and quality of the meals provided. We found various choices were available. Support was provided with specific diets. Drinks were readily accessible and regularly offered.

People spoken with had an awareness of the service’s complaints procedure and processes. They indicated they would be confident in raising concerns.

Arrangements were in place to encourage people to express their views and be consulted about High Brake House, they had opportunities to give feedback on their experience of the service.

High Brake House provides accommodation and personal care for up to 26 older people (including people living with dementia) and also provides personal care and support to people living in their own homes. There were 24 people accommodated in the home and one person receiving care and support in their own home at the time of the inspection.

The home is an extended older type property situated in a residential area of Clitheroe within walking distance to the town centre. Public transport is within easy access of the home. At the time of the inspection work was underway to extend and improve the home.

At the previous inspection on 9 April 2014 we found the service was meeting all the standards that were assessed at the time.

During this inspection visit we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, relating to management of people’s medicines and recruitment processes. You can see what action we told the registered provider to take at the back of the full version of the report.

The service was managed by a registered manager. 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.

People told us they did not have any concerns about the way they or their relatives were cared for. They were happy with the care and support provided. People said, “The care staff are very kind and friendly” and “The staff are lovely and there is always someone to help”. Visitors told us, “I feel [my relative] is safe, settled and well looked after” and “The staff are very considerate. [My relative] is safe and happy and has everything they need.”

Staff were able to describe the action they would take if they witnessed or suspected any abusive or neglectful practice and had received training on the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). This meant they had knowledge of the principles associated with the legislation and people’s rights.

People told us they were given their medicines when they needed them. However, we found areas where improvements were needed to ensure people’s medicines were always managed safely.

The service had clear recruitment and selection policies and procedures although we found a safe and fair process was not always followed. Staff received training and support to give them the necessary skills and knowledge to look after people properly.

People told us there were sufficient numbers of staff to meet their needs in a safe way. People receiving care at home told us they were familiar with all staff and they arrived on time and never missed a visit. Staff were knowledgeable about people’s individual needs, preferences and personalities and people were involved in making choices and decisions about their day.

People made positive comments about the staff. Staff responded to people in a good humoured and considerate manner; we observed good relationships between people.

People told us they enjoyed the meals. We noted the atmosphere was relaxed with chatter and friendly banter throughout the meal. Staff were aware of people’s dietary preferences, the support they needed and any risks associated with their nutritional needs. Appropriate professional advice and support had been sought when needed. Visitors told us they were able to stay and have a meal with their relatives which they appreciated.

People were encouraged to be involved in the running of the home and were kept up to date with any changes. People had no complaints and were aware of how to raise their concerns and were confident they would be listened to.

We found people lived in a clean, safe, pleasant and homely environment. All areas were tastefully decorated and furnished to a high standard and appropriate aids and adaptations had been provided to help maintain people’s safety, independence and comfort. People had arranged their bedrooms as they wished and had brought personal possessions with them. Improvements to extend the home were in progress which would provide additional facilities for people living in the home.

Everyone had a care plan, which had been reviewed and updated on a monthly basis. Information was included about people’s likes, dislikes and preferences, routines, how people communicated and risks to their well-being. People told us they were kept up to date and involved in decisions about care and support.

People were able to participate in a range of suitable activities and entertainments and were supported by staff to take part in worship services according to their individual beliefs.

Systems were in place to assess and monitor the quality of the service. People were encouraged to be involved in the running of the home and were kept up to date with any changes.

People made positive comments about the management of the home. Throughout our visit we found a warm, homely, relaxed and caring atmosphere. The management team were comfortable and at ease with people. We observed them taking time to sit, chat and laugh with people.

We considered the evidence we had gathered under the outcomes we inspected. We spoke with four people using the service, one visitor and two members of staff. We also spoke with the local authority (social services).

Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service caring?

Staff were observed interacting with people in a kind, pleasant and friendly manner and being respectful of people's choices and opinions. People made positive comments about the staff team. They said, 'Staff are lovely; they are very kind' and 'Staff are nice'.

We found people's needs were assessed and care, treatment and support was planned and delivered in line with their individual care plan. We found some care records included useful information about people's preferred routines and likes and dislikes, however this was not always clearly recorded. This information was needed to ensure people received the care and support they needed and wanted.

Is the service responsive?

Regular reviews were carried out to respond to any changes in people's needs and to ensure the level of care was appropriate. People who used the service, or their relatives, had been involved in discussions about their care although this was not always clearly recorded.

Staff told us they were able to discuss people's needs at regular 'handovers' which should make sure they were up to date with any changes to people's needs.

People's health and well-being was monitored and appropriate advice and support had been sought in response to changes in their condition. The service had good links with health care professionals to make sure people received prompt, co-ordinated and effective care.

We found there were processes in place to ensure relevant and appropriate information was shared with other providers when people were admitted, transferred or discharged to another service.

People were involved in discussions and decisions about the activities they would prefer and activities were arranged for small groups of people or on a one to one basis.

Is the service safe?

We found there were appropriate arrangements in place to manage people's medicines safely. Staff, who administered medicines, confirmed they had received training to help them to do this safely.

Staff had received induction and ongoing training and the staff team was skilled and experienced. One member of staff said, 'We get plenty of training; we are always training'. Staff told us they were supported, kept up to date and encouraged to share their views and opinions at regular meetings. They also told us their work was monitored on a regular basis.

Staff were aware of the procedures for reporting any concerns about poor practice. However, the Care Quality Commission (CQC) had not been notified of two serious injuries relating to people living in the home. The manager gave assurances all incidents would be reported in line with regulation.

Is the service effective?

People told us they were happy with the care and support they received. Comments included, "It is a good place; I have met some nice friends", "I feel I have been welcomed into a new family" and "I am happy to be here; they are very nice people".

People were encouraged to express their views and opinions of the service through regular meetings, reviews and during day to day discussions with staff and management. There was evidence people's views had been used to improve the service.

There were systems in place to assess and monitor how the home was being managed. There was evidence these systems identified any shortfalls and that improvements had been made. This should help to protect people from poor care standards and to identify any areas of non-compliance.

People told us they had no complaints about the service but felt confident they could raise any concerns with the staff or managers. Comments included, "I have no complaints; I am very happy with everything" and "I have not been happy in the past but I was able to discuss my concerns with the managers".

Is the service well led?

There were systems in place to regularly assess and monitor how the home was managed and to monitor the quality of the service. The service had a registered manager responsible for the day to day management of the home. Staff were clear about their responsibilities and were able to raise their views and concerns.

The service worked in partnership with other agencies, including the local authority and safeguarding teams, to ensure people's safety and well-being.

Following our visit we asked the provider to send us information about the action they would take to respond to the shortfalls. We were told action had been taken to respond to the shortfalls.

During this visit we looked at records and spoke with the acting manager. We found people had been encouraged to share their views and opinions about the home and that their suggestions had been acted on. We also found people were more involved in decisions about their care which would help to make sure they received the care they wanted and needed.

We found the systems to monitor the service and to monitor staff practice had been improved. This would help the provider to develop and improve the service.

We found the records that we looked at were accurate, up to date and fit for purpose.

People told us they enjoyed the food. Comments included, "The food is very good; I've really enjoyed my lunch. It was tasty", "We get plenty to drink through the day with cakes and biscuits" and "I like the food; I can choose what I want".

We looked at how people's medicines were managed. We found some improvements were needed, however a new system had been introduced which would help staff to manage people's medicines safely.

Most of the care staff had achieved a recognised qualification in care, which would help them to look after people properly. Staff were observed interacting with people in a pleasant and friendly manner and being respectful of people's choices and opinions. People told us there were sufficient staff to look after them. People made positive comments about the staff team. One person said, 'Staff are lovely; they are very caring and patient'.

We found some of the records that were required to be kept to protect the safety and wellbeing of people using the service were not always accurate or up to date and could result in people's needs not being met.