Braydeston Court

Updated 25 November 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection, we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection site visit was completed by two inspectors, one medicines inspector and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Braydeston Court is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Braydeston Court is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection site visit an application to register a manager was being processed by CQC. This was concluded whilst the remote aspects of the inspection were being carried out.

Notice of inspection

This inspection was unannounced.

Inspection activity started on 26 October 2022 and ended on 09 November 2022. We visited the service on 26 October 2022.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We also used information gathered as part of a monitoring activity that took place on 22 August 2022. We used all of this information to plan our inspection.

During the inspection

During the inspection site visit we observed the care and support people received and assessed the environment. We spoke with six people who used the service and six staff including care and domestic staff and senior managers including the nominated individual (the nominated individual is responsible for supervising the management of the service on behalf of the provider). Some governance records were also viewed such as maintenance checks and staff recruitment files. Medicines management was also assessed, and we looked at the medicines records for six people who used the service. We spoke with an additional four care staff in relation to medicines.

Off site, we spoke with six relatives and a further five care staff members; two further care staff members provided us with written feedback. Two professionals who worked with the service also provided written feedback. A selection of records was also viewed, and these included the care plans and associated records for nine people who used the service. The governance records viewed included policies and procedures, training information, quality monitoring audits and additional maintenance records.

Updated 25 November 2022

About the service

Braydeston Court is a residential care home providing personal care to up to a maximum of 43 older people, most of whom live with dementia. At the time of our inspection there were 33 people using the service. The home is a converted period building over three floors with gardens.

People’s experience of using this service and what we found

The provider’s quality assurance system had been effective at identifying concerns although timely and sufficient improvements had not been made. However, an action plan was in place to address these concerns and it was felt with the appointment of a new manager that progress would now be made after a period of instability.

The individual risks to people had not always been identified, recorded, mitigated or reviewed and this placed people at risk of harm. Whilst permanent staff delivered caring, patient and respectful care that gave people choice, dignity and independence, care assessments had either not taken place, were incorrect, lacked detailed information or had not been reviewed; this risked people receiving inappropriate care particularly as agency staff were being used to fulfil shifts. We also found concerns with the medicine management within the home.

We could not be assured that people were supported to have maximum choice and control of their lives and staff did not consistently support them in the least restrictive way and in their best interests; the systems in the service did not support this practice. Where Deprivation of Liberty Safeguards (DoLS) had been authorised, we could not be assured that attached conditions had been met.

Staff had not received the consistent training, support or supervision required to ensure they met their roles and the needs of the people who used the service. We also had concerns that the staffing levels at night would not be adequate to keep people safe in the event of an emergency such as a fire. There was some evidence to suggest there were not consistently enough staff to always meet people’s needs in a person-centred and timely manner.

The culture within the service was positive and caring. Staff told us they worked well as a team. However, the provider needs to ensure they fully engage with staff, the people who use the service and their relatives as they told us communication and support wasn’t consistently reliable in relation to the service being delivered. Relatives did, however, confirm staff were good at keeping them informed in relation to the health and wellbeing of their family member.

People’s nutritional needs were met and there were activities available. Visiting was in line with Government guidance and the infection prevention and control systems in place were good. The premises and equipment were clean, and staff used personal protective equipment (PPE) appropriately.

The provider had made improvements to the environment including redecoration, new furniture and fixtures and the introduction of a café. Plans were in place for further improvements. People told us they were happy living in the home and their relatives told us that whilst further improvements were needed, they would recommend the home.

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

Rating at last inspection and update

The last rating for the service under the previous provider was requires improvement, published on 01 April 2019, and there were breaches of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last four consecutive inspections. At this inspection we found the provider remained in breach of regulations.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to risk and medicines management, adherence to the Mental Capacity Act 2005 (MCA), staff training and support, person-centered care and governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.