Brambles Residential Care Home

Brambles Residential Care Home is a residential care home providing personal care and accommodation for up to 64 people. The service provides support to older people, including some people living with dementia. The care home provides support to people over 3 floors, all of which have adapted facilities. At the time of our inspection there were 50 people using the service.

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

Some minor improvements were needed in relation to medicines management to ensure practices reflected National Institute for Health and Care Excellence (NICE) guidance. Parts of the environment were worn and tired, the provider had identified this, and plans were in place for a refurbishment of the service.

Risk assessments and care plans had been developed to meet people's needs and were reviewed regularly. Recruitment processes were in place and there was enough staff on duty to meet people's needs.

There was a culture of continuous learning and improvement and systems were in place to monitor the quality and safety of the service.

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

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

Rating at last inspection

The last rating for this service was good (published 6 June 2019).

Why we inspected

This inspection was prompted by a review of the information we held about this service. We undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Brambles Residential Care Home on our website at www.cqc.org.uk.

Follow Up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

¿ There was a system to ensure any visitors to the home were screened for symptoms of Covid-19 and were required to completed a lateral flow test to ensure their visit could take place safely in line with current guidance.

¿ People were supported to maintain contact with others who were important to them in a variety of ways including mobile phones and video calls.

¿ A 'visiting pod' had been built at the front of the building. This allowed relatives the ability to meet their loved ones face to face in a safe space and the registered manager had considered the positioning of the pod so that in the event of an emergency a relative could summon help from staff in reception. Use of the area meant visits could take place safely, reducing the risk of infection.

¿ Thought had been given to potential sources for cross infection, for example cutlery was now given out at the time food was served to reduce the risks of it being handled by other people.

¿ Social activities continued for people but had been adapted to reduce the risks of infection. Zoned areas in the home ensured that people who were isolating had dedicated staff and areas away from other people, but staff still ensured people continued to have access to activities.

¿ Where people were ill or receiving treatment for end of life the manager and staff ensured that people could continue to visit their loved ones in a safe way. Specific routes had been identified to allow relatives to visit without going through areas where other people were present.

¿ Cleaning schedules and deep clean routines had been increased to monitor cleanliness of the environment. Staff compliance with the provider's infection control policy was monitored by the infection prevention lead and the registered manager. The laundry of people who were isolating was treated separately to other laundry to reduce the risk of cross contamination.

Brambles Residential Care Home is a residential care home providing personal care and accommodation for up to 64 people, some of whom have dementia. There were 60 people living at the service at the time of our inspection.

People's experience of using this service:

People who lived at the home and their relatives were happy with the standard of care they received. They felt the needs of people were met and supported by staff who had positive attitudes towards their caring roles and provided compassionate care.

There were enough staff to support people's care and safety needs. Risks to people had been identified and care was planned to keep people safe. Staff supported people so risks around eating safely and maintaining a healthy weight were identified and, where necessary people were referred to healthcare professionals for advice.

People’s medicines were safely managed. Staff had received training in infection control and knew how to work to minimise the risk of infection and the home environment was well maintained to meet the needs of people living there.

The provider’s recruitment and induction arrangements helped ensure new staff were able to support people. There was a good team spirit amongst the staff team who cared about each other and what mattered to people who lived at the home. Staff had varied opportunities to develop their knowledge and skills to enable them to provide effective care.

People were supported in different ways by staff, so their consent was gained before any care was provided daily. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People had been involved in planning their care and were confident to raise any issues they had with the registered manager. Electronic care planning was continually being developed and personalised to provide staff with guidance about people’s likes and dislikes.

People were supported emotionally and physically with a range of things to do for fun and interest which included singing and trips to places of interest. People were supported to be comfortable and pain free at the end of their lives.

The registered manager took corrective action to resolve any concerns identified. Incidents and complaints were analysed, and learning was shared with staff. People who lived at the home and their relatives were encouraged to raise issues around quality and safety at regular meetings.

The registered manager was supported by their staff team and the provider. There were ongoing quality checking arrangements in place where action plans were developed to support the continuation of improvements where required.

The registered manager had a vision which included plans to drive through their passion in supporting and promoting people’s quality of life.

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

Rating at last inspection:

At the last inspection, on 29 April and 10 May 2016, the service was rated Good (report published 24 June 2016).

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Follow up:

We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned for future dates.

The inspection took place on 29 April and 10 May 2016 and was unannounced.

At the time of our inspection a registered manager was in post. 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 felt safe living at the home. People told us and we saw staff to be kind and considerate and treated people with respect and dignity. People’s privacy was respected.

Staff were able to describe the actions they would take to keep people safe. People felt sufficient staff were on duty to meet their care and support needs. The registered manager was able to review staffing levels in line with people’s needs and increase staffing if needed. Systems to ensure safe recruitment processes were in place.

Staff were supported by the management and received training to ensure they had the skills and knowledge necessary to care for people. Staff were able to attended meetings where they were able to voice their opinions. People’s care needs were well known by the staff we spoke to including people’s likes and dislikes.

Care plans and risk assessments were in place. Although these were not always up dated to reflect people’s changing care needs staff were aware of how to care and support people.

People were asked for their permission prior to receiving care and support so people were able to give their consent. Where people were not able to give their consent decisions were made in their best interests. People who lived at the home and their relatives told us staff were kind and considerate.

People’s healthcare needs were monitored and health professionals were consulted in order to maintain people’s well-being. People told us they liked the food available and confirmed a choice was available to them.

People were satisfied with the care provided and were supported in a way they wanted. People had care plans in place describing their needs and risks associated with their care.

Staff told us they enjoyed their work and liked the management team. People and their relatives were confident any complaints made would be listened to and responded to.

Systems were in place to monitor the service provided for people as a means to improve the quality of care and support people received.

During our inspection we found that many of the people were not able to tell us about their experience of living at the home. However, we spoke briefly with some people living with dementia and with three relatives.

We left comment cards at the home for people to complete. These were collected seven days after our inspection. We received a total of 25 comment cards. Comments received were positive and included: 'Staff cope extremely well. They are very caring and treat him with dignity and respect' and: 'The care she has received has been excellent in a safe and motivating environment. All the staff have been sympathetic".

We observed that there were good relationships between the staff and the people with dementia. Staff were friendly and respectful when they spoke with people. We saw that staff offered people assistance with their personal care discreetly throughout the day. Staff offered people choices during the day and these included how they wanted to spend their time.

We saw that health and social care professionals were consulted with. We found that staff worked with other providers and professionals to ensure that people received the right care at the right time.

Effective systems were in place to enable the quality of care provided to be assessed, monitored and improved.

Each person had their own room and people and relatives told us that staff knocked on their door if they wanted to come in.

People who lived at the home told us they were happy with the care and support they received. One relative shared with us that they had been involved in all of the care planning and had listened to their relations preferences so that they received the right support in the right way.

People who lived at the home and relatives told us that staff were friendly and approachable so if they had any concerns they would feel comfortable in raising these. There were also regular meetings for people to attend and a book where people could write any comments they wished to make. This helped the manager to regularly assess and monitor the quality of the service people received at Brambles making sure people's experiences were acted upon.