Braemar Lodge Residential Care Home

Updated 24 August 2023

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

This inspection was undertaken by 1 inspector.

Service and service type

Braemar Lodge Residential Care Home 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. [Care home name] is a care home [with/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 there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

Inspection activity started on 04 July 2023 and ended on 25 July 2023. We visited the service on 11 July 2023.

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 and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 4 people who used the service and 3 relatives and used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We spoke with 3 care staff, 2 admin staff, the chef and the registered manager. We reviewed a range of records. This included 3 people’s care records and medication records. We looked at 2 staff files in relation to recruitment. A variety of records relating to the management of the service, including policies and procedures were reviewed.

Updated 24 August 2023

About the service

Braemar Lodge Residential Care Home is a residential care home providing accommodation and personal care for 14 people at the time of the inspection. The service can support up to 17 older people and people living with dementia.

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

At our last inspection the provider had not ensured the systems to monitor and improve the quality and safety of the service were reliable and effective. At this inspection we found some improvements had been made however, the provider remained in breach of regulations.

The provider's quality monitoring system was not effective in assessing and improving the quality of the recruitment processes and the administration of ‘as required’ medicines was not managed in line with the individual’s protocols. Staff administered people’s medicines calmly and safely making sure people were not rushed. The medicine rounds were evenly spaced out throughout the day to help ensure people did not receive their medicine doses too close together or too late. Staff had been trained in the safe administration of medicines and had their competency assessed to ensure they remained competent to undertake this task safely.

The provider’s quality monitoring had failed to identify where short-term actions to promote the safety of one person had not been assessed or reviewed to find alternative options suitable to promote the safety and wellbeing of all people using the service. Staff and management did not always recognise how their actions or the environment impacted negatively on people’s privacy and dignity. Facilities provided for people to use were not always maintained in a way that promoted their dignity.

Some facilities such as a bath hoist and a commode chair were damaged and therefore posed a potential infection control risk. The registered manager was aware of these issues but only took the necessary action after the inspection. The provider’s infection prevention and control policy was up to date and visitors were welcomed at any time without restrictions imposed and in line with current government guidance.

The provider had systems to monitor accidents and incidents, the actions taken, and lessons learnt and were shared across the team as a result. The provider and registered manager gathered views and opinions about the service by surveys, meetings and ongoing communication with people and their relatives.

People were protected from the risk of abuse because the entire staff team had now received training and demonstrated a clear understanding on how to recognise and report abuse. People’s care plans and risk assessments had been reviewed since the previous inspection and transferred onto a digital system so that staff had access to the up-to-date information they needed to care for people safely.

Accidents and incidents were monitored and environmental risk assessments, were in place. The provider operated a robust recruitment and induction process where all the appropriate pre-employment checks were undertaken. Staff felt well supported by the management team.

The registered manager had a good understanding of their responsibilities towards the people they supported. They promoted an open culture where everyone’s views and opinions were valued. People, relatives and staff said they would be confident to approach a member of the management team should they wish to raise a concern.

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 this service was requires improvement. (Published 30 June 2022). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for two consecutive inspections.

Why we inspected

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.

We carried out an unannounced comprehensive inspection of this service on 11 May 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and management oversight.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service remains requires improvement. This is based on the findings at this inspection.

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

Enforcement and Recommendations

We have identified breaches in relation to dignity and management oversight at this inspection.

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

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. 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.