Brampton Lodge

People’s experience of using this service:

We continued to receive positive feedback about Brampton Lodge. One person said, “Its very good care, I have a very comfortable room.” Another person said, “The staff are very kind. They are very good at respecting our privacy, we know the deputy manager well, they are very good to us.” A relative said, “We are very impressed with the home, Mum is being well looked after.”

People told us that staff met their needs with care and were friendly towards them. We continued to observe staff with kind and positive attitudes to delivering person centred care. During the inspection, we often heard staff saying kind things to people and observed that staff were friendly and attentive to people’s needs.

Equality, diversity and human rights policies were in place and the care assessments included sections about people’s backgrounds and lifestyles. Staff worked in partnership with people, respecting people’s rights and always offering people choices about their care.

Risks assessments and the ongoing maintenance of the premises and equipment minimised the risk of people being exposed to harm. The premises were adapted to people’s mobility needs to make all areas of the premises and garden accessible to people with mobility problems.

People’s needs were fully assessed and people’s right to retain independence in their day to day lives was respected. Staff understood how to safeguard people at risk and how to report any concerns they may have. The staff learnt from incidents and accidents to reduce the risk of them reoccurring.

Care plans had been developed to assist staff to meet people’s needs. The care plans were consistently reviewed and updated.

People, their relatives and health care professionals had the opportunity to share their views about the service. Complaints made by people or their relatives were taken seriously and thoroughly investigated.

Safe recruitment practices had been followed before staff started working at the service. Staff had supervision and personal development opportunities to learn skills in social care. Staff training was ongoing. There were systems in place for ensuring the staffing levels and staff skills balance were maintained to meet people’s needs.

There were policies and procedures in place for the safe administration of medicines. Staff had been trained to administer medicines safely.

People were offered a range of food choices and encouraged by staff to eat healthily. People had access to GPs and their health and wellbeing was supported by prompt referrals and access to medical care if they became unwell.

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.

Staff followed good hygiene practice to minimise the risks from the spread of infection.

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 Outstanding (published 11 January 2017).

Why we inspected:

This was a comprehensive inspection scheduled based on the previous rating.

Follow up:

We will continue to monitor the service.

Brampton Lodge is registered to provide personal care and accommodation for up to 26 older people. There were 22 people using the service during our inspection; some of whom were able to live quite independently and others who needed more support from staff. The service offers respite care as well as permanent placements and keeps rooms available, where possible for people who may benefit from short-term stays.

Brampton Lodge is a very large detached house situated in a residential area of Folkestone. There was a comfortable, well-decorated lounge with homely sofas and seating looking out over the attractive and enclosed garden to the rear. The dining area was well-furnished with padded seats and a restaurant-type feel.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Registered persons have a legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We received wholly positive feedback about Brampton Lodge from people, relatives and visiting professionals. We heard about exceptional standards of care which improved the quality of people’s lives and gave their families peace of mind. We observed warm, caring attitudes from staff and a real drive to provide the best possible service for people.

People were kept safe because staff knew how to recognise and report abuse, and a range of environmental and personal checks were regularly made to make sure risks and hazards were minimised. The service was exceptionally clean and hygienic so the chance of infection spreading was limited. Medicines were kept safe and managed properly, and people received them as the prescriber had intended.

Staff were well-trained and encouraged to develop their skills. There were plenty of staff on duty and people’s needs were met promptly and effectively by staff who knew people and their preferences very well. People praised the competency of staff to us and the registered manager carried out routine checks of staff knowledge and capability.

People’s health was carefully monitored and professional advice sought quickly and efficiently as needed. The service had forged excellent working relationships with professionals who reported that staff were aware of health changes and escalated these promptly.

The meals on offer were plentiful and of good quality; home cooked and made with local ingredients. People were extremely complimentary about the choice and taste of food. There was a wide range of stimulating activities available, which people enjoyed and were pitched at the right level for people.

Staff were knowledgeable about the principles of the Mental Capacity Act (MCA) 2005 and demonstrated these in practice. The registered manager had made applications under the Deprivation of Liberty Safeguards (DoLs).

There was notable affection between staff and people and this was evident in actions such as the registered manager visiting people in hospital in her own time. The care people had been given at the end of their life received much praise from relatives and staff showed commitment and maturity in supporting people and their families at that time; often volunteering for extra shifts to ensure people were not alone at the end.

People received care that was tailored to them individually. The provider had responded to the particular needs of some people, by investing in special equipment for their personal use; designed to enhance their experiences. Extra services such as free taxis and funded occupational health sessions had been put in place to benefit people and promote their independence.

The registered manager encouraged an open culture; and people, relatives, visitors and staff were all enabled to speak out with any concerns; so that they could be put right. Standards of care were continuously reviewed by the provider and registered manager to ensure they were maintained and to make improvements when necessary.

The provider and registered manager operated robust quality assurance systems which helped them identify any shortfalls and remedy them quickly. There had been no recent complaints but very many compliments about the standard of care provided at Brampton Lodge. One person told us “ This home is absolutely wonderful. I could not wish for better care, more loving carers or a delightful manager”.

We looked at the answers to five questions:

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

Is the service safe?

People we spoke with told us they felt safe living in the home and the staff supported them well. Relatives told us that they felt reassured that their relative was safe living at the service.

Risks associated with people's care delivery were identified during assessments. However not all risks had sufficient guidance for staff to follow to make sure they took a consistent approach to reduce the risks, so that people remained safe. We spoke with staff who were aware of how to minimise risk and support people safely but not all details were included in the risk assessments.

There were systems in place to make sure that the staff learnt from events such as accidents and incidents, complaints, concerns, and investigations.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLs) which applies to care homes. No DoLs applications had needed to be submitted, but policies and procedures were in place should the need arise. Relevant staff had been trained to understand when an application should be made, and how to submit one. Staff had been trained in regards to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) and were able to support people to make decisions about their daily lives.

Is the service effective?

People told us that they were very happy with the care that had been delivered and their care needs were fully met. They told us that there were lots of things to do in the service and they could choose which activities they preferred.

Although the care plans lacked some individual details of people's personal routines staff knew the people well and demonstrated they knew how to care for the people in line with their preferences and choices. Care plans had been regularly reviewed to make sure staff were aware of people's changing needs.

People told us that they received appropriate support from health care professionals when required and they also gave examples of how well they were looked after by the staff when they were feeling unwell.

The staff were complimentary about the support they received from the registered manager. We saw that regular meetings had taken place between individual staff members and the registered manager. Staff told us they were able to discuss issues with the registered manager at these meetings, or at any time they had a concern.

Is the service caring?

Relatives spoke positively about the staff and felt that staff were kind and respectful. They told us that they were happy with the care that had been delivered to their relative and their care needs were fully met. People told us that the activities in the home were varied and they had lots of choice to participate or sit quietly in their rooms. People said the staff really cared and made sure that they had the opportunity to join in the activities of their choice.

People told us that their relatives had the opportunity to have lunch with them and join in the social activities so that everyone was given the chance to enjoy themselves and be involved in the service.

People told us that the staff were always around when they needed them and nothing was too much trouble. We saw that staff interacted well with people and knew them well; they knew how to relate to them and how to communicate in a caring and respectful way. People living in the home made positive comments about the staff, with remarks such as: 'There is always enough staff; they are patient, kind and compassionate'. 'The staff are very good treating people with dignity and respect'.

Is the service responsive?

People told us that they were happy with the service. It was clear from observations and from speaking with staff that they had a good understanding of the people's care and support needs.

We found that the staff listened to people, and took appropriate action to support them in their daily routines. We saw staff respond promptly to people's requests, for example making drinks or escorting them to the dining room for lunch.

We observed that when people were in their rooms and pressed the call bell staff responded quickly. People told us that the staff were always around to support them and they did not have to wait long for them to arrive when they called them.

People's privacy was maintained. People could lock their bedroom doors if they wished, and there were places available where they could meet friends and relatives in private. Staff understood their responsibilities and they ensured that people's privacy and dignity was respected. A relative said: 'They have the balance right here, the staff treat people with dignity and respect and also manage to have a laugh and joke'.

Is the service well-led?

Quality assurance processes were in place. Staff told us they were clear about their roles and responsibilities and that they felt supported by the management team. They said: The management team is very good, any problems we just see the manager'. 'You can really talk to the management team, they are very approachable'.

Systems were in place to ask people who used the service, relatives and staff for their views about the service. This meant that people were being given the opportunity to have their say about the services being provided.

The service had systems in place to provide ongoing monitoring of the care being provided. This included care plan reviews, the management of medication and checks for the environment.

People who used the service had access to a range of information about the service, in a variety of formats, to help them make an informed decision about their care, treatment and support.

People told us that they were happy with their care and that staff had a good understanding of their individual needs and responded to them promptly. One person told us 'nothing's too much trouble' and "staff know my needs'.

Care records were detailed and contained appropriate risk assessments to minimise identified risks, so that staff were able to follow safe practices and keep people as safe as possible.

The home was clean and tidy with no unpleasant odours. We saw that cleaning schedules were in place and regularly checked and signed by staff. We saw that people were provided with appropriate equipment to support their needs, for example, mobility aids and specialist bathing facilities.

Staff told us that they felt well supported by the manager and that essential training and some opportunities for development were provided.

The home had a formal complaints procedure, as well as a day-to-day comments book. We found that complaints and comments had been addressed and investigated appropriately and outcomes conveyed to the complainant.

The people we spoke with who used the service told us that they enjoyed living there they spoke positively about the environment, the staff and the meals. Comments that people made included 'I feel very relaxed living here it's spacious, nicely decorated and comfortable. I enjoy the meals, the food is wonderful'. Another person told us 'I find Brampton Lodge a very pleasant place to live, it doesn't feel like a care home to me. The staff are all attentive and kind, they stop for a chat'.

When we looked around the service we saw that it was well decorated and furnished to a good standard. People commented that they enjoyed spending time in the communal lounge area which overlooked the garden and provided access to it. They spoke of enjoying the garden in the summer months and the variety of activities that the service arranged which included massage therapy and gentle exercise, music, arts and craft. People told us that they benefitted from other activities such as outings for country drives, going to see shows and the occasional pub lunch.