Brandon House

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

During our assessment of this key question, we found the provider was failing to meet their legal requirements and were in breach of regulation 17. You can find more details of our concerns in the evidence category findings below. The provider failed to ensure they operated good governance and leadership roles were ineffective to consistently monitor, identify and drive improvement. We found a number of significant concerns at this assessment and were not assured that the providers governance ensured people always received safe, effective, good quality care. Staff told us the culture in the home was negative and as they did not feel supported by the management team. We received mixed feedback from people in relation to the management team with some people feeling listened to and others not.

This service scored 46 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Managers told us they had a shared vision which was based on transparency. Managers told us they had traditional family values, and were an open, honest, transparent organization. Managers described a positive culture however this was not reflected in comments made by staff. Staff told us they felt there was an atmosphere in the home currently, and they felt like they were walking on eggshells.

There was a negative culture at the home. Staff meetings and supervisions were not effective because staff told us they did not feel supported by the management team. Staff told us management were not always responsive when they raised concerns in relation to people’s health.

Staff told us they did not always feel supported by management. They told us supervisions were not always regular or of much value. They told us staff meetings were not always regular. Comments included, “We used to have staff meetings” and, “At one point we had supervision, seems to have fallen under a lot recently”.

Whilst the management team had the knowledge and skills to lead the home, these skills were not always used compassionately and were not consistently inclusive. The provider did not demonstrate how they were listening and responded to staff when genuine concerns are raised.

Management told us they fostered a positive culture where people could speak up and their voice will be heard. However, staff told us they did not feel able to speak up. Staff said, “No not in the slightest with this new manager” and, “The last manager had an open-door policy which made us feel comfortable to enter into the office and discuss any matters at hand but now a simple good morning even goes a miss and when issues are raised it seems to be brushed under the carpet unless it is of a very serious matter.”

The service had appropriate policies in place to allow people to speak up. We saw evidence of feedback cards in the entrance of the home and an invite for a relatives meeting. However, relatives did not usually attend this meeting and the home had not explored other options to gather feedback.

The service had an equality and diversity policy in place. Management told us staff were trained in equality and diversity. However, staff told us the culture of the home was not always welcoming and inclusive. Comments included, “I feel really down, and I feel I been very negative” and, “Now I feel when I go in, I’m looked down on.”

The provider had policies in place to support fair recruitment, induction and training for all staff. The provider confirmed they had organisational processes to follow to identify and address any concerns with staff's working environment or access to development opportunities. However, staff told us their working environment was currently unpleasant and supervision was not effective for accessing development opportunities.

Management told us the home was in the process of developing a new quality and compliance system to improve oversight and governance. However, during our assessment, records of care were not always complete and quality assurance systems were not fully effective.

We found quality assurance systems in place had not always been effective in ensuring areas for improvement were identified and addressed. Care plan audits had been completed on the care plans reviewed, but the issues we identified during this assessment with records not being complete or lacking detail were not identified. Audits of daily notes, repositioning charts and food and fluid charts had not been completed showing a lack of effective quality assurance systems in place. The management team failed to ensure their regulatory requirements of reporting incidents to CQC and the local safeguarding team. The oversight of accidents and incidents were not robust as actions had not always been taken to investigate and learn from this. Evidence from this assessment demonstrates a breach of Regulation 17 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We received mixed feedback from people in relation to the management team. People told us, “They do ask what they can do to improve the situation, I say but it doesn’t materialise. [Name] does a wonderful job and asks what can be improved” and, “They do ask you what you want. I tell them I am happy here.” The provider did not have effective engagement with people’s families. No families of people living at Brandon House attended a relative meeting.

Some staff told us they were asked their ideas for learning and improvements others said they were not asked. Comments included, “Yes by the last manager” and, “Not really.”

No concerns or comments were raised by partners when we gathered feedback as part of our inspection.

The provider did not focus on continuous learning and improvement for the service. At the last inspection we identified a breach of regulation 17 due to ineffective governance processes. This inspection identified that whilst there was a system in place, it did not help to identify areas requiring improvement and/or mitigate risks. For example, people's feedback was not always acted on, audits carried out to monitor parts of the service were not always effective or completed, safeguarding referrals were not always done when required and care plans and risk assessments lacked detail. The governance systems also failed to monitor the ongoing culture of the service.

Staff and leaders told us that they were aware of how to report and investigate events and incidents. However, during our inspection there was one incident where unexplained bruising had not been reported by staff and another incident where staff had reported pressure damage, and this had not been investigated or monitored by management.

The provider was not effective in recording or investigating incidents. CQC were notified of incidents where harm occurred, but these were not investigated or analysed to identify trends or themes and to prevent future incidents.