Braeside Care Home

Braeside Care Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home can accommodate up to 36 people. At the time of this inspection there were 18 people using the service.

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

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 did not always support this practice. We could not be assured the provider was meeting the requirements of the Mental Capacity Act (MCA). Records at the home relating to some Deprivation of Liberty Safeguards (DoLS) authorisations had not been updated. Staff were not able to tell us which people who lived at the home had DoLS in place or which people had conditions placed on DoLS authorisations. Medicines were not always managed safely. Further improvement was needed to systems for auditing, assessing, monitoring and improving the quality and safety of the service.

Staff had received training and knew how to identify and report safeguarding concerns. Risks to people were identified and well managed. The required health and safety checks had been completed. There were sufficient staff deployed and safe systems of staff recruitment were in place. There were systems in place to minimise the risks associated with COVID-19 and other infectious diseases.

People’s needs were assessed and person-centred care plans and risk assessments had been developed. Plans were in place to further develop and improve these records. People told us they were happy with the care they received. A person said, “Staff are good, helpful when I need them. I’ve no complaints, I’m quite happy with things.” Staff received the induction, training and support they needed to carry out their roles effectively. People’s nutritional needs were being met, people were positive about the food. Peoples were supported to access a range of health care professionals. The building and decoration were in need of some updating. There was a detailed improvement plan in place for the updating and redecoration of parts of the building.

Everyone was very positive about recent changes in management and provider oversight. Staff told us communication with managers and the provider had improved. Throughout the inspection staff were observed to be patient, caring and responsive. They knew people really well. People who lived at the home told us they could raise any concerns and were listened to.

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 19 April 2019).

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 received concerns in relation to the management of medicines and people’s nursing care needs, recruitment checks, health and safety and governance systems. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

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 has changed from good to requires improvement based on the findings of this inspection.

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

Enforcement and recommendations

We have identified breaches in relation to consent, medicines management, and governance.

Please see the action we have told the provider to take at the end of this full 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 work alongside the provider and local authority to monitor progress. 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 were measures in place to reduce the risks associated with COVID-19 related staff pressures.

Staff had received training in the use of Personal Protective Equipment (PPE), we observed staff wearing PPE as required. There were ample stocks of PPE.

People who lived at the home and staff were tested regularly for COVID-19. The service was meeting the requirement to ensure non-exempt staff and visiting professionals were vaccinated against COVID-19. Visitors were required to undertake COVID-19 testing and wear PPE in line with current government guidance. The manager was supporting visits for people who lived at the home in accordance with the current guidance.

The home was very clean and uncluttered. Cleaning schedules were in place and there was a range of auditing and monitoring in place to ensure infection control procedures were being followed properly to reduce the risk of infection.

The systems in place ensured any infection outbreaks could be effectively managed. The manager had been in regular contact with the local authority and public health teams. The service had risk assessments and policies and procedures in place to manage the risks of COVID-19.

Braeside Care Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home can accommodate up to 36 older people, some of whom were living with dementia. At the time of this inspection there were 35 people using the service.

People’s experience of using this service:

¿The service had an experienced registered manager who had ensured all the issues from the previous inspection had been resolved and systems were in place to drive continued improvement.

¿We received positive feedback about the service from all stakeholders including people who lived at the home, their families, care staff and health and social care staff. One relative told us, “They are friendly and there is a very good atmosphere. They had her up and dancing last week. Mum has a good rapport with staff. I feel they look after mum as if she was one of their family.” A visiting professional told us, “This is one of the good homes. The care and attention given to the residents is very good”. Relatives told us that the good communication and openness gave them confidence and reassurance.

¿Stakeholders were engaged in a meaningful way where consultation led to improvements being made to the service.

¿We observed an open, friendly and caring atmosphere in the home and this was supported by a low turnover of staff.

¿People’s care needs were met safely and we received good feedback about staff being caring and treating people with dignity and respect. There was also good feedback about the cleanliness of the home, the food and the activities on offer.

Rating at last inspection: At the last inspection the service was rated requires improvement (published 23 March 2018). The overall rating has improved at this inspection.

Why we inspected: This was a planned inspection based on the current timescales for returning to re-inspect services rated requires improvement overall.

Follow up: We will continue to monitor the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

Braeside Care Home is a privately owned residential care home located in the Smallbridge area of Rochdale. Braeside Care home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The care home accommodates 36 people in one adapted building, over two floors. The lower floor accommodates people with nursing or residential needs and the upper floor specialises in providing care to people living with dementia. At the time of the inspection there were 34 people living at the home, there was one vacancy and one person was in hospital.

There was a registered manager in place who had managed the service for a number of years. 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.

There was an appropriate safeguarding policy and procedure in place, staff had undertaken safeguarding training and demonstrated a good understanding of the issues and how to report any concerns.

Staff recruitment was robust at the home and staffing levels were good on the day of the inspection. The medicines systems were safe.

The home was clean in most areas and there were no malodours. However, some areas required attention to ensure they were safe. Health and safety certificates were in place and general and individual risk assessments had been completed, though some of the individual risk assessments had not been not regularly updated.

The service was working within the legal requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Care files included a range of information relating to health and well-being. However, some specific care plans and monitoring charts had not been completed.

There was a good induction for new staff and training was on-going. However, a number of refresher training courses had been completed in one day, which undermined the quality of the training.

People told us the food was good and there were choices available. The mealtime experience could have been improved with better interaction with staff. The environment could have been better equipped for people living with dementia.

People we spoke with had mixed views about the care provided at the home. We saw that visitors were made welcome, but staff interaction with people who used the service was poor at times.

There were up to date policies on privacy and confidentiality, equality and diversity, fair access, diversity and inclusion. Residents’ and relatives’ meetings were held regularly so that people’s views could be taken on board.

Information within the care files was person-centred and included people’s preferences and background information. There were some activities on offer, but some people were left with no meaningful occupation through the day.

There was an end of life policy and procedure and staff had received training in end of life care.

There was an up to date complaints procedure and this was outlined in the service user guide and displayed in the reception area of the home.

People we spoke with said the registered manager was approachable. We saw evidence of staff supervisions, but the recording of these was extremely brief. Staff meetings took place on a regular basis.

The service worked in partnership with other agencies and were involved with some pilot schemes and initiatives.

There was a family satisfaction survey carried out on a regular basis to gain people’s views. Audits were in place but did not always include actions and follow up. Recording across the board was inconsistent.

Is the service safe?

We saw that people were treated with dignity and respect. People told us they felt safe. One person said, 'The staff are very good and very nice to us.' Systems were in place to make sure that managers and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

Relevant staff had received training about the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards to understand when an application should be made, and how to submit one.

We saw that significant areas of the home were dirty. This included the skirting boards, window sills and radiators in most rooms.

Medication was managed and administered by registered nurses who knew how to safely give medicines to people who used the service.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to cleanliness and infection control.

Is the service effective?

People's health and care needs were assessed with them or their relatives and they were involved in writing their care plans. Specialist dietary, mobility and equipment needs had been identified in care plans where required. Care plans were reviewed regularly and amended to reflect people's changing needs.

We found that people's care records included an assessment of their nutritional status so that appropriate action was taken if any problems were identified. One person said, 'The food is hot and delicious'. The relative of one person said, 'The food is excellent, they've got a wonderful cook.'

Discussion with care workers and examination of records confirmed that induction training for new employees and a rolling programme of training was in place so that all members of staff were kept up to date with current practice.

However, there was no evidence to demonstrate that members of staff had regular supervision meetings with the manager. This meant that staff were not given the opportunity to formally discuss their training and development needs and any work related issues.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to supporting workers.

Is the service caring?

We saw that members of staff were attentive to people's needs and offered appropriate encouragement and assistance when necessary.

People who used the service told us they liked living at the home and received the care and support they needed.

The relatives of one person said, 'The care is second to none, there's a family atmosphere. You'd have to go a long way to beat this place.' One visitor told us their relative was very happy at the home and said, 'When the staff come into her room her face lights up. They talk to her about everyday things and they use her name all the time.'

People's personal preferences, interests and diverse needs had been recorded in their individual care plans.

People who used the service and their representatives were given the opportunity to complete satisfaction questionnaires annually. The manager evaluated these surveys in order to identify any areas for improvement.

Is the service responsive?

Leisure activities were routinely organised at the home. The activities coordinator said, 'We play cards and bingo, and make cards. I take people out for a walk and to the local garden centre.' We also saw that one person was given a hand massage and manicure and others were assisted with drawing. One visitor told us that a member of staff read to their relative.

Outside entertainers visited the home every two months and members of a local Church visited monthly for hymn singing and prayers. Local clergy also visited regularly and offered Holy Communion to people who wished to practice their faith in that way.

The manager had an 'open door' policy so that people who used the service or their relatives could discuss any concerns. The relative of one person said, 'The manager has been very kind and nothing was too much trouble.'

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

There were systems in place for assessing and monitoring the quality of the service provided. We saw that audits completed regularly by the manager covered most aspects of the service provided. However, these audits had not identified the shortfalls we found during this inspection.

We received an action plan in June 2013 with details of how the provider was going to meet the areas of non-compliance. During our inspection we found that the provider had met the areas of non-compliance from the previous inspection in May 2013.

One person said 'The staff always wait patiently for people in a loving way.'

Both visitors felt that people living at the home seemed safe and had no issues or concerns.

Both visitors commented that the environment was pleasant and the home had a nice odour. One visitor said 'There are hand sanitizers everywhere you look.'

One person said 'The staff treat me with respect and it's a fantastic place.'

Both people were positive about the environment and living with the other people. Both people felt safe living at the home and did not have any concerns related to the wellbeing of any of the people at the home.

The people we spoke with told us they felt there were enough staff around and that the staff were friendly and helpful. They told us that they had no concerns about the care they received and would speak to the Registered Manager if they had any concerns or complaints.