Archived: Bracken Lodge Care Home

Bracken Lodge is a residential nursing home providing personal and nursing care to eight people aged 65 and over at the time of the inspection. The service can support up to 18 people.

The property is a converted residential house and provides both single and double occupied rooms with shared toilet and bathing facilities. There is a passenger lift to the upper floors. Communal space includes a sitting room, dining room and outside garden.

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

People and their families described the care as safe. Legal requirements to report significant accidents or incidents and safeguarding concerns to external professional agencies were being met. Staff understood their role in recognising abuse or poor practice and understood actions needed if they had concerns. People had their individual risks assessed, monitored and reviewed and actions to minimise avoidable harm were carried out by the staff team. Medicines were administered safely. Infection prevention and control practices were in line with government best practice guidance.

Staff had the training, skills and experience to carry out their roles effectively. Refresher training was out of date due to limited training available during the pandemic. The registered manager put this in place during our inspection. People had their healthcare needs met and good working relationships with health professionals ensured good outcomes for people. 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.

The home had an open, friendly, positive culture with visible management that led by example ensuring person-centred care. People, their families and the staff team felt involved in the service and spoke positively about communication and teamwork. Auditing processes were in place and ensured risks to people were managed effectively. Learning was shared with the staff team. External resources were used to keep up to date with good practice including NHS community clinical leads and Public Health England.

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 11 February 2020) and there were multiple breaches of regulation. 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 improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We found the following examples of good practice.

There was a clear process to welcome visitors to the home which included rapid result COVID-19 testing, Personal Protective Equipment (PPE), hand gels and health questions. All visitors to the home were pre-arranged and a member of staff was assigned to ensure the visit took place in a safe way. Relatives had a number of ways to stay in contact with their loved one’s including face to face visits and video calls.

Social distancing was encouraged and supported throughout the home with the arrangement of furniture in communal areas. Staff promoted social distancing around the home and in their interaction with each other. There were good supplies of PPE and staff were observed wearing this correctly and inline with current government guidance. There were hand gels and soaps around the home and posters reminding staff of the correct techniques for effective handwashing.

All staff were responsible for keeping the home clean and tidy. Frequent cleaning of high touch point areas such as door handles and light switches was in place. Adjustments had been made to cleaning products used and increased laundry temperatures to ensure hygienic cleaning practices throughout the home.

The home participated fully in the whole home COVID-19 testing programme and all people and staff had been offered a vaccination. People and staff had risk assessments in place to include their underlying health conditions and whether this made them more at risk if they were to contract COVID-19.

The registered manager told us they were supported by the provider and by other registered managers in their network. Attendance at regular registered manager meetings was a good source of support and information for the home. There was an infection, prevention and control policy in place and contingency plans for potential outbreaks.

The registered manager told us their staff had worked extremely hard throughout the COVID-19 pandemic and it was important to look after wellbeing. Regular conversations and meetings between the staff team enabled them to share their concerns and receive support.

Bracken Lodge is a residential care home providing personal and nursing care to 11 older people, some living with a dementia, at the time of the inspection. The service can support up to 18 people. The accommodation was over three floors and included a passenger lift, in house kitchen and laundry, specialist bathrooms and a communal lounge and dining room.

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

Systems in place to protect people from abuse or to mitigate risks to people’s health and well being were not operating effectively. Information from accidents and incidents had not been reviewed which meant they had not been investigated or legal requirements of reporting to external agencies met. Governance systems had failed to identify that risks to people had not always been managed effectively or that legal reporting requirements had not been met.

People and their families described the care as safe. Staff understood risks to people and actions needed to reduce avoidable harm, whilst being respectful of people’s freedoms and choices. Staffing levels met people’s needs and enabled care to be flexible and responsive. Staff had been recruited safely, including employment and criminal record checks. People had their medicines ordered, stored, administered and disposed of safely.

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.

Staff received training and support that enabled them to carry out their roles effectively. The environment enabled people to have access to both private and social space and had signage that enabled people to independently orientate themselves around the building. People’s rooms were personalised and reflective of our lives, interests and hobbies. Food was home cooked and provided well balanced meals. Special dietary requirements were known and met. People had access to health care for planned and emergency health needs. Collaborative working with other health professionals ensured good outcomes for people.

People and their families spoke positively about the care they received, describing staff as kind, friendly and responsive to their emotional needs. Staff had a good knowledge of people, their personal history and the people important to them. People had their privacy, dignity and independence respected by the care team.

Care plans gave clear guidance on people’s care needs and choices and were understood and followed by the care team. Care plans were reviewed regularly and responsive to change. People were involved in end of life planning which reflected their cultural and spiritual needs. People’s communication needs were understood by the care team which meant people were able to be involved in decisions about their day to day care. Activities were specific to people’s interests and included daily newspapers, board games, books, art and music.

People, their families and the staff team spoke positively about the management of the home, describing leadership as visible, friendly and approachable. People, families and the staff team felt listened to and able to share ideas and concerns and that the registered manager would take any necessary actions. There were opportunities to be involved in the service through informal conversation, social events, quality surveys and meetings. The registered manager kept up to date with best practice through attendance at local provider meetings and through professional bodies such as the Nursing and Midwifery Council.

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 29 June 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to systems not operating effectively to safeguard people from abuse. Risks to people not being investigated and legal requirements of reporting accidents and incidents to external agencies not being met. Governance systems failing to identify that risks to people had not always been effectively managed or legal requirements met.

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 for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Bracken Lodge is registered to accommodate a maximum of 18 people who require nursing or personal care. There were 10 people living there at the time of our inspection.

The home was led by a registered manager. 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, who were able to, told us that their care and support needs were met and that staff were kind, caring and respectful. People also felt safe and had confidence in the staff.

Staff knew people well and understood their needs. Care plans were detailed and regularly reviewed. This meant that there was always information for staff to refer to when providing care for people.

The provider had implemented satisfactory systems to recruit and train staff in a way that ensured relevant checks and references were carried out and staff were competent to undertake the tasks required of them. The number of staff employed at Bracken Lodge, and the skills they had, were sufficient to meet the needs of the people they supported and keep them safe. We were concerned that the registered manager was working long hours as the registered nurse on duty in the home in addition to their main role as registered manager.

People were protected from harm and abuse wherever possible. There were systems in place to reduce and manage identified risks and to ensure medicines were managed and administered safely. Staff understood how to protect people from possible abuse and how to whistle-blow. People knew how to raise concerns and complaints and records showed that these were investigated and responded to.

There was a clear management structure in place. People and staff said was the manager was approachable and supportive. There were systems in place to monitor the safety and quality of the service.

Bracken Lodge Care Home provides accommodation, care and nursing for up to 18 older people living with dementia in a small homely environment. At the time of the inspection there were 11 people living at the home.

There was a registered manager at the home at the time of the inspection. 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.

Relatives and staff were very positive about the standards of care provided at the home. People were treated compassionately as individuals with staff knowing people’s needs.

On the first day of the inspection we identified hazards that could pose a risk to people and the registered manager could not provide an environmental risk assessment. By the second day of the inspection this had been carried out with an action plan to address the potential risks to people.

Staff had been trained in safeguarding adults and were knowledgeable in this field.

Risk assessments had been completed to make sure that care and nursing was delivered safely with action taken to minimise identified hazards.

Accidents and incidents were monitored to look for any trends where action could be taken to reduce chance of such accidents recurring.

There were sufficient staff employed at the home to meet the needs of people accommodated.

There were recruitment systems in place to make sure that suitable, qualified staff were employed at the home. The home had a longstanding, loyal staff team who had worked at the home for many years.

Medicines were ordered, stored, administered and disposed of safely and overall there was good management of people’s medicines ensuring people had medicines as prescribed by their doctor.

The staff team were both knowledgeable and well trained and there were induction systems in place for any new staff.

There were good communication systems in place to make sure that staff were kept up to date with any changes in people’s routines or nursing requirements.

Staff were well-supported through supervision sessions with a line manager and an annual performance review.

Staff and the registered manager were aware of the requirements of the Mental Capacity Act 2005 and acted in people’s best interest where people lacked capacity to consent. The home was compliant with the Deprivation of Liberty Safeguards with appropriate referrals being made to the local authority.

People were provided with a good standard of food, appropriate to their needs.

People’s care and nursing needs had been assessed and care plans put in place to inform staff of how to care for people. The plans were person centred and covered people’s overall needs. However, the plans we looked at in depth were not up to date and lapses in recording could have led to people’s needs being overlooked and unmet. You can see what action we told the provider to take at the back of this report.

There were limited communal activities but steps were taken to provide individualised activities to keep people meaningfully occupied.

There were complaint systems in place and people were aware of how to make a complaint.

Should people need to transfer to another service, systems were in place to make sure that important information would be passed on.

The home was well-led. There was a very positive, open culture with staff proud of how they supported people.

There were systems in place to audit and monitor the quality of service provided to people.

During our visit we spoke with three relatives of people who use the service, one carer and the home manager. We also made observations throughout the visit and saw people being offered choices and were spoken to in a respectful manner.

The information pack shown to us by the manager was very comprehensive, however was not seen in any of the care files that we checked during our visit.

We looked at peoples care plans and saw that the information recorded enabled staff to plan and deliver the required level of care and support on an individual basis.

We saw that appropriate storage facilities for all types of medication were available and that these were secure when we visited, however medication records were not always completed as intended following administration of prescribed medication.

Everyone we spoke with during our visit told us that they felt staffing levels at Bracken Lodge were sufficient to meet the needs

of the people that use the service, however rotas seen did not always evidence that staffing levels were sufficient.

We saw that regular audits of the service were completed by the provider ensuring that people who used the service benefit from a service that monitors the quality of care that people received.

Another relative wrote 'Although unable to immerse herself with the staff and fellow residents in her latter years. I feel that she enjoyed a quality of care with you that she appreciated'.

The local church had written 'I should like to thank you and your staff for your very kind co-operation when our ministers visit your home'.

People's needs were assessed and care planned and delivered to met those needs.

Staff received appropriate professional development and there were systems for supervision and appraisal in place. This meant that people's needs were met by competent staff and their safety protected.

There was evidence that learning from incidents took place however the monitoring of actions taken as a result was limited. We were told told us that the provider visited the service to undertake audits but there were no records to show the audits undertaken or actions for the service to follow up as a result of these visits.