Archived: Bramber Nursing Home

Updated 9 February 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on the 28 November, 2 and 5 December 2016 and was unannounced. The inspection was carried out by one inspector.

Before the inspection we looked at information provided by the local authority, contracts and we spoke with the quality monitoring team. We also looked at information we hold about the service including previous reports, notifications, complaints and any safeguarding concerns. A notification is information about important events which the service is required to send us by law. Before the inspection, we asked the provider to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. They told us they had not returned a PIR due to issues with email connections and they had contacted CQC to prevent future problems.

As part of the inspection we spoke with all of the people living in the home, three relatives and two visitors, eight staff including the cook, registered manager and provider. We contacted health professionals following the inspection, but did not have any responses. We observed staff supporting people and reviewed documents; we looked at four care plans, medication records, four staff files, training information and policies and procedures in relation to the running of the home. Including safeguarding, medication and complaints policies.

Some people who lived in the home were unable to verbally share with us their experience of life at the home, because they were living with dementia. We spent time with people in their own rooms and in the lounge and, we 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.

Updated 9 February 2017

Bramber Nursing Home provides nursing, personal care and accommodation for up to 21 older people living with dementia. There were 17 people living at the home during the inspection and all required assistance with looking after themselves including personal care, eating and drinking and moving around the home. People had a range of care needs; some could show behaviour which may challenge and some were unable to verbally share with us their experience of life at the home because of their dementia needs. The home is a converted older building, bedrooms are on two floors, there was a lift to enable people to access all parts of the home and a garden to the side and rear of the building.

The registered manager was available for the last day of the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.’

This inspection took place on the 28 November, 2 and 5 December 2016 and was unannounced.

At our last inspection, on 25 August 2015, we found that the provider had been actively advertising for new staff so that they no longer had to rely on agency staff; there were some gaps in the care plans and daily records and the manager had not yet registered with CQC. The local authority had an embargo on admissions to the home at this time, which was lifted in June 2016 and people have been placed at the home by the local authority since then. The local authority had worked with the provider and registered manager to develop an effective quality assurance system so they could monitor the services provided and, ensure support and care met people’s needs.

At this inspection we found a range of audits had been developed. However, further work was needed to ensure the quality assurance system was effective so that it identified areas for improvement and made changes to the service to meet people’s needs. Such as reviewing and updating care plans when people’s needs changed..

The feedback from relatives and staff was that there were not enough staff working in the home and people sat for long periods with little interaction with staff. Although staff had a good understanding of people’s need and how these could be met.

The provider was responsible for checking that the fire safety system was working effectively. We found they had not provided clear guidance for staff to follow to evacuate people from the building in case of emergency. There was no written evidence that the fire alarm had been checked for over a month.

A training plan was in place and new staff were required to complete an induction programme during the first 12 weeks of their employment. However, staff employed within the last four months said they had not had the time to work through this properly and more experienced staff had not been available to assess their competency. Staff also said the training provided was good and they were required to complete this, including moving and handling. Although not all staff followed this when using hoists to assist people to move around the home.

There were systems in place for the management of medicines and we observed staff completing records as they administered medicines but, the guidance for staff to give out some medicines, such as those prescribed ‘as required’, was not clear.

All but one of the staff had attended safeguarding training, some had completed this at their previous job and was up to date. They demonstrated an understanding of abuse and said they would talk to the management if they had any concerns. They knew that referrals were made to the local authority and how to make these, but they had not needed to do this. People said they were comfortable and relatives felt people were safe living at Bramber Nursing Home.

Staff had a good understanding of people’s needs and treated them with respect and protected their dignity when supporting them with personal care. Activities were provided for people to participate in when activity staff were available.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The provider, manager and staff had an understanding of their responsibilities and processes of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

Pre-employment checks for staff were completed, which meant only suitable staff were working in the home.

Visits from healthcare professionals were recorded in the care plans, with information about any changes and guidance for staff to ensure people’s needs were met.

We recommend the provider takes advice from an appropriate source to ensure fire safety is fully managed.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

You can see what action we told the provider to take at the back of the full version of the report