All inspections: Bramber Nursing Home - Care Quality Commission

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

Bramber Nursing Home provides nursing, personal care and accommodation for up to 21 older people living with dementia. There were 10 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, including diabetes; 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 home has been without a registered manager since August 2013. 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.’ A registered nurse was managing the home during the inspection. They told us they had applied to register as manager with CQC and we found the application was being processed.

This inspection took place on the 26 August 2015 and was unannounced.

At the time of this inspection the local authority had an embargo on admissions to the home pending improvements in records. At the last inspection on 27 January and 6 February 2015 they were rated as inadequate. The Care Quality Commission (CQC) issued a Warning Notice after the inspection in respect of lack of accurate records. We found the provider had met the Warning Notice.

We asked the provider to make improvements to the safety and welfare of people, staff training and the monitoring and assessing the quality of the care and support provided. The provider sent us an action plan stating they would be addressed by August 2015. We found our concerns had been addressed, although additional improvements were required.

The care planning system had been reviewed and records for each person were specific to their needs, with guidance for staff to ensure people received the support and care they needed and wanted. Staff said the care plans were being developed and a final format had not yet been agreed. Nurses wrote the care plans and all staff were expected to record the care and support provided and any changes in people’s needs. The manager said care staff were being supported to do this and additional training had been arranged. Food and fluid charts were completed and showed people were supported to have a nutritious diet.

Staff and relatives felt there were enough staff working in the home and relatives said staff were available to support people when they needed assistance. The provider was actively seeking new staff, nurses and care staff, to ensure there was a sufficient number with the right skills when people were able to move into the home. The manager told us it had been difficult to recruit nurses with the right knowledge and understanding of supporting people with dementia, a deputy manager had been appointed and the provider continued to advertise for full time nurses. However, they had to rely on staff doing overtime and on agency staff at times.

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

The provider had made training and updates mandatory for all staff, including safeguarding people, moving and handling, management of challenging behaviour, pressure area care, falls prevention and dementia care. Staff said the training was very good and helped them to understand people’s needs.

All staff had attended safeguarding training. They demonstrated a clear understanding of abuse and said they would talk to the management or external bodies immediately if they had any concerns, and they had a clear understanding of making referrals to the local authority and CQC. People said they were comfortable and relatives felt people were safe.

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. There were systems in place for the management of medicines and we observed staff completing records as they administered medicines.

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.

Staff had a good understanding of people’s needs and treated them with respect and protected their dignity when supporting them. A range of activities were available for people to participate in if they wished and people enjoyed spending time with staff.

Staff said the management was fair and approachable, care meetings were held every morning to discuss people’s changing needs and how staff would meet these. Staff meetings were held monthly and staff were able to contribute to the meetings and make suggestions. Relatives said the management was very good; the manager was always available, they would be happy to talk to them if they had any concerns and residents meetings provided an opportunity to discuss issues with other relatives and staff.

The provider had systems in place to review the support and care provided. A number of audits had been developed including those for care plans, medicines and health and safety. Maintenance records for equipment and the environment were up to date, such as fire safety equipment and hoists. Policies and procedures had been reviewed and updated and were available for staff to refer to as required. Staff said they were encouraged to suggest improvements to the service and relatives told us they could visit at any time and they were always made to feel welcome and involved in the care provided.

Bramber Nursing Home provides accommodation and nursing care for up to 21 people living with a dementia type illness who need support for all aspects of their daily living. At the time of the inspection 12 people were living in the home.

The home did not have a registered manager and the provider had employed management consultants to assist managing the home until a manager was appointed. 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.

We carried out an unannounced comprehensive inspection on 27 January and 6 February 2015. We found there were some serious concerns related to the poor standards of record keeping. Following this inspection the local authority issued an embargo on admissions to the home.

We received concerns about people’s safety and undertook a focused inspection on 27 March to look into these concerns. This report only covers our finding in relation to this topic.

People were unable to tell us if they felt safe, because of their dementia needs, but we found that people were not always kept safe from harm.

We found there was no clear leadership or clinical guidance for staff when planning and delivering care.

The care plan we looked at did not have sufficient guidance in place to ensure staff had the information they needed to plan and provide appropriate support and care. Staff said they had been told by the nurses how to offer appropriate support, but there were no records to evidence this.

Risk assessments, including environmental assessments on the equipment available to support people, had not been reviewed and updated to ensure appropriate aids were in place.

We observed part of the lunchtime meal and saw staff supporting people to eat their meals. One person was being supported in a special chair in their bedroom, and was noted to eat the meal provided.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

Bramber Nursing Home provides nursing, personal care and accommodation for up to 21 older people living with dementia. There were 13 people living at the home during the inspection and all required assistance with looking after themselves, including personal care and moving around the home.

At the time of this inspection the local authority had an embargo on admissions to the home pending the outcome of on-going safeguarding investigations. At the last inspection 9 June 2014 we asked the provider to make improvements for respecting and involving people who use services; care and welfare of people who use the service and records. The provider sent us an action plan stating they would have addressed all of these concerns by December 2014.

This inspection took place on 27 January and 6 February 2015 and was unannounced

The home has been without a registered manager since August 2013. 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. A registered nurse was managing the home during the inspection. They told us they were applying to register with CQC as the registered manager of the home. The appointee manager was present on the first day of the inspection. Staff had difficulty contacting management on the second day of the inspection, and the manager was unable to attend. Staff said they did not always feel supported by the management of the home and relatives told us there was no management oversight or leadership at the home.

A generic safeguarding policy was in place to protect people, but the provider had not followed this, referrals to the local authority had not been made and CQC had not been notified of allegations. People may not have been protected, as far as possible from abuse.

Care plans did not show person centred care was provided, and as part of the care planning process risk assessments had been completed, but they had not been regularly reviewed and updated when people’s needs changed. This meant people may not have received the support and care they needed.

Food and fluid charts, used to record how much people had to eat and drink, were not completed appropriately. Therefore, staff were unable to evidence people received a nutritious diet, suitable to the needs.

People had access to healthcare professionals and staff said they visited the home when required. However, these visits were not always recorded, so there was no clear evidence to support staff comments.

There were systems in place for the management of medicines, but nurses did not follow always follow up to date guidance regarding record keeping. People may have been at risk of not receiving their prescribed medication.

There were not always enough staff to meet people’s needs and there was no system in place to determine appropriate staffing levels. This meant people had to wait for staff to assist them.

Not all staff had received up to date training, such as safeguarding, supporting people with dementia, moving and handling and infection control. People may not have received care and support based on current guidance.

A complaints procedure was in place. However, some relatives felt the management did not listen to their concerns and felt appropriate action may not be taken.

Staff did not feel they had opportunities to meet regularly and discuss or improve the support provided, because if this they felt management may not address concerns they might have.

There was no clear system in place to monitor and assess the quality of the service provided. Areas for improvement were not identified and appropriate action was not taken to improve the service.

People said they were comfortable and relatives felt people were safe, and relatives and friends could visit at any time and were made to feel very welcome.

People thought the staff looked after them and relatives thought the care staff were very good. Staff understood people’s specific needs and treated people with respect and protected their dignity when supporting them. We saw a range of activities were provided and people enjoyed spending time with staff.

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

Staff had knowledge of the Mental Capacity Act 2008. Not all staff had attended training and mental capacity assessments were not up to date, although staff had a good understanding of people’s capacity to make decisions about their care.

Mobility aids were available for staff to assist people to move around the home safely, and we observed staff using these. The home was clean and some rooms had been redecorated, with the involvement of people and their relatives.

We found several breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

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

We carried out this inspection to look at the care and treatment that people who lived at the home received. At the last inspection on 29 and 30 October 2013 we found that there were concerns with regard to involving people who used the service, people's care and welfare, the suitability of the premises and assessing and monitoring of the services provided. We found at this inspection that some of these issues had been addressed.

We spoke with all of the people who lived at the home. However, most people were not able to tell us about their experiences of living at Bramber Nursing Home, because of their complex needs. People that did speak with us said, "I am comfortable", "I decide what to do", and "Everyone is very nice".

We spoke with six relatives, three nurses, five care staff, the deputy manager/administrator and the provider during the inspection. We reviewed four care plans and associated documentation; we looked at the premises, staff rotas, complaints and relevant policies and procedures, and the assessing and monitoring of the services provided.

We considered our inspection findings to answer questions we always ask:

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?

We found that during this inspection the service was safe. Relatives we spoke with told us they felt people who lived at the home were safe. Staff felt that they provided the care and support in a way that ensured people's safety, whilst also allowing them to take make choices.

Systems were in place to ensure the management and staff learned from events, some of the issues identified at the last inspection had been addressed.

Is the service effective?

We found that during our inspection the service was not effective. People's health and social care needs had been assessed and care plans had been produced. However, people and their relatives had not been involved in developing the care plans; the support and care provided was not always based on people's choices and preferences, and may not meet people's individual needs.

Is the service caring?

We found that during our inspection that the service was caring. We saw that people were supported by kind, patient staff, who encouraged some people to make decisions about how they spent their time.

Is the service responsive?

We found that during our inspection that the service was responsive. We saw evidence that when people's needs had changed, the staff had made appropriate referrals to outside agencies.

Is the service well led?

We found during our inspection that the service was well led. An effective quality assurance system was in place, and shortcomings in the services provided were identified and acted upon.

Staff we spoke with were clear about their roles and responsibilities. They had an understanding of the needs of people who lived at the home and they said they were able to talk to the management if they had any concerns.

Over two days we spoke with close relatives of five people who lived in the home, all regular visitors. We observed practice, read records and spoke with staff, including the recently appointed manager.

People found staff caring and respectful in giving individual care. Some people commented on a lack of offensive odours in the home, and people presenting as comfortable and well presented. However, relatives and some staff saw people as under-stimulated. We saw people went long periods with no staff attention and staff missed opportunities to engage with people as they went about their work. There were no recorded regular checks on people's wellbeing through the day.

At times during our visit the home was cold. Staff on duty did not recognise people might not sense temperature changes or express discomfort. Care plans saw people as presenting 'problems' rather than 'needs' and did not include supporting people to maintain a safe body temperature. The manager showed awareness of institutional practices in the home and was encouraging staff in a more person-centred approach to care. Two relatives said staff appeared more motivated as a result of management changes.

Staff were alert to changes in people's health and were prompt making medical referrals. Relatives felt well informed and involved.

The environment was not stimulating. It made no allowance for the specific needs of people with dementia. There were insufficient systems for managing risks.

Archived: Bramber Nursing Home

All Inspections

28 November 2016

During a routine inspection

To Be Confirmed

During a routine inspection

27 March 2015

During an inspection looking at part of the service

27 January and 6 February 2015

During a routine inspection

9 June 2014

During a routine inspection

29, 30 October 2013

During a routine inspection