Archived: Branksome House

Branksome House is a care home for up to nine people with a learning disability, autistic spectrum disorder or mental health problems. 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. There were seven people living in the home at the time of our inspection.

Branksome House also provides staff to support people with their personal care who live in shared accommodation or in their own homes. This includes five ‘supported living’ settings, so that they can live in their own home as independently as possible. These include shared toilet and bathroom facilities, lounges and staff offices/sleeping rooms. The service was supporting ten people with the regulated activity in shared accommodation at the time of our inspection. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

Not everyone using Branksome House receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

Following the last inspection, we met with the provider to confirm what they would do and by when to improve the key questions of Safe and Well-Led to at least good.

At this inspection we found improvements to how risks to people’s safety were managed such as choking and environmental risks. Improvements had been made to quality monitoring systems. These were now effective in identifying areas for improvement action such as maintenance issues. Staff recruitment procedures had also improved.

The outcomes for people using the service reflected the principles and values of Registering the Right Support. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

Branksome House had four registered managers in post. 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 received support from caring staff who respected their privacy, dignity and the importance of independence. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People received personalised care and had opportunities to take part in activities both in their accommodation and in the wider community. People were supported to maintain contact with their relatives.

People were protected from harm and abuse through the knowledge of staff and management. Sufficient staffing levels were maintained and staff were supported through training and meetings to maintain their skills and knowledge to support people. There were arrangements in place for people and their representatives to raise concerns about the service.

Branksome House is a care home for up to nine people with a learning disability, autistic spectrum disorder or mental health problems. There were eight people living in the home at the time of our inspection. Branksome House also provides staff to support people with their personal care who live in shared accommodation or in their own homes. The service was supporting 13 people in shared accommodation at the time of our inspection.

The provider was a partnership. Branksome House had two registered managers in post. 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.

The provider demonstrated they could be responsive in making some improvements when needed. During our inspection they made improvements that immediately reduced the seriousness of some of the risks we found to people's safety and wellbeing. They had also reviewed risk assessments after our inspection to improve the quality of information available to minimise risks to people. However it was too early to judge whether these improvements could be sustained and maintained.

At this inspection we found the provider had not taken account of the recommendation we made at our previous inspection in May 2016 to improve the management processes and we found ongoing issues with the management and quality monitoring of the service.

Monthly audits were carried out to monitor the quality and risks in the home. However, these had not identified the shortfalls we found in relation to identification and management of environmental risks and staff recruitment procedures. Improvements were needed to ensure the provider’s own management systems would effectively identify any shortfalls in the service.

Staff recruitment procedures needed some improvement.

We found improvement with the reporting of deaths of people using the service where reports had previously not been sent to us.

People received support from caring staff who respected their privacy, dignity and the importance of independence. People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. People received personalised care and had opportunities to take part in activities both in their accommodation and in the wider community. People were supported to maintain contact with their relatives.

People were protected from harm and abuse through the knowledge of staff and management. Sufficient staffing levels were maintained and staff were supported through training and meetings to maintain their skills and knowledge to support people. There were arrangements in place for people and their representatives to raise concerns about the service.

We found breaches of The Health and Social Care Act (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

A registered manager was in place as required by the service’s conditions of registration. 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 were safe being supported by staff from Branksome House. They understood their responsibilities to protect people and report any concerns. People were relaxed and empowered around staff and were encouraged to make suggestions about their day. They were supported and encouraged by staff who were caring and compassionate towards them. People’s dignity and privacy were respected. People who did not have family to support them were given opportunities to be supported by an advocate to speak on their behalf.

Detailed support plans identified people’s risks, support needs and preferences. However, this information was not always consistently reviewed and updated, although staff were aware of changes in people’s needs. Staff encouraged people to make choices about their day. They gained people’s consent before they provided them with care. However the assessment of people’s mental capacity was not always evident when people could not make a decision about their care and support for themselves. New support plans were to be implemented which would address the issue of consent to people’s care and this was seen as an opportunity to review people’s care needs.

There were sufficient numbers of staff to the meet the needs of people who used the services associated with Branksome House. Additional staff were provided if people needed support for appointments or community based activities. Staff had been trained and supported to carry out their role. All staff had been trained in similar subjects that allowed them to remain flexible and provide care and support across the service.

People enjoyed activities around the home and in the community. They were encouraged to eat a health balanced diet. Arrangements were in place to make sure people received their medicines appropriately and safely. However summary lists of people’s current medicines did not reflect their prescribed medicines. The registered manager told us this would be acted on immediately. Where a person’s mental or physical health well-being had changed it was evident that staff had worked with other professionals including the community mental health team and occupational therapist to seek additional advice and support.

The registered manager and managers led by example and was supportive to people and staff. They had a ‘hands on’ approach and new people who used the services well. They valued people opinions and acted on any identified shortfalls. Some systems were in place to monitor the care and support people receive, however effective systems were not always used to monitor parts of the management and running of the home. A deputy manager had been employed to address this area. We have made a recommendation regarding the governance and monitoring systems of the home.

We found one breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of this report.

People had positive views of Branksome House. Comments from people who used the service included, ' (the provider) is great, he's like a dad to us ', ' it's good here', the staff 'are good, I like going shopping'.

People were effectively assisted by the staff so that their range of care needs were met, engaging in activities to develop independence and confidence.

The majority of people spoken with felt satisfied with the meals that were provided with at the home and liked being involved in menu planning.

The service also operated a small domicillary care service. Comments from three people using the Domicillary Care Service. included, they bend over backwards to assist me and provide a personalised service' and 'very good, usually on time' ,and ' quite happy'.

People who used the service were able to have time with staff on a one to one basis to develop their person centred plans. The service was able to offer support to enabled people to develop confidence and independence skills. People who used the service become were accessing community facilities on a regular basis.

Staff said that they enjoyed working in the home. Staff demonstrated a commitment to maintaining, a clean, safe and comfortable environment for people used the service. A person who used the service smiled and said, "I really like the staff here and living here".

Systems were in place to monitor quality and to keep people safe.