This inspection took place on the 13 and 16 January 2015, and was unannounced. The second visit made to complete the inspection on 16 January 2015 was by appointment.
Bramble Down is a care home with nursing, situated in the village of Denbury, approximately three miles from the market town of Newton Abbot. The home is registered to provide nursing care for up to 40 people, and was full at the time of our inspection. People who lived at the home were older people with general nursing needs. Some people had moved to the home for end of life care, while others were there for a period of recovery and rehabilitation before returning to their own home.
As a policy the home does not provide care for people with dementia as a primary diagnosis, although we saw some people who lived there had a mild degree of memory loss associated with other ill health.
On our last inspection of the home in February 2014 we had identified concerns in relation to the staff recruitment processes in place and the staff’s understanding and recording of people’s capacity to consent to their care. The provider sent us an action plan telling us that they would complete improvements to put these right by the 30th April 2014. On this inspection we saw that the improvements needed had been made and sustained.
The service had a registered manager 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.
We saw that people were supported in a service that was safe. Risks to people’s health and safety were managed appropriately and people had opportunities to remain independent and take appropriate risks to enhance their quality of life. Staff understood people’s rights and how to protect them from potential abuse or harm.
We saw that fluid balance charts had not always been fully completed where people were at risk of poor hydration. This meant that it was not possible for nurses to accurately check how much fluid people had taken. This put people at potential risk of poor hydration, although we did not identify anyone who was poorly hydrated on the inspection.
There were enough staff on duty throughout the day and night to meet people’s needs. People we spoke with told us their needs were met, and we saw that although the home was busy people received individualised care in the way they wanted.
People were asked about how they wanted their care to be delivered, and we saw that care was delivered in accordance with people’s care plans and their wishes. Care staff were well organised so that it was clear each day who they were responsible for supporting. This helped to ensure that people’s care needs did not get missed.
We saw that staff had the skills, knowledge and training to help them meet people’s needs. Staff told us they received good support at the home and that it was a good place to work.
We saw that the home managed people’s medication well, including complex pain relief for end of life care. The home’s staff were proactive in supporting people’s healthcare, and account was taken of people’s recovery goals and aspirations wherever possible. We saw that people had access to good community healthcare support services such as community physiotherapy or end of life care nurses.
People told us they enjoyed the meals at the home, which were described as good wholesome cooking, using fresh and local produce wherever possible. We saw people who needed support to eat were given this sensitively and in ways that respected their dignity.
People’s capacity to consent to care was recorded, and where they could not do this records and assessments showed that decisions had been made in people’s best interests. People's communication needs were assessed. We saw that no-one who lived at the home was being deprived of their liberty.
We saw that the staff were caring, both helping people to celebrate positive events and offer support at times of distress. We saw that there were good relationships between people receiving care and those supporting them. Staff we spoke with told us they were proud of the home’s approach to end of life care which was based on good practice and positive links with local hospice services.
People had access to interesting activities that met their needs and wishes. We saw that the activities organiser had used innovative, creative and individual approaches to supporting people to remain active and involved where they were able to be.
We saw that care was individual and person centred. Staff we spoke with had a good understanding of the backgrounds, needs and wishes of the people they were caring for. They understood the importance of social, emotional and spiritual elements of people’s care as well as medical needs.
The service managed any complaints or concerns well. People told us they felt able to raise any issues and be confident of a resolution without recrimination. The culture at Bramble Down was open and the manager told us her door “is always open”.
We saw that the provider met legal obligations to the Care Quality Commission, and was operating in accordance with their conditions of registration. Quality assurance and audit systems in place ensured that people received a consistently good standard of service, and that learning took place to develop the service further.