Brackenlea Care Home

Brackenlea Care Home accommodates up to 25 people in one adapted building. There were 21 people at the service at the time of inspection. The accommodation is over two floors, each floor is accessible via stairs or a passenger lift.

The service was rated Requires Improvement at its last inspection in September 2016 and had breached two regulations in relation to safe care and good governance. Following the last inspection, we asked the provider to complete an action plan to show what they would do to meet the breach and improve the key questions of Safe and Well Led to at least Good. At this inspection, we found that the provider had made sustained improvements by ensuring that were systems in place to ensure people's records were accurate, complete and contemporaneous. The provider had also made improvements to its medicines management system to ensure the safe ordering, storage, administration, recording and disposal of medicines.

Risks to people’s health and wellbeing were assessed and monitored. The registered manager used a range of assessments to determine the appropriate level of care people required. Where people had incidents or suffered falls, the provider investigated and reflected on incidents to reduce the likelihood of recurrence.

Where people had changes in behaviour or health, the provider made appropriate referrals to health professionals and made appropriate changes to care provided in response.

People’s dietary and nutritional needs were fully assessed and monitored. Where people required staff to monitor their fluid or food intake, records were kept accurately and shared with relevant medical professionals to ensure that people were receiving the correct level of support.

Risks associated with the spread of infection were assessed and monitored. The home was a clean environment and staff understood their responsibilities around infection control.

The provider had made adaptions to meet the needs of people living there. This included adapting signage and décor to make the environment more suitable for people living with dementia.

There were systems in place to protect people from the risk of abuse or harm. The provider had an open and transparent culture, which was reflected by the registered manager informing CQC about important events that happened in the home. Where concerns were raised, the registered manager investigated issues thoroughly to ensure that people were as safe as possible and protected from harm.

There was a clear management structure in place. People told us the registered manager was effective in their role. The registered manager monitored the quality and safety of the service through a series of audits, residents meetings, staff meetings and through responses to questionnaires. The registered manager had an ongoing ‘action plan’ in place, which identified where key improvements would be made and the timescales for completion.

There were systems in place to ensure that concerns and complaints were dealt with appropriately.

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 support this practice.

People received personalised care. Staff understood people’s preferred routines around their daily living and personal care. People told us staff were caring and considerate of their needs and that there were plenty of activities available to keep them busy and occupied.

People received support to plan how they wished their care to be delivered during their last days. People were treated with dignity and respect and the provider welcomed relatives and visitors into the home.

There were enough suitably qualified and skilled staff in place to meet people’s needs. The registered manager calculated staffing levels to ensure people did not have to wait for staff to support them. The registered manager frequently worked alongside staff and had a good understanding of people’s needs.

The provider had systems and processes in place when recruiting staff to help ensure they were of good character and had sufficient experience to carry out their role.

Further information is in the detailed findings below.

Brackenlea Care Home provides accommodation and care for up to 25 older people, some of whom may also be living with dementia. At the time of the inspection 22 people were using the service.

Brackenlea Care Home has 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.

Medicines were not stored safely. Medicines were stored in a locked medicines cupboard in a locked room. However, the key for the room and the cupboard was kept in an unlocked key cupboard in the staff room which was not locked. The index clearly indicated which key was the medicines key. This meant there was a risk that people living in the home or visitors could access the medicines and take them. The provider could not be assured that medicines were kept at a temperature which ensured they remained safe and effective. This was because the temperature in the room where they were kept was not monitored and although the fridge temperature was checked, the maximum and minimum temperatures reached were not recorded.

The provider could not be assured that medicines were administered safely. The Medicines Administration Record (MAR) chart did not record whether anyone had any allergies to specific medicines. There was a risk that people may be prescribed medicines which they were allergic to. There was guidance in place for each person that received ‘as required’ medicines, known as PRN; however, these were not always up to date. There was a risk that PRN medicines may not be administered appropriately. The topical MAR charts (TMAR) did not demonstrate that medicines applied topically had been applied within prescribed guidance and applied consistently.

People were protected from abuse. Staff had completed safeguarding training and were able to explain to us how they protected people from abuse. Staff told us they were aware that they could report safeguarding concerns to outside agencies such as the police, the local authority and the Care Quality Commission. The safeguarding policy was available for staff to review in the staff room and staff said they were familiar with it. Staff said they would feel able to whistle-blow, if necessary, without fear of reprisal. Whistle-blowing is where staff can raise concerns about the quality or type of care provided.

There were specific risk assessments for each person in relation to falls, malnutrition and pressure ulcer prevention. The provider had taken action to ensure staff knew how to manage these risks to keep people safe. Risks in relation to falls were carefully monitored and people were referred to the falls team if they experienced repeated unexplained falls.

There were enough staff deployed to meet people’s needs. The provider used a dependency tool to calculate required staffing numbers. This was to ensure there would always be enough staff deployed to meet people's needs.

Recruitment and induction practices were safe. Relevant checks such as identity checks, obtaining appropriate references and Disclosure and Barring Service (DBS) were being completed for staff. The DBS helps employers make safer recruitment decisions and helps prevent unsuitable people from working with people who use care and support services. This assured the provider that staff were suitable for their role.

People were supported to have sufficient to eat and drink and maintain a balanced diet. Drinks were readily available throughout the day and staff encouraged people to drink. However, for those people identified as at risk of malnutrition, records did not demonstrate this. Records about people’s nutritional requirements were unclear and inconsistent and records about what people had eaten and drunk were unclear and incomplete. Due to staff knowledge, people received food consistent with their nutritional requirement in sufficient quantities and there was no impact on people.

The environment was not specifically designed to support the needs of people living with dementia. We have made a recommendation about improving the environment to support these needs.

Staff had received appropriate training to meet people’s needs. Records showed that staff had received training in key areas such as fire training, moving and handling, food hygiene and first aid. Staff were supported to study for health and social care vocational qualifications. Staff told us they felt supported in their role.

Staff were knowledgeable about people’s needs and how to support them. Staff said they knew about people’s needs from handovers, care plans, risk assessments, people themselves and their families. We saw that staff interacted with people appropriately and kindly, appearing to know them well as individuals, and treating them accordingly.

People were asked for their consent before care or treatment was provided and the provider acted in accordance with the Mental Capacity Act 2005 (MCA). People made their own decisions where they had the capacity to do this, and their decision was respected.

People were supported to maintain good health through access to ongoing health support. Records showed that district nurses, continence and falls specialists and the GP had been involved in people’s care and referrals were made where appropriate.

Staff were kind and patient with people, using gentle persuasion and encouragement to support them. They took time to listen to people and understand how they were feeling. People’s dignity was respected. People were supported to be as independent as possible.

People were involved in decisions about their care and were offered choices in all aspects of their daily life. Where they had capacity, people had signed their care plans showing that they agreed with the plan of care.

People’s care plans were not complete and care records included inconsistencies which may have been confusing to new staff or agency workers. However, staff were able to respond appropriately to people’s needs because they knew them well and understood their care needs. Staff knew people personally so they could respond to their preferences, likes and dislikes providing personalised care. Care plans were reviewed and updated every month and when necessary to ensure that staff were always aware of people’s needs.

People were able to engage in different activities, such as music, quizzes or arts and crafts. People who liked to stay in their room received one to one time with staff to reduce the risk of social isolation.

The provider had a complaints procedure which detailed how complaints should be dealt with. This procedure had been discussed at the last residents meeting in October 2016 to ensure people knew what to do if they had a complaint. There had been no complaints in the last year.

Record keeping in the home did not meet the required standard. Individual care plans were incomplete. We found inconsistencies in record keeping across different types of records held within the home. Daily records were not always completed with accuracy. This meant there was a risk that new or agency staff would not know what care to provide or how to provide it.

The quality of the service was monitored through a series of audits and checks. Whilst comprehensive in their coverage of areas of inspection, the audits were not completely effective as they failed to pick up areas of concern identified during this inspection, in particular the unsafe storage and administration of medicines.

There was a positive and open culture within the home. Staff said they felt able to raise concerns, and were confident they would be responded to.

Feedback surveys were sent to people, staff, relatives and professionals every six months. A recent survey had been sent out but not all replies had been received as the deadline was not yet due. The registered manager told us the comments would be considered once all replies had been received.

The registered manager demonstrated good management and leadership. Staff knew what was expected of them in their role as clear guidance had been issued for daily tasks which needed to be completed. Staff told us the registered manager took responsibility for the running of the home and that they trusted her.

Policies and management arrangements meant there was a clear structure within the home which ensured the service was effectively run and closely monitored. Policies included staff recruitment, safeguarding, complaints and medicines.

During this inspection we found two breaches of regulation. You can see what action we asked the provider to take at the back of the full version of this report.