Background to this inspection
Updated
2 February 2023
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
This inspection was carried out by three inspectors and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
The Branksome Care Home is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. The Branksome Care Home is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The service did not have a manager registered with the Care Quality Commission. The provider is legally responsible for how the service is run and for the quality and safety of the care provided. The manager in post had applied to register with CQC and their application was being assessed.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We reviewed information we had received about the service since the last inspection, this included from relatives and external professionals.
During the inspection
We reviewed 14 people’s care records, multiple people’s medicine records. We spoke with six people and 11 relatives about their experiences of care. We spoke with 16 members of staff including care staff, nurses, the manager, deputy manager, managing director and nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We reviewed governance records and other records relating to the running of the home.
After the inspection
We continued to review information we had gathered. We reviewed staff training records. We discussed our findings with the nominated individual and managing director.
Updated
2 February 2023
About the service
The Branksome care Home is a residential care home providing accommodation, nursing and personal care to up to 34 people. The service is registered to support older people and younger adults. At the time of our inspection, there were 29 people using the service.
People’s experience of using this service and what we found
There were widespread safety concerns that left people at risk of harm. We found people had unexplained injuries that had not been reviewed, investigated or referred to safeguarding professionals. People were at risk of choking as they were not always supported to eat safely. Staff did not always know the risks to people’s safety. People’s medicines were not always safely managed, records showed people did not always have their prescribed creams applied. Staff were not always safely recruited. There were enough staff on duty. Infection prevention measures were in place to protect people from the spread of COVID-19, however staff did not always wear face masks which left people at risk of contracting viruses.
The provider had not ensured they maintained oversight of the running of the home. They had not implemented improvements required since their last inspection. Governance and audit systems were not effective at identifying and reducing risks to people’s safety. When things had gone wrong the manager had not always made sure they were open and honest with people, relatives and professionals. Staff felt they were happier and more supported in their role since the last inspection.
People were not always supported to drink enough to prevent the risk of dehydration. People’s food and fluid records were not routinely reviewed. Staff did not always complete training to know how to support people safely. Healthcare professional advice for monitoring people’s health conditions was not always followed.
When complaints were received from relatives they were not used to recognise where improvements were required. There were activities for people to take part in the communal areas of the home but people who preferred to spend time in their bedrooms were not always offered meaningful activities and were therefore at risk of social isolation.
People’s privacy was not always respected as their personal care records were sometimes stored in communal corridors. People and relatives told us staff were mainly kind and caring. People were supported to maintain and develop their independence.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was inadequate (published December 2021).The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.
Why we inspected
This inspection was carried out to follow up on action we told the provider to take at the last inspection. You can see what action we have asked the provider to take at the end of this full report. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Branksome Care Home on our website at www.cqc.org.uk.
Enforcement and Recommendations
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.
We have identified breaches in relation to safety, safeguarding, nutrition and hydration, handling complaints, governance and openness with people when something has gone wrong. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
Follow up
We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.
The overall rating for this service is ‘Inadequate’ and the service therefore remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.
For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.