Archived: The Branksome Care Home

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.

The Branksome Care Home is a residential care home providing personal and nursing care to 33 people at the time of the inspection. The service can support up to 34 people.

The home can accommodate 34 people in single rooms across two floors in one building. The home has shared communal bathrooms. There are communal lounges, a dining area and an outside space.

People’s experience of using this service and what we found

The judgement of this service takes into account the previous breaches and rating in each domain.

Accident and incidents had not been properly recorded, reported, investigated or monitored. We found people had sustained multiple unexplained injuries which had not been reported to the manager so necessary actions had not been taken to reduce the risk of reoccurrence.

Risks to people had not been identified, monitored or reduced. At this inspection we found people were at risk of pressure sores, choking, dehydration and infection.

Medicines were not safely managed. We identified multiple instances where prescribed creams had not been recorded as administered in line with the prescribing instructions.

Staff were not always safely recruited. We reviewed recruitment records for staff and found the provider had not fully completed background checks for one staff member.

Care records did not always contain the correct information. One person’s care records contained conflicting information about their choking risk. One section stated the person required monitoring whilst eating and drinking however another section stated they ate independently.

The majority of relatives we spoke with told us of concerns they had about the care being delivered. We raised safeguarding referrals to the local authority for investigation following the information relatives shared with us.

The provider had failed to ensure there was adequate oversight of the service. Quality assurance systems and processes did not identify or address issues in the service during this inspection and the previous inspection.

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; however, the systems in the service did not support this practice.

People were supported to access healthcare and appropriate referrals had been made when people had lost weight or were experiencing swallowing difficulties.

All of the people we spoke with during our inspection were happy and told us they enjoyed living in the home.

People's care plans contained information about their life history, preferences, likes and dislikes. We saw evidence that people's preferences had been respected and followed.

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 requires improvement published 12 November 2020 and there were 2 breaches of regulation. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about risks to people not being managed safely. A decision was made for us to inspect and examine those risks.

We found the provider had not taken effective actions to mitigate the risks.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

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/We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care, meeting people’s nutrition and hydration needs, recruitment practices and oversight of the service.

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 request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service is therefore 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.

The Branksome Care Home is a care home with nursing providing personal and nursing care to 26 people aged 65 and over at the time of the inspection. The service can support up to 34 people. The home is located close to the centre of Buxton.

People’s experience of using this service and what we found

The provider had not done all that was reasonably practicable to mitigate the risks to people’s safety and welfare. Information about risk was not always up to date. Some people had lost significant amounts of weight and were not monitored more closely in response to this.

Governance and performance management were not always reliable or effective. The management team had not always followed the provider’s governance policy and had not identified themes and trends in order to recognise how to prevent recurring incidents.

The provider had effective safeguarding systems and there were enough suitably trained or qualified staff on duty. Staff were recruited safely and were subject to appropriate pre-employment checks and competency assessments before working independently.

The home had a positive culture that was person-centred. Relatives told us they were happy with their relations care and were comforted by regular communication during the Covid-19 pandemic

Rating at last inspection

The last rating for this service was Good (published May 2018).

Why we inspected

We received concerns in relation to staffing levels, weight loss, end of life care and care for people with sore skin. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvements. You can see what action we have asked the provider to take at the end of this full report.

After the inspection the provider contacted us to explain what improvements they had made and why they had assessed these to be effective.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The Branksome Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The Branksome Care Home accommodates up to 34 people in one adapted building. At the time of our inspection 34 people lived at The Branksome Care Home.

At the time of our inspection there was a registered manager in post, who was present at the inspection. The service is required to have a registered manager. 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.

There was enough staff available to meet people’s needs as well as spend time with people on an individual basis. Staff had been trained in safeguarding and understood how to raise any concerns. Recruitment processes were in place to ensure any new staff would be subject to pre-employment checks on whether they were suitable to work at the service.

Appropriate arrangements were in place for medicines management and these followed procedures designed to ensure safe medicines practice. People were offered their medicines as prescribed.

Processes were in place to ensure risks and people’s health needs were assessed, managed, monitored and responded to. The premises had been adapted in ways to make sure it was suitable for people using the service.

People’s needs and choices were promoted in a way that prevented and reduced the impact of any discrimination. People’s communication needs were assessed and people were supported to communicate effectively with staff. The Accessible Information Standard was being met. Staff knew how to support people to make decisions and ensure their rights were respected, working in line with the principles of the Mental Capacity Act 2005. 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.

Staff were trained and were well supported. Staff were caring and delivered care in a manner that promoted people’s dignity and independence. People enjoyed a variety of different interests and hobbies and had good contact with the local community.

People felt able to raise any issues or concerns. There was a complaints process in place to manage and respond to any complaints should they be made. The service had received many compliments.

The registered manager focussed on providing care that was centred on individuals; and open and transparent management style was promoted. The registered manager had audits and checks in place to provide assurances for the governance of the service. Policies and procedures had been updated to reflect the needs of the service.