Braywood Gardens

Braywood Gardens is a purpose-built residential care home providing accommodation and personal care to up to 99 people. Braywood Gardens accommodates people across 7 units over 2 floors, although at the time of the inspection not all units were occupied.

The service provides support to older people and people who are living with physical disabilities and dementia. At the time of our inspection there were 80 people using the service.

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

Potentially harmful products were not always stored securely. Unsecured windows also increased risks related to people falling from heights, as risk assessments had not been completed. Care plans were not always updated following incidents and accidents when the provider identified equipment to promote people's safety. Areas of the home were not always clean, and safe food storage practice was not always followed, which increased the risk of infection spreading. We observed that people were not always given support promptly when they needed help.

The provider had not consistently operated its systems and processes effectively to ensure action plans relating to environmental safety were completed and people's care plans were reviewed and contained current information.

However, relatives felt people were safe. Staff had received training and understood their responsibilities to ensure people were safeguarded from abuse and received their medicines safely. Staff told us the registered manager was approachable. There was evidence of the provider seeking and acting on feedback from people, their relatives and external professionals.

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

The last rating for this service was good (published 25 April 2023).

Why we inspected

We received concerns in relation to the management of accidents and incidents. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe 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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Braywood Gardens on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Braywood Gardens is a residential care home providing personal care to 83 people living with dementia or physical disabilities at the time of the inspection. The service can support up to 99 people.

Braywood Gardens is a purpose-built care home which accommodates people across seven units over two floors, although at the time of the inspection not all units were occupied.

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

People were kept safe by suitably trained staff who knew how to protect people from risks associated with their health and environment. People were protected from abuse by the systems in place. People were supported with their medicines in an effective, safe, and caring way.

People’s individual needs were assessed, and staff were provided with guidance on how to support people with these. Staff supported people with their eating and drinking requirements in an effective way to ensure they maintained a balanced diet. People were given support to access healthcare and staff worked in a proactive way to maintain people’s health.

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.

The service had a new registered manager, who had made positive changes to the service to improve the quality of care delivered. We received positive feedback from people, relatives and staff on improvements that had been made.

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

Rating at last inspection

The last rating for this service was good (published 20 May 2021).

Why we inspected

We received concerns in relation to staffing and the quality of care being provided. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and effective sections of this full report.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Braywood Gardens on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Braywood Gardens is a residential care home providing personal care to 54 people aged 65 and over at the time of the inspection. The service can support up to 99 people.

Braywood Gardens is a purpose-built care home which accommodates people across seven units over two floors, although at the time of the inspection not all units were occupied.

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

People were kept safe by the systems and processes in place. Risks to people’s health and wellbeing were being assessed, monitored and mitigated against. People were supported to take their medicines in a safe way. People were protected against the risk of infection by good infection control processes, staff were seen to be wearing the appropriate PPE. There was adequate staffing in place to meet people’s needs.

People had plans of care that were individualised and provided staff with personalised guidance in order to meet people’s needs. People had a choice of activities to participate in and were supported to maintain important relationships with their friends and family. There was process in place for people to raise concerns, any complaints received had been appropriately responded to.

There was a new manager at the home who had helped make the necessary improvements to ensure the quality of care provided. There were effective audits and quality monitoring processes. Staff, relatives and people who lived in the home had opportunities to provide feedback in a number of different forums. The home worked well with other healthcare professionals to help achieve good outcomes for people.

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 12 November 2020) and there were multiple breaches of regulation. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 12 November 2020. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an unannounced focussed inspection of this service on 1 October 2020. Breaches of legal requirements were found. Breaches were around safe care and treatment, good governance and staffing. At a previous inspection on 6 August 2019 a breach of person-centred care was found.

We undertook this focused inspection to check they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Responsive and Well-led which contain those requirements.

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.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from inadequate to good. This is based on the findings at this inspection.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Braywood Gardens is a residential care home providing personal care to 75 people aged 65 and over at the time of the inspection. The service can support up to 99 people.

Braywood Gardens is a purpose-built care home which accommodates people across seven units over two floors.

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

People living in the service were not safe and were placed at risk of harm. People experienced high level of falls and there was poor pressure area management. Risk management, staffing levels and poor infection control processes at the service put people at risk. Safe medicines management and administration was not effectively ensured and people did not always receive their medicines as prescribed. Records relating to people's care did not always contain sufficient information and guidance to enable staff to provide the safe care and support people required.

We received mixed feedback from both people and their relatives regarding their opinions of the quality of

the care and support they received and the response to any concerns they had raised. Most people said they waited long periods of time for support and our observations indicated there were not enough staff to meet people’s needs safely.

The leadership, management and governance arrangements did not provide assurance the service was

well-led, that people were safe, and their care and support needs could be met. Lessons were not being learned, and improvements were not made when things went wrong.

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 19 October 2019) and there were multiple breaches in regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made/ sustained, and the provider was still in breach of regulations.

Why we inspected

We received concerns in relation to infection control, staffing, management and risk. As a result, we undertook a focused inspection on 12 August 2020 to review the key questions of safe and well-led only. Following this we received further concerns that potentially meant service users were at risk and undertook a second day of inspection on 01 October 2020.

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 requires improvement to inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe 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. The provider has already taken steps to mitigate the risks.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Braywood Gardens on our website at www.cqc.org.uk.

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 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 management of risk, medicines, infection control, staffing and governance at this inspection.

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 have met with the provider prior to 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

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.

Braywood Gardens is a residential care home providing personal and nursing care for people at the time of the inspection 81 people were using the service. The service can support up to 99 people.

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

There was not always enough staff to provide care and support for people. There was a variation in the levels of support people received on each unit. In the upstairs units where people’s needs were higher there were not always enough staff to meet their needs. This resulted in people not always being protected from the risks of abuse, as people living with dementia were not always monitored, and this impacted on their behaviours towards other people at the service.

The risk assessments associated with people’s care needs did not always contain enough information to provide staff with guidance to manage people’s care. People received medicines from staff who had been trained in the safe handling of medicines. However there was a lack of information on some protocols for as required medicines, to give sufficient guidance for staff to ensure these medicines were given appropriately. People were protected from the risks of infection through safe staff practices.

People’s nutritional were not always well managed. The meal time experience we monitored on the first day of our visit in some of the areas was not well managed and people were not supported appropriately. People’s health needs were well managed but the records supporting the actions taken by staff and external health professionals were not always up to date and did not always contain clear information on actions.

People were not always supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Staff were provided with training and supervision to support them in their roles and people lived in an environment which met their needs.

People’s records did not always support personalised care. For some people there was a lack of pertinent information around their cultural needs and relationships. Some people’s communication needs had not been fully met. There was a lack of information on some people’s end of life care wishes.

Systems to ensure the safety and quality of the service were not fully effective and had not highlighted some of the concerns we found during our inspection. There was a lack of robust analysis of incidents and accidents to ensure learning from events.

People were supported by staff in a kind and caring way and felt their privacy and dignity was well managed by staff. They were protected from the risks of infection through safe staff practices.

Staff were provided with training and supervision to support them in their roles and people lived in an environment which met their needs. There was a clear complaints policy in place and complaints were responded to in line with this policy. People told us they would know who to complain to should they need to.

The management team were responsive to feedback and took action to address issues identified in this inspection. There was positive partnership working with health professionals who visited the service.

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 2 January 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of some regulations.

The last rating for this service was requires improvement (published 2 January 2019). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

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 on our website at www.cqc.org.uk.

We have identified breaches in relation to adequate staffing, person centred care and governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

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.

Braywood Gardens is situated in Carlton, Nottinghamshire and is operated by Runwood Homes Limited. The service accommodates 99 people across eight units which are split across two floors. At the time of our inspection there were 95 people living at the home.

At our last inspection in December 2015 the service was rated good. At this inspection we found the quality of some aspects of the service had deteriorated. Consequently, we found concerns across a range of areas including safety, staffing, hydration and nutrition, consent and choice and leadership and governance. This resulted in several breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report. This was the first time the service had been rated as requires improvement.

There was a registered manager in place at the time of our inspection. 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.

During our inspection we found there were not always enough staff to meet people’s needs or ensure their safety. We saw staff were not always present to reduce risks such as falls. Risks in areas such as choking, skin integrity were not always identified or addressed and this placed people at risk of harm. Equipment used in people’s care and support was not always used safely. People were not always protected from the risk of abuse and improper treatment as staff were not always present, or did not always intervene in verbal and physical altercations between people. Improvements were required to ensure the home was clean in all areas. Overall, medicines were managed and administered safely, some improvements were needed to ensure staff had clear guidance about medicines. There were systems in place to learn from accident and incidents. Safe recruitment practices were followed.

There was a risk people may not be provided with enough to eat and drink. Mealtimes were not well organised; people were not always served with an appropriate diet and were not always offered timely or appropriate assistance at mealtimes. People were not supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible; the policies and systems in the service did not support this practice. Staff required more training to enable them to provide effective support to people with dementia. In other areas staff had training and support to enable them to do their job and told us they felt supported. People had access to a range of specialist health care professionals and feedback form these professionals was positive. The home was adapted to meet people’s needs.

Staff were not consistently kind and caring and did not always communicate clearly with people. People and their relatives told us that changes in the staff team meant they were not able to develop meaningful relationships. People’s rights to privacy and dignity were not always respected. People were not supported to be as independent as possible. People had access to advocacy services if they required this to enable them to express their views.

People did not consistently receive personalised care that met their needs and staff were not always responsive to people’s needs. People and their relatives were not always involved in planning their care and support. Further work was needed to ensure people had the opportunity to discuss their wishes for the end of their lives. People were not always provided with opportunity for meaningful activity. There were systems in place to respond to complaints. However, concerns were not always resolved. People’s diverse needs were accommodated. People’s diverse needs were identified and accommodated.

Systems to ensure the safety and quality of the service were not fully effective. Where issues had been identified, improvements had not always been made or sustained. This failure to identify and address issues had a negative impact on the quality of the service provided at Braywood Gardens. People and staff had opportunities to make suggestions about the home and this was used to make improvements. The management team were responsive to feedback and took swift action to address issues identified in this inspection. There was positive partnership working with health professionals.

The service had 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.

People felt safe living at the home and measures were in place to protect people from the risk of abuse. Relevant information about incidents which occurred in the home was shared with the local authority. Staff ensured that steps were taken to reduce risks to people’s safety, such as the risk of falling.

There were sufficient numbers of staff to care for people and support was provided in a timely manner. The provider ensured appropriate checks were carried out on staff before they started work. People received their medicines as prescribed and they were safely stored.

Staff were provided with the knowledge and skills to care for people effectively and felt well supported. People were given the opportunity to provide consent to their care. The Mental Capacity Act (2005) (MCA) was used correctly to protect people who were not able to make their own decisions about the care they received.

People were provided with sufficient quantities of food and drink that were appropriate to their needs and told us they liked the food. People received support from various healthcare professionals when required and staff followed the guidance provided by them.

There were positive relationships between people and staff and we saw kind and caring interactions. People were able to be involved in the planning and reviewing of their care and told us they were able to make day to day decisions. People’s privacy and dignity were respected and visitors were welcome at any time.

People received the care they needed and staff responded to any changes in their needs. There was a programme of activities available which were widely enjoyed. People knew how to complain and the complaints were appropriately investigated and responded to.

There was a positive, open and transparent culture in the home. People and staff felt able to speak up about any matters of importance to them. There were clear management structures in place and everybody felt the registered manager led by example. There were different ways people could provide feedback about the service and these were well utilised by people. The quality monitoring systems had identified areas where improvements were required and ensured action was taken.

At this inspection we found that the provider had taken positive steps to meet the standards.

We found that care and treatment was being delivered in accordance with people's care plans to ensure their individual needs were met.

Effective processes had been put in place for the secure handling of medicines.

There were enough qualified, skilled staff who were well supported to meet people's needs.

The provider had put systems in place to assess and monitor the quality of services.

People using the service told us that they were mostly happy with the care they received. They made decisions about their care and daily routines. Some people told us that their care was rushed at times and they had made compromises about their care preferences because staff were so busy. One person said, "I'm generally happy with the care." Another person said, "I'm very happy, and I love the attention I get."

We found that people did not always experience care, treatment and support that met their needs and protected their rights. We also found that there were not enough qualified, skilled and experienced staff to meet people's needs at all times.

We found that staff had not received up to date training and the provider did not have an effective system to regularly assess and monitor the quality of service that people receive.

The provider had not achieved compliance with the standards within their stated timescales.

We were told the staff understood people's care needs and were very helpful. One person said, "They're always obliging and ready to help." Another person said, "I feel they attend to my needs all the time."

At our first visit we had concerns that medicines were not managed safely so we asked a pharmacist inspector to inspect the management of medicines with us on 12 February 2013. We looked at the medicine administration records for 13 people who lived at the home. We looked at how medicines were stored and found that improvements were needed to ensure that there were appropriate arrangements in place to manage the risks associated with the unsafe use and management of medicines. We found that people's prescribed medicines were not always available to give and people's medicine administration records were not always clearly documented. This meant that we were not confident that people were receiving their medicines as prescribed and could not therefore determine the effect this had on their health conditions.

We found that people's records did not always reflect their level of current need.

We found people's needs were planned for and delivered appropriately in three units of the home. However on one unit care was not always planned and delivered to people safely. Most people we spoke with were happy with the care they received.

People using the service felt safe from the risk of abuse and knew who to speak with if they had any concerns. However the failure to respond to information which might constitute abuse had put people at risk of potential abuse.

Staffing levels were not being increased to meet the changing needs of people and on one unit we had concerns there were not enough staff to meet the needs of people safely. People we spoke with spoke positively about the staff working in the home and felt they were caring and kind to them.

There were systems in place to ensure people knew how to make a complaint and complaints were recorded by the manager.