Bracken House

Bracken House is a residential care home providing personal care to up to 34 people. The service provides support to older people some of whom are living with dementia. The care home accommodates people in 1 adapted building across 2 floors. There are 3 communal lounges downstairs and a dining area. At the time of our inspection there were 31 people using the service, 2 of whom were on respite placements.

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

Cleaning schedules were in place and the home was generally clean. However, systems in place failed to ensure the carpet cleaner was replaced in a timely manner when it was broken which meant stained carpets were not always cleaned effectively. Systems in place were not always effective in ensuring decision specific mental capacity assessments were recorded when needed. Systems were in place to check the quality of the service. Audits were undertaken and actions identified were overseen by senior management. Whilst we saw evidence of a number of actions being addressed by the provider, sufficient action was not always taken to address environmental risks identified.

People told us they felt safe, and relatives felt people were safe. Staff had completed safeguarding training and knew how to keep people safe. People had risk assessments in place for moving and handling and clinical risks and staff followed them. People were supported by a sufficient number of competent staff. People told us staff were available to support them when needed and they made them feel safe. People were supported by staff who were recruited safely and were required to complete an induction when they commenced their employment. People’s medicines were administered safely, and protocols were in place to guide staff when to administer ‘when required’ medicines. Where medicines errors occurred, action was taken to reduce the risk of reoccurrence.

The provider analysed accidents and incidents data to identify themes with a view to reducing the risk of reoccurrence. Staff told us the morale at the home had improved and people liked living at the home. The provider sought feedback from people, relatives, and staff to try to improve the care provided. The management team were open and honest when things went wrong and were proactive in seeking learning opportunities.

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 requires improvement (published 1 December 2022). 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 improvements had been made and the provider was no longer in breach of regulations. However, the service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

We received concerns in relation to unwitnessed falls, the governance of the service and management of medicines. 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 remained as requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the well led section of this full report. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Bracken House 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.

Bracken House is a residential care home providing personal to up to 34 people in one adapted building. The service provides support to older people, people living with dementia, younger adults and people with physical disabilities and sensory impairments. At the time of our inspection there were 30 people using the service.

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

The providers oversight systems were not consistently effective in identifying areas for improvement. Where peoples care plans lacked information this had not been identified and medicines stock counts were not identifying when accounting balances were incorrect.

Assessments and care plans were in place for people, but improvements were needed as some areas lacked detail. There were improvements needed to staff skills and understanding of working with people with dementia, distressed behaviours and supporting people within the principles of the MCA.

People were mostly supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in acted mostly their best interests. The policies and systems in the service did not consistently support this practice and some people had not had their capacity considered in line with the principles.

The environment required improvement to the décor and the provider had a plan in place to address this. We have made a recommendation about adapting the environment for people with dementia.

People were protected from the risk of abuse by staff who understood how to recognise signs and report any concerns. Risks to people’s safety were understood by staff and they took action to protect people from harm and minimise risks to their safety. There was enough safely recruited staff to keep people safe and meet their needs.

People had their medicines as prescribed and medicines administration records were in place. There were systems in place to minimise the risk of infection. People were supported when incidents occurred, and learning was applied to prevent reoccurrence.

People were supported to eat a balanced diet and had a choice of meals and drinks. People’s health needs were understood, and they were supported to maintain and improve their health and wellbeing, with access to health professionals to support them.

People were supported by kind and caring staff who took time to get to know people’s needs and preferences. People were supported to make choices and their privacy and dignity was protected. When people came to the end of their life there were plans in place to support people in the way they wanted.

Staff were responsive to people’s needs and these were kept under review. Relatives were encouraged to engage in people’s lives and take part in activities with people. Where complaints were made these were responded to and learning applied.

The provider had systems in place to seek the views of people and staff. Staff were supported through induction and supervision. The registered manager ensured there were partnerships in place, and they had sought opportunities to learn from external networks.

People and their relatives felt the service was person-centred and homely and well managed.

This service was registered with us on 10 October 2020 and this is the first inspection.

The last rating for the service under the previous provider was good, published on 28 March 2018.

Why we inspected

The inspection was prompted in part due to concerns received about infection prevention control, nutrition and hydration concerns, management of risks and about building safety. A decision was made for us to inspect and examine those risks. We found no evidence during this inspection that people were at risk of harm from these concerns, but some areas of improvement were needed. The provider took immediate action to address areas of improvement.

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 and will take further action if needed.

We have identified breaches in relation to governance and oversight systems 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.