Brailsford House

We found the following examples of good practice.

There was a restriction on visiting the service at the time of the inspection. There were procedures in place for visitors to the service, including healthcare professionals and relatives to reduce and prevent the spread of infection.

The provider ensured people maintained contact with relatives by staff supporting them with telephone calls. People we spoke with confirmed staff had supported them to stay in contact with their family during the pandemic.

The registered manager told us they had accommodated garden visits during the summer. They were reviewing visits for the winter once they had come out of their quarantine period and reviewed current guidance for accepting visitors.

There was a clear regular programme for staff and people living in the home to be tested for COVID-19. This meant swift action could be taken if or when positive tests were received.

Staff followed procedures for Personal Protective Equipment (PPE) and how to dispose of it safely, in line with government guidelines. All staff wore appropriate PPE, which was in good supply. Posters and information about COVID-19 were visual throughout the service. The provider was also working with Public Health England to ensure they had appropriate safety measures in place.

There was a stable staff team who did not work in any other care settings. No agency staff were used in the service. This meant the risk of cross infection was reduced.

A robust contingency plan was in place and used when positive testing or isolation for staff or people arose.

Handover meetings were completed in line with safe distancing guidelines.

People using the service had tested positive and were self-isolating in their own rooms. Communal areas were used when people came out of the isolation period. Arrangements were in place to reduce the spread of infection.

Enhanced cleaning schedules were in place including high touch areas such as door handles and hand rails. The cleaning regime had been increased to ensure all areas were kept clean and disinfected. This reduced the risk of infection spread.

Further information is in the detailed findings below.

People’s experience of using this service: People told us they received a good service and felt safe with the support they received from staff. Recruitment processes were in place to make sure the provider only employed workers who were suitable to work in a care setting. Risk assessments arising from people’s health and the environment were in place with plans to mitigate the risk. Medicines were not managed safely; fire drill and evacuation practices were not taking place and there was no record of checks on bed rails or window restrictors. One upstairs window did not have a window restrictor in place. The registered manager said this would be fitted the next day.

Care and support were based on assessments and care plans, which were reviewed and kept up to date. Staff received appropriate training and supervision to maintain and develop their skills and knowledge to support people according to their needs. People's rights were protected by staff who understood the Mental Capacity Act and how this applied to their role. Where appropriate, people were supported to eat and drink enough to maintain their health and welfare. People were supported to access healthcare services, such as GPs.

Care workers had developed caring relationships with people they supported. People were supported to take part in decisions about their care and treatment, and their views were listened to. Staff respected people's independence, privacy, and dignity.

People's care and support considered people’s abilities, needs and preferences and reflected their physical, emotional and social needs. People were aware of the providers complaints procedure.

Although management systems were in place to monitor the quality of the care provided and to promote people’s safety and welfare, they had not identified the concerns we raised.

Rating at last inspection: Good. (report published 18 March 2016).

The overall rating for this service after this inspection is requires improvement.

More information is in the full report below.

Why we inspected: This inspection was a scheduled inspection based on the previous rating.

Action we told provider to take: We identified two breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 around safe care and treatment and good governance.

Follow up: We will request an action plan from the provider to understand what action they will take to improve the quality and safety of care provided to people. We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

We found people were respected and involved. A person who used the service told us they were very happy there and had never had cause to complain.

We found people received care and support that met their needs. A person described their care as 'Wonderful. Couldn't be better.'

We found people were safeguarded from abuse. All the people we spoke with told us they felt safe in the home.

At a previous inspection we had been concerned that there were not always sufficient and suitable staff available. However, since the last visit we made in January 2013, the staff numbers had been increased to ensure there was always a minimum of three staff on each shift during the day and two at night. People we spoke with said they thought the staff numbers were right and they were not left waiting when they asked for help.

We found the staff team were supported through training. Training records we looked at showed us that staff had attended regular training in areas relevant to their work, such as, safeguarding people, moving and handling etc.

We found the provider assessed and monitored the quality of the service. A person told us, 'We have residents' meetings. I find these very useful.'

We found people were respected and involved. A person who used the service told us they felt honoured to have been asked to become a dignity champion.

We found people's ability to consent was not always known.

We found people received care and support that met their needs. A person described their care as 'varying between good and excellent.'

We found people were safeguarded from abuse. One person said they 'definitely' felt safe in the home.

We found there was not always sufficient and suitable staff available. One person told us, 'One thing I want to say is we do need more staff.'

We found the staff team were supported through training. A person told us, 'I am happy with these staff. They go on courses and sometimes talk about their training.'

We found the provider assessed and monitored the quality of the service. A person told us, 'We have residents' meetings. I find these very useful.'

We found records were not properly managed.