Bramley Court

Bramley Court is residential care home providing accommodation, nursing and personal care to up to 72 people. The service provides support to older people some of whom were living with dementia. Each person’s accommodation included en-suite facilities with shared communal areas. The home is divided into 3 units, called Damson, Pear, and Cherry. At the time of our inspection there was 67 people using the service.

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

Staff understood how to protect people from poor care and abuse. Staff had training on how to recognise and report abuse and knew how to do this. The service had enough safely recruited staff who were appropriately skilled and knew people's needs to help keep them safe.

Risks to people were identified and systems in place to reduce them, including falls, skin integrity, eating and drinking and accessible means for people to go outdoors. However, we found staff had temporarily left a mobility aid blocking a fire escape. The registered manager removed this immediately. They told us our inspection had interrupted their walk round which covered checking fire escapes. Audit records and fire safety checks showed these areas were covered on a daily basis. Lessons were learned and shared across the staff teams as required with reflective practice sessions being available so staff could learn what to do better next time.

Staff had regular, effective medicines administration training and had their competency assessed to do this safely. Staff supported people with their medicines in a way that respected their independence and achieved positive health outcomes. People were enabled to administer their own medicines independently where this was safe. One person told us, “I don’t have any worries about my medication. I know what I take and I am full of admiration for [staff], they bring it on time and make sure I take it.”

The service was clean and suitably equipped to meet people's support needs. One relative told us, “There are never any unpleasant smells here.”

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. One person told us that when they asked staff to help them go outside, this was enabled.

Staff were reminded of their responsibilities in meetings, such as for medicines administration recording. The provider set high standards of care and there was an embedded open staff team culture. All staff spoken with praised the registered manager for being approachable, listening and acting on concerns raised including reporting any concerns staff may have.

Management and quality assurance teams were in place to effectively evaluate the quality of support provided to people, and to make changes as needed. This involved people, their families, advocates and other professionals as appropriate. Staff respected people's wishes, needs and rights and values and acted upon their views. People had a say in how the service was run. People’s lives were enriched by staff who put people first and foremost. One relative said, "It is definitely a place I would recommend to others if they needed care. I know my [family member] is in the right place being able to [spend their life in a way they want to]."

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

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.

Rating at last inspection

The last rating for this service was outstanding, published on 16 January 2020.

Why we inspected

The inspection was prompted by a review of the information we held about this service, concerns received about people's care and support, risks to people's safety, the staff team culture and management of the service. 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. Where the provider had already identified risks, actions taken had been effective. Please see the safe and well-led sections of this full report.

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 outstanding based on the findings of this inspection.

Follow up

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

We found the following examples of good practice.

All staff working at the home underwent weekly polymerase chain reaction testing (PCR), and twice weekly lateral flow testing to ensure that anyone with possible covid infection was identified quickly. The tests were completed in an external cabin outside of the building. Staff then only entered the premises if their test was clear.

People’s temperature was taken three times a day, and their oxygen saturations were monitored regularly so staff could quickly pick up any symptoms of Covid infection.

Every area and room in the home had been designated with a specific traffic light colour to prompt staff which type of personal protective equipment was required. For example, a red area meant that staff needed to wear full protective equipment.

Family escorts who were taking relatives to external health appointments were offered a PCR test three days before the appointment, so they could be sure they were not a risk to their relative or others.

Perspex screens had been installed in office areas to add protection for staff who could not sit two metres apart.

Bramley Court is a care home providing personal and nursing care to 72 people aged 65 and over at the time of the inspection. The service can support up to 72 people on three floors, each of which has separate adapted facilities. One floor specialises in providing care to people living with dementia.

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

People who lived at Bramley Court received outstanding care from a passionate and dedicated staff team. Staff valued people and their life experiences, and they knew people extremely well. They provided care that was exceptionally individual to each person and their likes, dislikes and preferences.

People told us they really liked living at Bramley Court, relatives trusted the staff team to look after their family members, and staff enjoyed coming to work to see people. Staff were extremely kind and caring and were described as such by people and visitors.

The home had been adapted to ensure people were safe and could be as independent as possible. Some areas had been further adapted to provide environments that supported people living with dementia. Staff went the extra mile to find out people’s interests and provide them with surroundings that made a real difference to their lives at Bramley Court.

People felt safe living at the home because staff knew what they were doing, they had been trained, and they assessed and reduced risks as much as possible. There were enough staff to support people with their care needs and to be able to spend time with them. The provider and staff kept people safe by ensuring key recruitment checks, giving medicines as prescribed and using protective equipment, such as gloves and aprons.

Staff supported people with meals, drinks, and accessing advice and treatment from health care professionals and made sure they asked people’s consent before caring for them. 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 registered manager was very well thought of by people, their relatives and staff. They worked by example and provided extremely good management and leadership. Bramley Court was part of the local community, despite being set away from residential housing, and benefited from frequent visits from local groups. Staff worked towards continually improving people’s experience of living at the home and had a ‘can do’ attitude that meant nothing was impossible.

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 (report published 22 October 2018). 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.

Why we inspected

This was a planned inspection based on the previous rating.

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.

This unannounced inspection was carried out on the 22 and 28 August 2018.

At the time of the inspection there was a registered manager in place. However, they were not present for the 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.

At the previous inspection in June 2017 the home was rated Good. However, at this inspection the rating has changed to Requires Improvement. The registered manager had not submitted notifications to the Commission about serious injuries acquired in the home, as required by the regulations. The Commission requires notification of these events to assess if there has been any avoidable harm or if people are at risk from further harm. You can see what action we told the provider to take at the back of the full version of this report.

Staff were aware of how to keep people safe from harm and what procedures they should follow to report any harm. Action had been taken to minimise the risks to people. Risk assessments identified hazards and provided staff with the information they needed to reduce risks where possible.

Medicines were managed safely. Staff received training and competency checks before administering medicines unsupervised. Medicines were stored securely. The records were an accurate reflection of medicines people had received.

Care plans gave staff the information they required to meet people’s care and support needs. People received support in the way that they preferred.

There was an effective quality assurance process in place which included obtaining the views of people that lived in the home, their relatives and the staff. Where needed action had been taken to make improvements to the service being offered.

Staff were only employed after they had completed a thorough recruitment procedure. Staff received the training they required to meet people's needs and were supported in their roles.

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 and staff worked within the guidance of the Mental Capacity Act 2005.

Staff were motivated to provide care that was kind and compassionate. They knew people well and

were aware of their history, preferences, likes and dislikes. People's privacy and dignity were respected.

People were supported to maintain good health as staff had the knowledge and skills to support them. There was prompt access to external healthcare professionals when needed.

People were provided with a choice of food and drink that they enjoyed. When needed staff supported people to eat and drink.

There was a varied programme of activities including activities held in the service, trips out and entertainers that came into the home.

There was a complaints procedure in place. People and their relatives felt confident to raise any concerns either with the staff or manager. Complaints had been dealt with appropriately.

This inspection took place on 29 June 2017 and was unannounced.

There was a registered manager in place. 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.

Staff had taken action to minimise the risks to people. Risk assessments identified risks and identified how to reduce them where possible. Staff were competent to administer medication. They were following the correct procedures when administrating, recording and storing medication so that people received their medication as prescribed. Staff were aware of the procedures to follow if they thought anyone had been harmed.

Staff were only employed after they completed a thorough recruitment procedure. There were enough staff on shift to ensure that people had their needs met in a timely manner. Staff received the training they required to meet people’s needs and were supported in their roles.

The CQC is required by law to monitor the Mental Capacity Act (MCA) 2005, Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The provider had completed some capacity assessments and DoLS applications. The provider could demonstrate how they supported people to make decisions about their care and the principles of the MCA were being followed.

Staff were kind and caring.They knew people well and were aware of their history, preferences, likes and dislikes. People’s privacy and dignity were respected and promoted.

Staff monitored people’s health and welfare needs and acted on issues identified. People had been referred to healthcare professionals when needed. People were provided with a choice of food and drink that they enjoyed. People were given the right amount of support to enable them to eat and drink.

There was a varied programme of activities including in-house group activities, one-to-one activities, entertainers and trips out. Staff supported people to maintain their interests and their links with the local community to promote social inclusion.

Care plans gave staff the majority of information they required to meet people’s care and support needs. People received support in the way that they preferred and met their individual needs.

There was a complaints procedure in place and people and their relatives felt confident to raise any concerns either with the staff or manager. Complaints had been dealt with appropriately.

There was an effective quality assurance process in place which included obtaining the views of people that lived in the home and their relatives and the staff. Where needed action had been taken to make improvements to the service being offered.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements.

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

Bramley Court provides accommodation, personal care and nursing for up to 67 people including those living with dementia. Accommodation is located over three floors with one unit per floor, called Damson, Pear and Cherry. There are communal areas for people and their visitors to use. There were 59 people living at the home when we inspected.

At the time of this inspection there was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 and associated Regulations about how the service is run.

At our focused inspection on 12 December 2016, we found that the provider had followed their plan, which they had told us would be completed by 3 July 2016, and legal requirements had been met.

People who lived at the home were supported by staff in a kind and respectful way. Staff understood their role and responsibilities to report poor care and suspicions of harm. The local authority safeguarding team and the Care Quality Commission were notified about any safeguarding incidents that had occurred within the home.

We saw that there was a sufficient number of staff to meet the needs of people living at the home. A dependency tool (people’s assessed dependency support needs) was used by the registered manager to determine safe staffing levels.

Whilst improvements had been made we have not revised the rating for this key question; to improve the rating to ‘Good’ would require a longer term track record of consistent good practice.

We will review our rating at the next comprehensive inspection.

This unannounced inspection took place on 5 and 6 April 2016. There were 65 people receiving care at that time.

The service had a registered manager in place. 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 were not always sufficient staff on duty to ensure people’s needs were met safely. People’s safety was not always managed effectively. Staff were aware of the procedures for reporting concerns. However, these systems were not always followed and concerns were not always investigated.

Staff were only employed after the provider had carried out comprehensive and satisfactory pre-employment checks. People received their prescribed medicines appropriately and medicines were stored safely.

Staff were well supported by their managers. People’s health, care and nutritional needs were effectively met. People were provided with a balanced diet and staff were aware of people’s dietary needs.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and report on what we find. We found that there were formal systems in place to assess people’s capacity for decision making and applications had been made to the authorising agencies for people who needed these safeguards. Staff respected people choices and were aware of the key legal requirements of the MCA and DoLS. People were involved in decisions about their care.

People received care and support from staff who were kind, caring and respectful to them and their visitors. Staff treated people with dignity and respected their privacy.

Care records were detailed. However, these did not always provide staff with sufficient guidance to provide consistent care to meet each person’s individual needs.

People had access to information on how to make a complaint and were confident their concerns would be acted on. However, we could not be confident that all complaints had been fully investigated.

There was a varied programme of events for people to join in with and opportunities for people to develop hobbies and interests. Staff supported people to spend their time in a meaningful way.

The registered manager was supported by a staff team that including registered nurses, care workers, and ancillary staff. The service had a quality assurance system in place. However, although areas for improvement were identified, actions were not always taken to bring about improvements to the service.

People and relatives were encouraged to provide feedback on the service in various ways and their views were listened to and acted on. People benefitted from good links with the local community.

We found two breaches of the Health and Social Care Act (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.

Most of the people had positive comments to make about the standard and quality of their support, care and treatment. However, improvements are needed to ensure that people's support, care and treatment needs, including any changes in these, are monitored, reviewed and recorded.

There were systems in place to make sure that people were protected from the use of unsafe equipment. People were generally satisfied with the aids and adaptions to support their comfort, care and safety needs.

We received positive comments about members of staff's attitudes and their suitability. Recruitment systems were in place although improvements are needed with these, to ensure that vulnerable people are protected from unsuitable staff who were employed to work at Bramley Court.

People were aware of the complaints procedure, although the written information about it was out-of-date and incomplete. Some, but not all, of the people said that they were confident that actions would be taken in response to their comments. Improvements are needed.

Relatives we spoke to were very positive about the care provided. One relative said, "Mum is very well looked after". Another family told us, "Staff are wonderful. They cope with difficult situations". We found that people and their families were involved in decisions about the care provided.

Staff we spoke to told us they enjoyed their work and felt supported. One said, "I absolutely love working here. I am proud to work for the company". However, some expressed concern there were not enough staff. The new manager told us about the plans to address this, with additional staff currently being recruited.

Staff we spoke to all told us they received an annual appraisal. However, we did not find records to support this consistently. The provider already had an action plan in place to put this right.

We saw that a variety of activities were offered to people. On the day of our inspection, people enjoyed a visit from a 'pets as therapy' dog. We also saw that a hairdresser was present.