29 & 30 October 2015
During a routine inspection
The inspection took place on 29 and 30 October 2015. This was an announced inspection.
Bramble Court is a domiciliary care service which provides personal care and support with domestic tasks to people living in an extra care scheme. At the time of this inspection 43 people were using the service.
No registered manager was in place at the time of our inspection, although an acting scheme manager was in place who had been at the service for several years. 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 2008 and associated Regulations about how the service is run.
We found the provider had breached Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the registered provider did not have accurate records to support and evidence the safe administration of medicines. We found gaps and inaccuracies in medicines records. The registered provider did not have systems in place to identify issues with medicines records in a timely manner. You can see what action we told the provider to take at the back of the full version of the report.
People told us they felt safe as care staff were always on site, and they responded quickly when people needed help. One person said, “I am very happy with everything here. I have made lots of friends and I am safe here.”
Staff completed safeguarding training as part of their induction, and this was updated annually. Staff knew how to report concerns and were able to describe different types of abuse. Staff told us when they raised safeguarding concerns with the previous manager they didn’t find out what happened as a result. Staff felt this was a missed opportunity to improve care practice. Staff said they had confidence in the acting manager to investigate such concerns thoroughly.
There were enough staff employed to carry out the visits required, and thorough background checks were carried out before people started working at the service.
Accidents and incidents were recorded and dealt with effectively by the provider. Risks to people’s health and safety were assessed and reviewed regularly. A business continuity plan was in place in the event of emergencies.
Staff completed regular refresher training to keep their skills up to date. Staff received spot checks, supervisions and appraisals regularly, although the records of these sometimes lacked detail, and areas of development for staff were not always identified.
The acting manager understood the requirements of the Mental Capacity Act 2005 (MCA), and told us no one was subject to a court of protection order. Staff received training in MCA and knew what to do if people’s capacity changed.
People’s food and fluid intake was monitored to support their nutritional wellbeing. People were supported to attend health related appointments.
People spoke positively about staff maintaining their privacy and dignity. Most people told us staff encouraged them to be as independent as possible. People’s relatives said staff were caring and respectful.
Care plans reflected people’s background, needs and how they preferred to be supported, so staff could provide care in a way that was appropriate to their individual needs. Care plans were kept in people’s homes so they could be referred to at any time.
People knew how to complain, although several complaints had been made in the last year about the previous management team, which had not been resolved to people’s satisfaction. People told us they had confidence in the acting manager to investigate complaints thoroughly in the future.
The registered provider had systems in place to assess the quality of care people received, but these were ineffective in relation to medicines records and safeguarding concerns. Despite regular checks being made in these areas issues were not identified.
Staff told us there was a positive and open culture at the service, and the acting manager was approachable.