19 January 2023
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
The inspection was carried out by two inspectors.
Service and service type
Bramley House is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Bramley House is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.
At the time of our inspection there was a registered manager in post.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.
During the inspection
We observed people’s care and spoke with 4 people and 1 relative about their experience of the care and support provided at Bramley House. We spoke with 5 members of staff including the registered manager, care staff, activities co-ordinator and the provider.
We reviewed a range of records. This included 7 people’s care records and 2 people’s medicines records. We looked at 3 staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.
19 January 2023
About the service
Bramley House is a residential care home providing accommodation and personal care to up to 16 people in an adapted building. The service provides support to older people, some of who may be living with dementia. At the time of our inspection there were 15 people using the service.
People’s experience of using this service and what we found
We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.
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. However, we found the principles of the Mental Capacity Act 2005 were not fully embedded into practice. We have made a recommendation in relation to this. There was no evidence this was impacting on people’s lives.
People’s care was personalised and people told us they felt at home. Staff knew people’s needs, life histories and preferences well. Whilst people received the care they required, care plans were not always updated promptly and audits had not been completed to monitor this. The registered manager and provider told us they were aware of this and were implementing changes to the systems used to address this.
People told us they felt safe in their home and staff were aware of their responsibilities to report safeguarding concerns. Risks to people’s safety and well-being were assessed and monitored to ensure they received the support they needed. Infection control procedures were in place and training had been completed by staff. Safe medicines practices were followed and people received their medicines in line with their prescriptions. The environment was designed to meet people’s needs and regular health and safety checks were completed.
There were sufficient staff available to support people safely. People told us they felt staff were competent in their roles and they did not have to wait for their care. They described Bramley House as being a home from home and said they were treated respectfully. Staff had a kind and caring approach and knew people well. We observed easy conversations and people appeared relaxed in the company of staff. Activities were developed in line with people’s interests and people were supported to go out should they wish to do so. Visitors were welcomed to Bramley House and people were supported to maintain links with friends and family.
The majority of people told us they enjoyed their food and people’s individual preferences were catered for. Where people required support to eat this was provided in a safe and dignified way. People had access to healthcare professionals when required and healthcare needs were monitored.
There was a positive culture within the home with a commitment to providing a homely and personalised service to people. The management team were highly visible and people and staff felt they were approachable and supportive. The registered manager and provider continued to look at ways to develop the service and to provide new opportunities 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
The last rating for this service was good (published 22 August 2018).
Why we inspected
The inspection was prompted in part due to historic concerns received about the support people received when eating and how guidance from professionals relating to this was followed. A decision was made for us to inspect and examine those risks. During the inspection we did not identify concerns in this area. People were supported appropriately and staff were fully aware of people’s needs.
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.
We will continue to monitor information we receive about the service, which will help inform when we next inspect.