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Archived: Bramble Lodge Care Home Requires improvement

The provider of this service changed - see new profile

Inspection Summary


Overall summary & rating

Requires improvement

Updated 21 September 2018

This inspection took place on 25 and 31 July 2018. The first day of the inspection was unannounced, which meant that the staff and provider did not know we would be visiting. The second day was announced.

This service provides support and accommodation for up to 41 people who are assessed as requiring residential or nursing care. This includes support for people living with dementia and/or mental health conditions. At time of our inspection there were 19 people living at Bramble Lodge Care Home.

Bramble Lodge Care Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home is a purpose built, detached building in a residential area of Middlesbrough. It is set out over two floors.

At our last inspection in January 2017 we found that there were continued gaps in records in all areas looked at. Audits had not highlighted any of the concerns which we found during inspection. Staff completed records for people when they had not been involved in their care and care records were not completed in a timely manner. A safeguarding alert for neglect had been upheld in respect of record keeping. We issued a warning notice for this breach of Regulation 17 (HSCA RA) Regulations 2014 in relation to Good governance. We asked the provider to make improvements in this area.

Whilst improvements had been made to quality assurance systems within the service, audits had not identified issues we found with staff training and the fire procedure. We have made a recommendation about provider audits.

We also found at the last inspection that people’s care records did not show if they were subject to a ‘Deprivation of Liberty Safeguard,’ (DoLS). Care plans did not contain any information about people’s capacity to consent or their level of understanding in each of their identified care needs. Staff displayed limited knowledge and understanding of DoLS and best interest decision making had not been carried out when needed. This was a breach of Regulation 11 in relation to the need for consent. We asked the provider to make improvements in this area and this action had been completed.

When we inspected the service, the manager was going through the process of becoming a registered manager having taken up their position in February 2018. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered person’s'. 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 during this inspection that the fire evacuation procedure was not clear. Information provided by staff was inconsistent and contradicted information on notices displayed throughout the building. The manager sent us information following the inspection showing that the fire procedure had been rewritten and that liaison with the fire brigade had taken place. They also provided us with the dates that staff would be trained in the new procedure.

Nursing staff had not always received training or refresher training to develop and maintain their clinical skills in areas such as catheter care. The manager had ensured that care staff were scheduled to have or had received training to be able to carry out their role, including training in areas the provider deemed as mandatory such as health and safety, safe food handling and falls prevention. However, there was no evidence that staff had received face to face people movement training, only an online version. This meant that their competency in this area may not have been thoroughly assessed. The manager sent us a plan following this inspection which set out how the training issues identified would be addressed.

People’s files contain

Inspection areas

Safe

Requires improvement

Updated 21 September 2018

The service was not always safe.

The fire evacuation procedure was not clear.

The administration of medicines was not always recorded appropriately.

Staff had been trained in safeguarding people and were knowledgeable about the potential signs of abuse. There were enough staff available to meet people's needs.

Effective

Requires improvement

Updated 21 September 2018

The service was not always effective.

Staff had not always had the up to date training they required to meet the needs of the people they supported.

Consent was sought from people before tasks were undertaken.

Care plans included information for staff about how to support people as individuals. Staff were knowledgeable about people's needs.

Caring

Good

Updated 21 September 2018

The service was caring.

People and their families told us staff were kind and caring.

Staff interacted in warm, light-hearted and caring ways with people.

People�s independence was promoted.

Relatives told us they were made welcome.

Responsive

Good

Updated 21 September 2018

The service was responsive.

A range of activities were on offer to people living at the service.

People knew how to complain if they needed to.

End of life policies and procedures were in place for when they were needed.

Well-led

Requires improvement

Updated 21 September 2018

The service was not always well-led.

Quality assurance systems were in place however they had not identified the issues with the fire procedure and training that we found during this inspection.

People and their relatives were provided with opportunities to provide their feedback on the quality of the service.

The management team were open and keen to address the areas of improvement identified during this inspection.