Archived: Braunton

Updated 11 December 2015

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 13 October 2015. Before the inspection we reviewed the information we held about the service. This included previous inspection reports, reports commissioned by the home, statutory notifications (issues providers are legally required to notify us about), other enquiries from and about the provider and other key information we hold about the service.

During our inspection we spoke with the registered manager, three staff, six people living at the home and received feedback from three relatives and three health professionals.

We also looked at records relevant to the running of the home. This included staff recruitment files, training records, care files for four people living at the home, medication records, maintenance records, complaint and incident reports, surveys and audits.

Updated 11 December 2015

Braunton is a residential care home which is registered to provide care for up to eleven older people requiring assistance with personal care. The home is family run and situated in a quiet residential area of Yeovil. The home specialises in the care of older people but does not provide nursing care. There is a registered manager who is responsible for the home. 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 and associated regulations about how the service is run.

The service was last inspected in March 2015. During that inspection we identified seven breaches where legal requirements were not being met. This meant that the service was rated “Inadequate” overall and in the areas of “safe”, “caring” and “well-led”. The areas of “effective” and “responsive” also required improvement. From March 2015 to the time of this inspection the service had been the subject of a whole service safeguarding process and quality monitoring. This resulted in a voluntary agreement from the service with commissioners not to admit any further people to the home until improvements had been made. We also looked at the minutes from these meetings. After the March 2015 inspection, the provider wrote to us with an action plan to say what they would do to meet legal requirements in relation to the breach.

We undertook this inspection on 13 October 2015 to carry out a comprehensive inspection and to check that they had followed their action plan and to confirm that they now met the legal requirements made at the previous inspection. At the last inspection in March we found there were breaches relating to care and treatment not being provided in a safe way as risks were not adequately assessed. People were not always protected against the risks of infection which was not well managed. The Mental Capacity Act 2005 framework was not being followed and arrangements to assess people’s mental capacity were inadequate. People were not always treated with dignity and respect or involved or enabled in their care planning and reviews. The systems and processes for assessing and monitoring the quality of the service were not adequate or people focussed and there were not enough staff to meet people’s needs.

During this inspection on 13 October 2015 we found that the registered manager and staff team had worked hard to meet the legal requirements. Although these breaches had been met there were still some other areas that required further improvement to ensure the service continues to improve. These areas for improvement were bed rails risk assessments, medication audits practical manual handling training, end of life care planning records and accessing advocates for people in relation to best interest decision-making.

On the day of the inspection there was a calm and relaxed atmosphere in the home and we saw staff interacted with people in a friendly and respectful way. People were encouraged and supported to maintain their independence. They made choices about their day to day lives which were respected by staff. People told us they felt safe living at the home. Comments included “Yes, we are safe here” and “I’m lucky to be here, I’m well looked after.” Relatives said “Staff helped to get [my relative] more mobile and to gain their confidence back after a long stay in hospital” and “For our family we believe [our relative] is in good, safe hands. Their needs are being met and I feel that there is a family approach of looking after the residents.”

Although people and their relatives felt the home was a safe place for them to live we found some elements of care provision did not ensure safe care. There were no bed rail risk assessments to ensure the safe use of bed rails.

Practical manual handling training was not robust enough to be effective and keep people safe. Staff had good knowledge of people including their needs and preferences. Staff were up to date with mandatory training and there were opportunities for on-going training and for obtaining additional qualifications.

Improvements were required in the application of the Mental Capacity Act and accessing advocacy services in relation to best interest decision making.

There were no records to show how people wished to be cared for at the end of their lives to ensure people’s needs would be met.

There were not always effective quality assurance processes in place to monitor care and plan ongoing improvements. The service had not identified the areas for improvement which we raised. However, there were systems in place to share information and seek people’s views about the running of the home. People’s views were acted upon where possible and practical and feedback was used to drive forward further improvements

People said they would not hesitate in speaking with staff if they had any concerns. People knew how to make a formal complaint if they needed to but felt that issues would usually be resolved informally.

People were well cared for and were involved in planning and reviewing their care. There were regular reviews of people’s health and staff responded promptly to changes in need. People were assisted to attend appointments with appropriate health and social care professionals to ensure they received treatment and support for their specific needs. However, comments from health professionals mentioned that management were sometimes communication with management was difficult due to a defensive attitude.

People’s privacy was respected. Staff ensured people kept in touch with family and friends. Relatives all said they were always made welcome and were able to visit at any time. People were able to see their visitors or take calls in communal areas or in private.

People were provided with a variety of activities and trips. People could choose to take part if they wished. Attention was given to people’s likes and preferences which were respected and staff had time to sit with people on a one to one basis doing things people wanted to do or chatting. One person said “

There was a new management structure in the home which provided clear lines of responsibility and accountability. The registered manager had worked hard to involve staff in making people the focus of their improvements and wanted to provide good care for people who they knew well.