The Care Quality Commission
  • Care Home
  • Care home

Archived: Braunton

Overall: Requires improvement read more about inspection ratings

23 Grove Avenue, Yeovil, Somerset, BA20 2BD (01935) 422176

Provided and run by:
Braunton Residential Home Ltd

All Inspections

13 October 2015

During a routine inspection

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.

25 and 26 March 2015

During a routine inspection

The inspection took place on 25 and 26 March 2015 and was unannounced. The service provides personal care and accommodation for up to eleven older people. The service does not provide nursing care. The home has rooms on the ground floor and on the second floor which are reached by a passenger lift. The home has one large communal area on the ground floor divided into a dining area and a lounge area which leads onto a garden, which has ramp access. Short stays are provided as well as long term care. At the time of the inspection there were eight people using the service including two people on short stays.

The service had a registered manager. 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.

People gave us mixed feedback about their experience. Some people commented on aspects of the home they liked while other people told us they were not always involved in making choices or decisions about their care. Relatives gave mixed feedback with some commenting that staff were kind and others saying the environment needed improvement and staff turnover was high. The relationships between people and staff were not well developed. Most people told us they did not know the names of staff or the name of the registered manager.

We saw that care was mainly based around completing tasks and did not take account of people’s preferences. Some people told us they felt isolated or bored as there were not enough meaningful activities for people either as a group or to meet their individual needs. Staff did not always speak with people respectfully or ensure their privacy. People were sometimes interrupted or ignored by staff who carried out tasks and did not seem to have time to spend with people. One person told us, “I get very lonely here sometimes.” Two relatives told us their relative had benefitted from being at the home in the short time they had been there and since they came out of hospital. Friendships had developed between people which they evidently enjoyed and found supportive.

Care was delivered by staff, some of whom, told us they felt they did not have enough time to spend with people as they were too busy carrying out tasks. This affected team motivation and the atmosphere in the service. Some staff told us they did not have the time to spend with people to meet their needs for supervision or social interaction. Although staff had training, they did not always understand people’s individual needs and preferences. Care was not personalised because people had to fit in with a routine they had not chosen. Healthcare professionals who worked regularly with the service told us there was a lack of compassion in the culture of care at the home.

Staffing was not arranged to ensure people’s needs were met consistently, in relation to their day to day care and support, including their mobility While the service demonstrated some awareness of risk for individuals, guidance to staff in how to manage this risk was inconsistent and information about risks to people’s welfare was not detailed enough to ensure people’s safety.

There were needs assessments; however they were incomplete. Care plans did not record people’s views about their care. One person told us, “I haven’t got a care plan, I have never heard of one.” Another person told us, “You should be able to do want you want and go to bed when you like.” Care plans did not contain enough personalised information about people’s preferences, interests or background to deliver an effective service. One person, who was able to mobilise independently and confidently manage most of their own care, told us they were happy living in the home and that they had choice over their daily routine. The management team acknowledged they needed to make the care plans more person centred and involve people in decisions about their care.

People were supported to receive a balanced diet; however there was minimal choice of meals and people’s preferences did not influence the menu. There was an appropriate menu being provided for two people who had special dietary requirements.

People’s mental capacity had not been assessed and recorded. Staff were not always following the Mental Capacity Act 2005 for people who lacked capacity to make particular decisions. For example, the provider had not made an application under the Mental Capacity Act Deprivation of Liberty Safeguards for two people, even though their liberty was being significantly restricted.

Although there was a policy for the prevention and control of infection, measures set out in the policy were not were not always carried out. The home was not visibly clean. A relative told us, “Although my relative is settled here I am not satisfied with the levels of cleanliness.” The management team made efforts to rectify this during the inspection.

The home was not well led. Although checks and audits of the service were carried out these were insufficient as they did not identify gaps and omissions in the service. Risks to people were not adequately monitored and reviewed. The overall leadership of the service was shared between the owners, the registered manager and deputy manager with a shared responsibility for different aspects of the running of the service. Where concerns were brought to the registered manager or owner’s attention, they were not always used as an opportunity to improve the service. Not all staff felt supported. Some staff told us they did not feel supported or heard when they raised issues however some staff told us they did feel listened to and felt supported to carry out their duties.

People’s experience of the service was affected by the provision of frequent short stays, either for respite care or as a ‘step down’ bed from hospital. This meant there were new people coming to live in the home on a regular basis, who were not known to people or to staff.

The service was in regular contact with community healthcare services. Advice was sought from the hospital on behalf of people to arrange medical examinations, urgent treatment or nursing care. Equipment was arranged for people who needed it and there was evidence that the home sought advice appropriately when needed. However staff at the home and local community healthcare professionals both told us they did not always work well together because communication was a problem, which meant people did not always receive care which was responsive to their needs.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 related to how staffing was arranged, the lack of effective risk assessments, respecting and involving service users and how consent to care was sought; infection control and how quality and risks were assessed and monitored.

You can see what action we told the provider to take at the back of the full version of the report.

6 November 2013

During a routine inspection

Some people had lived at the home for a number of years and others had moved in more recently. The service catered for people who needed some help with personal care and regular support with activities of daily living. The home was designed to provide a homely atmosphere and the people we spoke with told us this was what they wanted.

We observed people being treated with respect by staff and a friendly and supportive atmosphere between people who lived in the home.

The service had a process of on-going review and care planning for each person which helped to monitor their health and well-being and guide staff in the care and support needed. The service encouraged feedback from people and their relatives through regular meetings and correspondence. The home worked with other services and agencies to promote a safe and effective service.

One person told us they moved to the home as they used to live nearby and because it was homely. Another person we spoke with told us 'I feel relaxed here'.

A relative told us the staff were very kind and helpful and when their relative first came that the staff did everything they could to make them feel at home.

A sufficient number of staff were employed to meet the needs of the service and back up was available in emergencies. We saw that training and supervision of staff took place.

6 November 2012

During a routine inspection

We spoke with people who told us they were very happy with the service. One person told us 'It feels like a family here' and that 'it's nice and social here.'

People told us the food was 'very good' and one person told us that they felt 'safe' in the home. One person told us 'I can't put my finger on anything I would want to change' when asked about their views of the service.

We saw that staff were supported by the provider through regular training and that staff were encouraged in their professional development.

The home had suitable systems to monitor the quality of the service provided and to assess and manage risks to the health, safety and welfare of people using the service and others.

21 March 2012

During a routine inspection

We spoke with several people who lived in the home who told us that staff provided the care and support they needed. Everyone we spoke with spoke very highly of the home. People said staff were very patient and kind and they listened to them.

We saw that staff worked hard to ensure people were given the opportunity to make choices. People were able to say what they would like and staff respected people's views. We observed how staff interacted with people who lived in the home and all of the interactions we saw were kind and respectful. There was a relaxed and homely atmosphere. One person we spoke with said 'I choose what I want to do. I can still do some things for myself and they let you do as much as you can. I choose what time I get up and go to bed. You always have a choice of meals. It's very good here'.

People who lived in the home told us they felt well cared for and that staff were available when they needed them. People said staff helped them to do the things they needed help with. Comments from people included 'I like it here. I'm glad I came. I thought it would be a nice place to live', 'I'm fine and I'm very happy here' and 'this home is very good'.

We saw that people who lived in the home had built relationships with each other. People chatted between themselves. One person made sure another had a drink which had been made for them. Another person responded when someone asked for help.

During our visit we saw staff interacted with people in a patient, kind and respectful way. Staff clearly knew people well and understood their needs. One person told us 'all the nurses are very good. They all know what help you need. I've got a cord in my room so I can call for the staff if I need them. When I use it they come pretty quickly. You don't have to wait'.

People told us they liked the food served in the home and that they always had a choice of meals and snacks. They chose where they wished to eat their meals; most people preferred to eat in the dining area.

People we spoke with said they thought the home was a safe place for them to live. One relative told us it was a safe place to live and they had no concerns about the home.

People said they would raise any concerns if they had any and would be happy to share these with staff. Every person we spoke with said they were very happy with the home and had never had cause to complain.

People who lived in the home said staff were available when they needed them. One person said 'the staff are very nice. There are always enough staff here'. Another person said 'there are staff here in the day and at night. There are enough staff here. You don't have to wait if you need help. All the staff are very good and kind'. One relative told us 'all the staff here are so patient. I visit a lot, different days and different times. Staff are always very good with people'.

People who lived in the home told us they were asked to give their views on the home and that they were listened to. They told us about the resident's meetings (described in Outcome 1) and that the manager or other members of the family who owned the home spoke with them every day. They said they felt able to raise any issues with any of the staff. The relative we spoke with said they would speak with staff, the manager or owners should they have any concerns.

One person who lived in the home told us 'I always ask people if they are alright every morning. The staff or the owners always ask you if you are ok. We see them everyday. Everything is always fine here'.