We carried out a review of the data available to us about Brendoncare Alton on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Brendoncare Alton, you can give feedback on this service.
Brendoncare Alton is a large nursing home providing personal and nursing care to 60 people aged 65 and over at the time of the inspection. The service can support up to 80 people.
Brendoncare Alton provides purpose-built accommodation across five households, each with their own facilities. Two of the households specialise in providing care to people living with dementia. At the time of the inspection, the service was coming to the end of a major refurbishment programme. Four of the five households were in use and re-development of the final household was almost complete.
People’s experience of using this service and what we found
People were safeguarded from the risk of abuse and processes were in place to share any relevant learning from incidents, to reduce the risk of re-occurrence. Staff ensured people received their medicines safely and as required. There were sufficient staff to meet peoples’ care needs in a timely manner.
Staff’s delivery of care to people incorporated best practice guidance. People received their care from well trained staff who had on-going support and supervision in their role. Staff ensured any referrals to other services were made promptly for people and their healthcare needs were met. People benefited from the well designed and thoughtfully decorated environment, which was clean, homely, familiar and attractive.
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.
Staff treated people with kindness, respect and compassion as they provided their care. People were encouraged to express their views and to be actively involved in decisions where possible. Staff ensured people’s privacy and dignity was upheld during the provision of their care.
People received individualised care, planned around their needs and preferences. People were provided with opportunities for activity and social contact. People’s complaints were listened to and responded to appropriately. People were consulted about their end of life wishes and were well supported.
There was a positive, open culture focused on achieving good outcomes for people. The provider ensured people and staff’s views were sought and acted upon. There was a clear governance framework for the service. Processes were in place to identify any potential risks to people’s safety or the quality of the service and to drive improvements. The service worked with key organisations to enhance the delivery of people’s care.
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 30 June 2017).
Why we inspected
This was a planned inspection based on the previous rating.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Brendoncare Alton is registered to provide care for up to 80 people who need nursing support. There are five units: Jade, Blue and Pink units care primarily for people who are physically frail and Cedar and Oak units look after people who are living with dementia. We visited all of the units during the course of the inspection. At the time of the inspection there were 69 people using the service.
The service had a registered manager; however, they were in the process of de-registering and the new manager was in the process of registering. 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 were kept safe from the risk of abuse as relevant processes and procedures were in place. Staff were up to date with their safeguarding training and understood their role in protecting people from abuse.
People told us staff looked after them safely. Nursing staff assessed potential risks to people and people’s risk management plans were reviewed on a monthly basis. Processes were in place to ensure incidents were analysed and acted upon for people’s safety.
People were satisfied with the level of staffing provided and reported their call bells were responded to promptly. We observed that although staff were busy; people were not rushed with the delivery of their care. People were kept safe because the provider had robust recruitment procedures to ensure suitable staff were recruited to provide people’s care.
People received their medicine from trained, competent staff. Processes were in place to ensure the safe administration and management of medicines for people.
A person told us “Staff are competent.” Staff in all roles were offered training, supervision, support and development appropriate to their needs. This ensured they had the skills and knowledge to provide people’s care effectively.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.
People told us they were satisfied with the food. People received the support and care they required to ensure their nutritional and fluid intake was sufficient for their needs. Staff took action to address any risks to people associated with their eating and drinking. Lunch was a pleasant experience for people and they appeared to enjoy their meal.
People were supported by staff to access health care professionals as required in response to their identified health care needs.
People reported “Staff are kind” and “Staff are so good; they make you feel as if you are at home. I feel very happy here.” A staff member told us there had been a focus on recruiting “Caring staff.” Staff showed an interest in the people they were caring for.
Staff understood how to communicate caringly with people. People were consulted about and involved in day to day decisions about their care. People’s choices were respected. Staff understood how to uphold people’s privacy and dignity and were observed to do so.
People told us their care was planned and reviewed with them and that it met their needs. People had an assessment of their care needs and preferred outcomes. Their care plans were regularly reviewed and their feedback was acted upon.
Staff were responsive to the needs of people living with dementia and understood how to meet their needs. People were provided with a variety of opportunities for social stimulation.
Processes were in place to enable people to make complaints about the service and these were used to improve the quality of the service provided.
The provider’s statement of purpose outlined their philosophy of care, which was that; people should experience: care, respect, compassion, friendship and laughter, warmth and welcome. There was transparency and openness both from the provider and from within the service. The service had good external links and this enabled staff to learn about and to share good practice in order to improve the care people received.
People were satisfied with the management of the service and told us “Yes it seems well led.” Staff told us they felt “Optimistic” with the new manager in place. “The service has in place a clear management structure. The new manager brought stability to the registered manager’s role.
The provider was regularly supplied with information about the performance and quality of the service provided to people. The service received input and oversight from the provider’s senior management team. The manager was looking at sharing responsibility for the completion of audits and action plans with staff, to create a sense of ‘ownership’ for the quality of the service.
This report only covers our findings in relation to this requirement. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Brendoncare Alton on our website at www.cqc.org.uk.
Brendoncare Alton is registered to provide care for up to 80 people who need care and nursing support. There are five units: Jade, Blue and Pink units care primarily for people who are physically frail and Cedar and Oak units look after people who are living with dementia. We visited all the units during the course of the inspection. At the time of the inspection there were 79 people using the service.
The service does not currently have a registered manager as required, however the provider is in the process of recruiting a 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. The provider is in the process of recruiting a manager and has ensured that in the interim the service is run by a covering manager.
At our focused inspection on 3 February 2016 we found the requirements of regulation 18 had been met. There were sufficient staff rostered to ensure one to one care could be provided safely for people, there had been a decrease in the use of agency staff and there was consistency in care planning for people whose behaviour challenged staff, as staff now had the time to write the required care plans. However further improvements were required to ensure staffing levels for people were ‘Good’ across all of the units.
There had been an increase in the level of staffing on one of the units that accommodated people who experienced dementia. The provider had processes in place to ensure the required number of staff were rostered to provide people’s care on these units and checked to ensure sufficient staff had been deployed. Staff on these units told us there had been an improvement in staffing since the last inspection. There were enough staff to provide people with the care they needed for example, one to one supervision. Staff knew the people they were caring for and people’s needs were met. Where required people had challenging behaviour care plans in place as staff now had the time to write them.
On the nursing units there had been an increase in the number of staff who moved between the units to provide people’s care. Whilst there appeared to be enough staff on the nursing units to provide safe care. people told us that they did not think there were enough staff to provide the quality of care they should expect. For example, staff told us they were especially busy in the morning on the nursing units. The provider used a dependency tool to assess staffing requirements. They had identified that the tool in use was potentially not accurate at assessing people’s staffing needs. They were in the process of trialling a new tool and at the end of the inspection they informed us the new tool would be introduced onto one of the nursing units with immediate effect. This was to ensure that the numbers of staff provided were appropriate to meet the assessed needs of people.
The use of agency staff had decreased and the provider taken action to ensure continuity for people in the agency staff they booked for the service. The provider had taken appropriate action to recruit more staff. The provider had taken action to mitigate any impact upon people from the use of agency staff not being familiar with people’s needs by booking the same staff where possible.
We carried out an unannounced comprehensive inspection of this service on 2, 4 and 12 December 2014. Breaches of legal requirements were found in relation to care and welfare and staffing. After the comprehensive inspection, the provider wrote to us to say what they would do to meet these legal requirements. They told us they would complete their action plan for staffing by 29 May 2015 and for care and welfare by 28 August 2015.
We undertook this focused inspection on 7 September 2015 to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Brendoncare Alton on our website at www.cqc.org.uk.
Brendoncare Alton is registered to provide care for up to 80 people who need care and nursing support. There are five units: Jade, Blue and Pink units care primarily for people who are physically frail and Cedar and Oak units look after people who are living with dementia. We visited all the units during the course of the inspection. At the time of the inspection there were 75 people using the service.
The service has a manager who has submitted an application to become the 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.
At our focused inspection on 7 September 2015 we found the provider had met the requirements in relation to people’s care and welfare. Staff had undergone further training and understood how to meet people’s needs when their behaviours challenged staff.
However, the provider had not fully completed the action plan they had written to meet shortfalls in relation to staffing. There were not always sufficient staff deployed to meet the needs of two people assessed as in need of one to one observation from staff due to the risk of them falling. The provider had been recruiting staff to the service and this process was ongoing. In the interim they ensured shifts were covered by agency staff if their own staff were unable to cover them. As a result there had been an increase in the use of agency care staff which people, their relatives and staff told us had impacted negatively upon the delivery of people’s care, which took longer. They also told us there were insufficient staff to meet their care needs in a timely way. People whose behaviours challenged staff had information about how to respond to their needs in their care plans. However, for some people this information was only contained within their personal care plan rather than in a specific behavioural care plan. To ensure staff had guidance in situations other than the delivery of people’s personal care. Staff told us they had struggled to complete this due to the lack of permanent staff. There was a breach of the legal requirements in relation to staffing.
We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.
The unannounced inspection of Brendoncare Alton took place on 2, 4 and 12 December 2014.
Brendoncare Alton is located in Alton, Hampshire, close to the town centre. It is registered to provide care for up to 80 people who need care and nursing support.
There are five units. Jade, Blue and Pink units care primarily for people who are physically frail and Cedar and Oak units look after people who are living with dementia. We visited all the units during the course of the inspection.
When we inspected the service in January 2014 we found the service was not acting in accordance with the Mental Capacity Act 2005. We also found some care records were not completed properly. We visited again in May 2014 in response to some safeguarding concerns. At that time we found the service did not have suitable arrangements in place to protect people against the risk of control or restraint being unlawful or otherwise excessive. The provider sent an action plan detailing how they were going to address these issues and improvements had been made at the time of this inspection.
The home has a registered manager. 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 and associated Regulations about how the service is run.
People said they felt safe at Brendoncare Alton. However, the service needed to improve the consistency of care to people who could at times be resistant to care to ensure they always met their individual needs. There were times when the service did not provide enough staff to meet people’s needs in a timely way.
Improvements had been made to staff awareness and understanding of potential abuse and safeguarding procedures were robust. Risks to people’s health and environmental risks were identified and reviewed regularly. Medicines were managed consistently and safely so people could be assured they received their medicines as required.
People received effective care from suitably trained and supported staff. Staff supported people to make decisions and to have as much control over their lives as possible. Staff understood and had a working knowledge of the Deprivation of Liberty safeguards and the key requirements of the Mental Capacity Act 2005. Most people were complimentary about the food and people had a choice both of what they ate and where they had their meals. People’s nutritional needs were assessed and staff ensured they had an appropriate diet. People were happy with the health care provided and the service liaised effectively with health care professional when they needed to keep people in the best of health.
People said staff were kind and caring and we saw a lot of positive interactions between staff and people who lived at Brendoncare Alton. Regular staff knew people’s interests and preferences and tailored care and support accordingly. People were provided with a range of information and were consulted and involved in their plans of care and support. Their views were also considered in the development of the service.
Visitors were welcomed and relatives were contacted promptly if for example there had been a change in a person’s health. There were good links with the local community and people benefitted from a wide range of activities, many of which were provided by volunteers who contributed their skills and experience to enrich the quality of care and support provided. Concerns and complaints were taken seriously, explored thoroughly and responded to in good time.
There was a positive culture at the service and a consistent management structure. The service had clear vision and values and the management team put these into practice by ensuring people and their loved ones were involved and by maintaining good links with the local community. The service worked in partnership with other organisations to make sure they were following good practice and providing a good quality of care. Quality assurance arrangements were used to drive improvement.
We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which now corresponds to Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Sometimes there were not enough staff employed and staff were not consistently supporting the individual needs of people who at times were resistant to care You can see what action we told the provider to take at the back of the full version of this report.
Is the service safe?
Is the service effective?
Is the service caring?
Is the service responsive?
Is the service well-led
This is a summary of what we found.
Is the service safe?
Although people said they felt safe we concluded that the service needed to make improvements because staff had not followed procedures in raising alerts and reporting allegations of abuse. We also found that guidance to staff about how to manage people's behaviour when they became agitated or distressed was not always appropriate or in line with legislation.
Is the service effective?
The service produced good care and support plans to help staff to manage people's care and health needs. Staff had a good understanding of what people needed and expected from the service and monitored their health consistently and effectively.
We saw that the home was clean and well maintained and adaptations were in place to support and promote people's independence.
Is the service caring?
People told us they were treated with kindness and staff were respectful. Care and interactions we observed throughout the day showed staff were considerate, supportive and aware of people's needs. Staff showed a caring and responsive attitude when providing care and support, even at times in difficult situations. People told us the staff were very good and very kind. Two visitors said 'the residents are very well looked after'. They said 'the staff are very patient and they know what they have to do'.
Is the service responsive?
There was a varied activity programme and people were supported to take part.
People knew how to make a complaint if they were unhappy. Two people told us they did not have any worries but would talk to the manager and were confident their concern would be looked into.
Is the service well-led?
The service had a registered manager who demonstrated a good understanding of the needs and wellbeing of people who lived at Brendoncare Alton.The service has a quality assurance system but records showed that not all of the shortfalls identified had been addressed. There was a monthly quality audit; however this was not robust and it did not inform the overall quality assurance process.
The relatives were complimentary about the care and support the staff provided. A relative commented "they know him well and have him smiling, laughing and dancing - something that I have been unable to get him to do for years". Another relative said "they are absolutely first class - all the staff are wonderful". They told us the staff were "very kind". A third relative told us "my husband is very happy here and I have peace of mind. I could not ask more of the staff".
The care plans were variable and did not always reflect people's current needs. The records maintained in the home were inadequate because care, treatment and support given were not clearly and accurately recorded. Care plans did not include information that enabled staff to support each person's specific needs. The lack of support plans in place meant that people using the service were not protected from harm and the risks were not reduced.
People were satisfied with the care and support provided. One person who lived at Brendoncare Alton said for example 'I can't fault this place.' Another person and their visitor said 'Its like home from home.' Another visitor said 'Its ok here'. Visiting professionals were satisfied that the service worked positively with them. We observed a lot of positive interactions between staff and people who lived at the home.
People's health care and welfare needs were recorded accurately. Where people were unable to provide this information relatives, friends and professionals had been consulted to ensure that staff understood peoples wishes about how they wanted to be treated and cared for. Arrangements were in place to ensure that the premises and grounds were suitable for purpose and that they were adequately maintained.
Staff were provided with a wide range of training and once this had been completed, their competencies were checked.
There was an effective complaints system in place and people felt able to raise a concern if they had one and were confident that their views would be listened to.
We observed the staff interacting with the residents in the wing for people with dementia. We saw the staff were kind and caring and, apart from a short staff break when there was no interaction, the staff spent time meeting the residents' needs and chatting to them.
The staff said they had training approrpiate to their roles and they knew how to report any safeguarding concerns.
The staff told us they usually worked in small teams in the same areas of the home so they got to know the residents really well.