Archived: Brendoncare Woodhayes

Brendoncare Woodhayes is a care home providing nursing and personal care for up to 27 older people. At the time of the inspection there were 20 people living at the home. The service is a large older style building on two floors with gardens to the front and back.

People's experience of using this service and what we found

Brendoncare Woodhayes had a visible person-centred culture which ensured that staff in all roles were highly motivated and offered care and support that was compassionate and kind. There was a good ethos within the service of treating people with dignity and respect. People were at the forefront of the service delivery and the registered manager and team were committed to and passionate about providing a good quality service. We received positive feedback from people and a relative. Any issues were taken seriously and swift action taken by the registered manager supported by head office. The feedback reflected staff were kind, caring and committed.

Staff, supported by the activity co-ordinator, recognised what was important to people and ensured that people's personal needs, wishes and preferences were delivered. Safe access to visitors and leisure activities had been well managed to ensure promotion of positive wellbeing for people and their loved ones.

Care and support plans were reviewed and changed as people's needs changed. The service worked closely with healthcare professionals. People were supported to maintain good health and to meet their nutritional needs.

Staff told us they were supported by the management team with empathy and understanding. Many staff had worked at the service for some years. There had been some difficult times during the pandemic but these had been managed well with additional support for staff and recognition of their hard work. The registered manager, provider and management team provided supportive leadership and had developed a dedicated staff team who were committed to the vision and values of the service.

The provider had effective quality assurance systems, led by the Head of Quality and Compliance, which were used to drive improvement. People living at Brendoncare Woodhayes told us they received safe care from skilled and knowledgeable staff. Staff knew how to identify and report any concerns.

The provider had safe recruitment and selection processes in place. Risks to people's safety and well-being were managed through a risk management process. There were sufficient staff deployed to meet people's needs, with staff working together to cover shifts during the pandemic.

Medicines were managed safely, and people received their medicines as prescribed. 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.

Rating at last inspection The last rating for this service was Good (published 12 February 2019)

Why we inspected

The inspection was prompted in part due to concerns received about some areas of care at night such as re-positioning, fluid management and staff teamwork. We found no evidence during this inspection that people were at risk of harm from this concern.

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.

No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. The overall rating for the service therefore remains Good. This is based on the findings at this inspection.

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 Woodhayes provides nursing care and accommodation for up to 25 older people who may also be living with dementia. At the time of this inspection, 18 people were living at the home, mostly over the age of 90. The Brendoncare Foundation provides support from their head office to ten homes nationally.

At the last inspection, the service was rated Good.

At this inspection we found the service remained Good.

There was a registered manager in post. 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 registered manager had recently been on long term sick leave so an acting manager was in place and the provider had kept us up to date with management arrangements. The registered manager was due to return the next day and had kept in touch with staff and people living at Brendoncare Woodhayes.

People received person-centred care which was responsive to their specific needs and wishes. Each person had an up to date, personalised care plan, which set out how their care and support needs should be met by staff. Assessments were regularly undertaken to review people's needs and any changes in the support they required.

People had access to a wide range of group and individual activities and events they could choose to participate in, which were tailored to meet their specific social needs and interests. This enabled people to live an active and fulfilling life.

People who preferred or needed to stay in their bedroom were protected from social isolation. People regularly participated in outings and activities in the local community. The service also had strong links with local community groups and institutions.

When people were nearing the end of their life, they received compassionate and supportive care. People's end of life wishes were sensitively discussed and recorded.

Staff were aware of people's communication methods and provided them with any support they required to communicate in order to ensure their wishes were identified and they were enabled to make informed decisions and choices about the care and support they received.

The service had appropriate arrangements in place for dealing with people's complaints if they were unhappy with any aspect of the support provided at the home. People and their relatives said they were confident any concerns they might have about the home would be appropriately dealt with by the managers.

People were kept safe at the home, cared for by staff that were appropriately recruited and knew how to highlight any potential safeguarding concerns. Risks to people were clearly identified, and ongoing action taken to ensure that risks were managed well.

People's medicines were managed safely and the provider ensured that incidents and accidents were fully investigated. The home was well kept and hygienic. There was ongoing investment in the older style building.

Staff were well supported through training, supervision and appraisal. Staff worked effectively together to ensure people's needs were communicated and supported them to access healthcare professionals when they needed them.

People enjoyed the meals available to them and were appropriately supported with eating and drinking. 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.

The home was dementia friendly and met the needs of the people living there. Staff demonstrated they knew people well and people and their relatives were positive about the care provided.

People were treated with privacy and dignity and supported to be as independent as possible whilst any differences or cultural needs were respected.

The service had a robust management structure in place, and quality assurance systems were effective in driving improvements across the home. Regular feedback was sought from people and their relatives to ensure they were involved in the development of the service.

Further information is in the detailed findings below.

At the last inspection carried out in April 2015 we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Care plans did not reflect how care and treatment was designed with a view to achieving people’s preferences and ensuring their needs were met. There were not enough staff to ensure people’s needs could be met in a person centred way. Staff did not receive appropriate support, supervision and appraisal to enable them to carry out the duties they were employed to do. People were not involved about their care plans and relevant persons were not provided with the information they needed relating to care plans. Quality assurance systems were not robust to ensure they assessed, monitored and improved the quality and safety of the services provided. Records did not always ensure that people’s hydration and nutrition was monitored robustly. We rated the service as ‘Requires Improvement’.

Following the last inspection we received a satisfactory action plan from the provider. This addressed all the issues we raised. We carried out this inspection in May 2016 to check whether these actions were in place and people’s needs were being met. We found the service had worked hard to ensure all the above areas had been addressed and we rated the service ‘Good’ overall.

On the day of the inspection there was a calm and happy atmosphere throughout the home. People were going about their day as they wished and were enjoying and engaging with staff taking part in activities. People were well looked after and staff were knowledgeable about their needs and how to meet them. Staff were kind and interacted with people in a friendly and respectful way.

There had been an increase in staffing levels which had been adjusted to ensure people’s needs could be met using a dependency score tool. This ensured that staff had time to meet people’s care needs in a holistic way including their social needs.

A new senior care worker role had been developed and staff were valued and supported to carry out their roles. One senior care worker was the training lead with responsibility for ensuring staff understood their roles and was involved in care planning. Staff told us they were much happier and able to meet people’s needs effectively. Comments included, “It feels like we are well supported and work together as a team”, “We feel like one big family”, “I’ve been to other homes and come back here, it’s so much better” and “It’s so much better, we have lots more staff and we are really happy.” One registered nurse said, “We have better support and it’s a real improvement on last time.” People who were able to speak to us commented positively saying, “I like the activities. I am happy to live here” and “I like everything about the home. I like the care and kindness of the staff.”

A new activity programme had been developed involving staff at the home rather than solely the activities co-ordinator. Staff felt empowered to offer and arrange activities and events and felt able to spend time with people in a way that they wanted. The new deputy manager said, “Staff can spend time with people, for example we use everyday objects to create a moment. Staff can sit and have coffee with people and we keep records in people’s rooms so we don’t spend time away from people as much.” Staff ensured people who were at risk of isolation or needed support and stimulation had their needs met and issues were addressed and monitored in their care planning.

Staff had a good understanding of people’s legal rights, and understood the correct processes regarding the Deprivation of Liberty Safeguards and use of restrictive measures intended to keep people safe.

The provider had systems in place to make sure people were protected from abuse and avoidable harm. Staff had received training in how to recognise and report abuse. All were clear about how to report any concerns. Staff spoken with were confident that any allegations made would be fully investigated to ensure people were protected.

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. We saw many examples of people formally complimenting the care they received. One response said, “All the staff have responded sensitively and professionally to the changes in [person’s name’s] care needs. All the care staff are kind, caring and professional and contribute to the sense of well-being and calm.”

People and/or their advocates were now involved in planning and reviewing their care. They had been involved in the care plans to ensure they were person centred and reflected people’s needs and personalities. People had been involved in recording their past history and life stories and staff were using this information to instigate conversation and offer appropriate activities for individuals.

There were regular reviews of people’s health and staff responded promptly to changes in need. Nurses were knowledgeable about people’s needs and health professional advice was sought appropriately. People were assisted to attend appointments with appropriate health and social care professionals to ensure they received treatment and support for their specific needs. One health professional told us, “I have no concerns about placing people at Woodhayes. The staff know what they are doing and communicate well with us.”

Staff were well trained and training was up to date or booked, there were good opportunities for on-going training and for obtaining additional qualifications. Staff felt valued and were encouraged to develop professionally. For example, by being encouraged to develop their roles and undertake further qualifications and lead roles.

Staff now received formal one to one supervision sessions on a regular basis. Issues were monitored and discussed formally. Staff had all received an annual appraisal and felt able to discuss any issues at any time with management.

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

There was a management structure in the home which provided clear lines of responsibility and accountability. The new registered manager was previously the deputy and knew the service well. Staff and people told us they saw the manager all the time and they were always ‘out on the floor’ supporting staff. During our inspection the registered manager was supported by the Head of Care Services from Brendoncare head office. The registered manager said they had also had a lot of support from head office in relation to audits and visits which had improved greatly.

There were now effective quality assurance processes in place to monitor care and plan on-going improvements. Issues identified in audits and quality monitoring had been addressed in a timely way to ensure the service was continually improving. There were now 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. In the recent Your Care Rating 2015 resident’s survey results the service had achieved a high percentage of people expressing satisfaction with the care they received. An action plan then addressed any improvements need to be made.

We found that people's care was comprehensively assessed prior to admission and that information from external health professionals and families as appropriate was used to ensure that personalised care planning was in place. Staff were knowledgeable about people's needs and had easy access to clear information so that these needs could be met.

The home was well maintained with a rolling maintenance programme and any issues had been identified and quotes obtained, for example. There was an on-going programme of replacing all the windows in progress. Vacant rooms were being refurbished and the home had policies in place to ensure that the home was kept clean and hygienic.

There was a robust complaints and recruitment system overseen by the providers' head office staff. These ensured that people were able to voice any concerns and that they would be listened to and that people were protected from unsuitable staff through effective recruitment processes. Records were well kept and stored securely.