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Brandon House Requires improvement

Reports


Inspection carried out on 20 July 2020

During an inspection looking at part of the service

About the service

Brandon House provides nursing and personal care for a maximum of 42 older people, some of whom are living with dementia. At the time of our inspection there were 15 people living at the service. The home provides single room accommodation with most rooms having en-suite facilities.

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

Improvements had been made following the previous inspection in July 2019. People and their relatives told us they or their family members felt safe and well supported at the service. People were protected from abuse and avoidable harm and were treated with respect and dignity.

Overall, the provider maintained safe staffing levels to meet people’s needs. We have made a recommendation that the provider continues to monitor sufficiency of staffing. Risks to people’s health and safety were managed well, although some improvements on the completion of records to monitor people’s fluid intake were needed. Improvements had been made to medicines management with clear records showing people received their medicines and topical creams as prescribed.

The registered manager and staff promoted and encouraged person centred care to ensure people were treated as individuals. They knew how people preferred to receive their care and support. This included activities, which had been tailored to try and meet people’s needs in the current circumstances of the Covid-19 pandemic.

There was positive leadership in the service. People, their relatives and staff spoke highly of the registered manager. They were described as approachable. Improvements had been made to governance systems. Audits and monitoring procedures were used effectively to monitor the service and to make improvements. When accidents or incidents occurred, learning was identified to reduce the risk of them happening again.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 27 August 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 27 August 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out a comprehensive inspection of this service on 15 and 18 July 2019. Breaches of legal requirements were found.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions safe and well-led which refer to those requirements.

The ratings from the previous comprehensive inspection for those key questions, not looked at on this occasion, were used in calculating the overall rating at this inspection. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Brandon House on our website at www.cqc.org.uk.

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.

Inspection carried out on 15 July 2019

During a routine inspection

About the service

Brandon House is a nursing home situated in the Meanwood area of Leeds and provides accommodation for up to 42 older people. The home provides single room accommodation with most rooms having en-suite facilities. The building provides wheelchair access throughout, with private grounds and parking facilities.

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

People did not always receive a service that provided them with safe, effective and high-quality care. Risk management was not always effective. Some infection control practices were ineffective and potentially placed people at risk of harm. The management of people’s medicines was not fully safe. Areas of the home looked tired and did not fully provide a dementia friendly environment.

Care plans were not always consistent, and some agency staff were not fully aware of people’s needs. Governance arrangements were not robust. Audits undertaken had not always identified where improvements were needed so appropriate action could be taken. For example, in relation to the environmental and hygiene standards. People’s records were not kept securely.

Staffing numbers were insufficient to ensure people received safe and timely support. Even though staff were caring in their approach, staff were task focused in their interactions with people. People’s dignity was not always respected. Activities were limited and did not meet the needs of people who used the service. People’s nutritional, hydrational and healthcare needs were not always met.

Staff understood how to identify and report any safeguarding concerns. Recruitment procedures were followed. Staff had received an induction, had completed mandatory training and supervision was conducted. However, appraisals had not been completed prior to these being started in June 2019.

People said they were happy with the service provided. People and relatives had the opportunity to provide feedback on the service received and there was a system to respond to complaints.

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. People’s end of life care needs were met.

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 19 March 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement: We identified five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 namely safe care and treatment, dignity, person-centre care, staffing and good governance. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider

Inspection carried out on 6 December 2016

During a routine inspection

This inspection took place on 6 December 2016 and was unannounced. At the last inspection we rated the service as requires improvement. The provider was not in breach of regulation, however, we identified there were areas to improve. We also said they required a longer term track record of consistent good practice before we rated the service as good. At this inspection we found they had made improvements and have demonstrated a longer track record of good practice.

Brandon House is a nursing home and provides accommodation for up to 42 older people. 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 who used the service and their relatives told us the service was safe. Staff had received training to help them understand how to keep people safe. The home looked well maintained, clean and tidy, and checks were carried out to make sure the premises and equipment was safe.

There were sufficient staff with the right skills and experience; several staff told us the staffing arrangements had improved. Appropriate checks were carried out before staff were employed. Medicines were managed safely.

People who used the service and their relatives told us they were happy with the staff who provided care and support. Staff we spoke with said they felt well supported and received training that made sure they knew how to do their job well. They said they understood their role and responsibilities. The registered manager was going to review the induction arrangements to ensure they met recognised guidance. Staff we spoke with understood their responsibilities around how they should support people with decision making. People had good meal experiences, enjoyed the food, and had plenty to eat and drink. Systems were in place that ensured people accessed healthcare services.

People told us they were well cared for and visiting relatives told us the service was caring. We observed care workers supported people in a calm, compassionate and caring way. Staff were cheerful and friendly. When they walked by people they would say “hello” and checked they were ok. When staff assisted people to move and transfer they explained what was happening and reassured them throughout. Staff knew people well, for example, what people liked to do and their family members. We saw one situation where staff were not responsive to a request for support.

People had access to information which kept them informed.

Staff responded to people’s individual needs and delivered personalised care. People’s care plans and other records showed their needs had been assessed and care was usually planned, although there was inconsistency with the level of detail and we saw examples where care plans had not been followed. Action was being taken to improve activities.

The service had developed a 1950's village around the back of the nursing home which people could access. People told us they would talk to staff and management if they had any concerns and complaints had been responded to in a way which resolved the issue where possible to the person’s satisfaction. Several written compliments had been received.

We received positive feedback from people about the registered manager. Several relatives described them as “welcoming” and several staff described them as “supportive”. Resident and relative meetings and staff meetings were held. We saw from meeting minutes that people had opportunity to discuss the service and were informed of planned events. Where people had made suggestions for improvement the provider had responded. At the inspection we reviewed a wide range of audits which had been completed at the service, which were then used to

Inspection carried out on 4 August 2015

During a routine inspection

This inspection took place on 4 August 2015 and was unannounced. This is the third inspection Care Quality Commission (CQC) has carried out since July 2014. In July 2014 the provider was found not to be appropriately respecting and involving people who used the service, ensuring people consented to their care, managing medicines, supporting workers, assessing, planning and delivering safe care, and assessing and monitoring the quality of service provision. We told them they needed to take action to make sure they were not breaching regulations.

In November 2014 we inspected the service again and found they had not made all the required improvements so we took enforcement action. They had improved systems to make sure they met people’s nutritional needs, safeguarded people from abuse and respected and involved people in their care. But they were still not assessing, planning and delivering safe care, supporting staff, ensuring people consented to care, and assessing and monitoring the quality of service provision We served four warning notices. We also set three compliance actions because we found some areas of the home were not clean, there was not enough staff and they were not carrying out robust checks when they recruited workers. In February 2015, we met with the provider and discussed our concerns. They told us they were keen to improve their service and would make the required changes. They sent us a plan of action and told us how they were going to do this. At the inspection in August 2015 we found the provider had taken the necessary action, completed their plan and all legal requirements were met.

Brandon House provides nursing care for up to 42 older people, some of whom maybe living with dementia. At the time of the inspection, the home did not have a registered manager. A registered manager is a person who has registered with the 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. The home’s manager had submitted an application to CQC to be registered and this was being processed.

We found people were happy living at the home and felt well cared for. People enjoyed a range of social activities and had good experiences at mealtimes. They were supported to make decisions and received consistent, person centred care and support. People received good support that ensured their health care needs were met.

People told us they felt safe. Staff had a good understanding of safeguarding vulnerable adults and knew what to do to keep people safe. People lived in a safe, clean and homely environment. Medicines were managed consistently and safely.

There were enough staff to keep people safe. Robust recruitment and selection procedures were in place to make sure suitable staff worked with people who used the service. Staff were skilled and experienced to meet people’s needs because they received appropriate training, supervision and appraisal.

The service had good management and leadership. People got opportunity to comment on the quality of service and influence service delivery. The manager and staff operated effective systems that ensured people received safe quality care; however, the provider was not carrying out their own checks to make sure the improved standards were being maintained. People told us they would feel comfortable raising concerns or complaints.

Inspection carried out on 18 & 24 November 2014

During a routine inspection

The inspection was unannounced and took place over two days on 18 and 24 November 2014.

At the last inspection in July 2014 we found the provider was breaching eight regulations. The breaches related to respecting and involving people who use services; consenting to care and treatment; care and welfare of people who used services; meeting nutritional needs; safeguarding people who used services from abuse; management of medicines; supporting workers and assessing and monitoring the quality of service provision. At this inspection we found the provider had made improvements in some areas but they were still in breach of four of the eight regulations. We also found other areas of concern.

Brandon House provides nursing care for up to 42 older people, some of whom maybe living with dementia. The home 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 and associated Regulations about how the service is run.

Although people told us they felt safe we found this service was not providing consistently safe care. Staffing levels were not adequate to keep people safe. People told us there were not enough staff. People were not adequately supervised and had to wait for support and assistance. The provider did not have effective recruitment and selection procedures in place. Appropriate cleanliness and hygiene standards in the home were not maintained which put people at risk of acquiring infection. People were given their medicines in a safe way. Medicines were kept safely and adequate supplies were maintained to allow continuity of treatment.

Staff were not provided with sufficient supervision and training to ensure they were able to meet people’s needs effectively. Management and staff did not fully understand the requirements or principles of the Mental Capacity Act (2005)(MCA) and Deprivation of Liberty Safeguards (DoLS). Providers are required to submit applications to a ‘Supervisory Body’ for authorisation to restrict people’s liberty but it was clear from the paperwork we reviewed the correct process was not followed so people were not safeguarded. People were offered varied snacks and drinks during the day and enjoyed the food. However, meal experiences were not enjoyable for everyone. Some people had to wait for their meal whereas others received theirs promptly. Staff did not always explain to people what they were having to eat. A range of healthcare professionals were involved in people’s care.

Some people we spoke with were very happy with their care whereas others thought it could improve. We also got a mixed response when we spoke with visitors about the care that was provided. During the inspection we observed good care being provided. Staff were caring and compassionate in their approach.

Aspects of people’s care was not assessed, planned and delivered appropriately. There was not enough information to guide staff on people’s care, treatment and support. The morning routine in one unit was not personalised. A visiting healthcare professional told us the same issues about people’s care and treatment constantly had to be reinforced. People could join in group activities. On the day of the inspection we saw a group enjoying a painting session. People told us they knew who to speak with if they had any concerns.

The provider’s systems to monitor and assess the quality of service provision were not effective. Actions that had been identified to improve the service were not implemented. The provider asked people to comment on the quality of care through surveys but results were not analysed or acted upon. Staff provided positive feedback about the management team. They said the registered manager and general manager were approachable and addressed issues straightaway.

We found multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

Inspection carried out on 14 July 2014

During a routine inspection

We carried out this inspection to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, speaking with visitors, speaking with the staff who supported them and from looking at records.

Is the service safe?

The home did not have policies in place in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The policies the home did have in place had not been dated nor did they have a review date. The service had not taken steps to ensure practice was updated through the review of policies. The home was not compliant with DoLS.

The safeguarding policy was followed correctly by staff and all staff received training in this area.

People received an assessment which helped to ensure that the home was able to meet their needs. We saw care records and risk assessments were in place. The care records we looked at were generic and were not person-centred. We saw examples of incorrect information in the care records we looked at. This meant people were at risk of receiving inappropriate care and support.

There was no evidence to show that incidents had been analysed and lessons learnt from any accidents or incidents. This meant the service was not able to identify risks to people and to develop plans to reduce the risks.

In one of the bathrooms we looked at we saw the toilet seat was soiled. In another bathroom, the door wouldn�t close securely and the toilet seat was broken. The interior of the service was in the process of being refurbished and there was a lot of dust in one of the rooms on the dementia unit. Some of the carpeted floors looked dirty and the hardwood floors felt sticky underfoot. The paint on some of the doors and skirting boards had chipped. There was a risk that the chipped areas could harbour germs that could put people�s health at risk.

Is the service effective?

There was no evidence to show people's health and care needs were assessed with them. In the care records we looked at we could find no evidence to show people had been involved in decisions relating to their care. This mean that there was a risk staff were not able to deliver care in a way that supported people because the service had not taken steps to ensure people had been involved in their care planning.

Although visitors we spoke with told us they felt staff cared for their relatives and friends very well, in the training matrix we looked at we saw less than 50% of staff had attended training on key areas such as moving and handling, fire safety, health and safety and Mental Capacity Act 2005. Staff had not been enabled to take part in learning and development that was relevant and appropriate to their role.

Is the service caring?

We found people were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. We observed people looking well dressed.

Staff had a good relationship with people who used the service and it was clear care staff were committed to their role.

During the inspection we observed the call bells were not answered promptly. In some of the rooms we visited we saw that call bells had been placed out of people�s reach. We spoke to one person about this, they told us their bell was always slipping off their bed.

Is the service responsive?

The service carried out annual reviews of the service which included people who used the service and their relatives/friends. The service did not routinely include external agencies in their review. The service did not have a plan of how they would involve people who had difficulty communicating. This meant people were not included in the review of the service and were not given the opportunity to express their views.

The service had held a residents and relatives meeting in the past but we could not see that a meeting had been held recently. The visitors and relatives we spoke with told us they felt the manager listened to their concerns and acted on them.

The service employed an activities coordinator and they told us about the range of activities on offer. On the day of inspection, we saw that none of the people on the dementia unit had been included in the activity planned for that day.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way. The care staff confirmed the manager was very supportive. Staff meetings were held so that people could air their views. Staff felt they had been listened to by the manager.

We could see no evidence care staff were offered formal supervision and there was no record of them having had an annual appraisal. The manager told us they did not feel supported by their line manager. They had not received supervision and had not received an annual appraisal.

Inspection carried out on 9 September 2013

During a routine inspection

We spoke with five people who used the service and five members of staff. We reviewed six care plans. The people we spoke with were happy living at Brandon House. One person told us, "I like it here; the staff are very nice to me. I like my room it�s very cosy and I can bring anything into it." Another person said, "The staff are lovely, they get me anything I want and help me choose my meals every day." We saw there were daily activities and people were able to go out.

We saw the communal areas and the bedrooms were clean and free of any malodours. A person who used the service said, "It's always clean, someone is always cleaning." There were effective systems in place to reduce the risk and spread of infection.

During the visit we observed staff supporting people and saw that staff responded promptly to any requests for assistance. Staff told us the staffing levels were sufficient to meet people's needs.

A staff member said, "We try and make Brandon House a friendly place to live in, after all it is their home."

Inspection carried out on 21 December 2012

During a routine inspection

During our visit, we had the opportunity to talk with three people who used the service and to two visitors. People told us they were happy with the care and support they

received.

People said, �I�m very well looked after here. If I need help during the night, they (staff) come and help me straight away�. �The staff are marvellous, each and every one of them�.

One relative told us that they, ��Always turned up at any time and we don�t have to stick to visiting hours�. They told us that they were totally confident that staff cared for their relative well. They stated they found the care their relative received was, ��Consistent� and that, �Their nails are always clean and their hair is always brushed�. They said they thought that all the staff were, �Honest and accommodating� with them.

People told us that there were always plenty of staff on duty and they felt able to approach staff when they wanted to. Both relatives we spoke with told us that they felt that staff listened to them. They told us that they felt involved in decisions regarding their relatives care.

One person told us that,� They (staff) always treat me with great respect�.

A relative told us that their relative �Had improved a lot since being here, they have started to feed themselves and they don�t need their food liquidising anymore�.

Inspection carried out on 28 February 2012

During an inspection in response to concerns

During the visit, we had the opportunity to talk to people living in the home and to some visitors. Overall, people told us they were satisfied with the care and support they received. Some people were complimentary about the staff and described them as �wonderful�, �pleasant� and �sociable�. However, others told us that some staff could be a little impatient at times and said the staff did not always attend to their needs in a timely way. Generally, people had mixed views regarding their involvement with the service. Some told us that they are well informed and felt involved. Others told us that they did not always feel involved, as they had to ask for information.

Inspection carried out on 16 June 2011

During an inspection looking at part of the service

People who live at the service were satisfied with their care, these are some of the comments they made to us �

�nice carers�

�the carers look after her well�

�it�s good here�

We spoke with relatives who visit the service regularly. Although they were, overall, happy with the care provided they had some frustrations with attention to detail in the care of some of the people living at the service. For example, inconsistent use of denture fixative meaning that people can struggle with their false teeth to eat and talk properly; people not always having a daily shave; wrist splints not being fitted properly.

People who use the service had mixed views about the food, these are some of the comments people made to us �

�food is good and I like it�

�they get you something else if you don�t like what it is�

�sometimes it is cold�

�don�t like the way it is cooked�

On the day of our visit the meal included �herby dumplings� and several people said that they did not like, what they considered, to be highly flavoured foods.

People told us that there was a new chef, this is a weekend chef, and that they had enjoyed the food he cooked.

We saw the lunchtime meal and the food looked well cooked and appetising and most people seemed to be enjoying it. People were able to eat at their own pace and had their pudding served as they finished their main meal.

Staff supported and assisted people as needed, on a one to one basis and were patient. Squash and tea was served over the meal time.

We saw people being offered the chance to wipe their face and hands after the meal.

Inspection carried out on 8, 28 February 2011

During a routine inspection

We observed staff interaction with people and saw people treated with respect. Staff crouched down to talk to people and spoke quietly with them.

People seemed confident in the way they related to the staff.

Not many people were able to tell us directly about their experience but those who were said that they had been asked about their care and staff, overall, looked after them in the way they wanted.

People using the service and one relative told us that they had been involved in what was called a review of their care plans.

People told us that they thought things had improved at the service and these are

some of their comments:

�better for the change�

�more chance of getting attention�

�very happy�

(staff) �very kind�

People told us about care reviews and their involvement in them.

People told us that they felt things were improving at the home.

People told us that they were involved in their care although sometimes staff �would not be told� when people wanted things done in a particular way.

Relatives of people living at the service told us that they had been asked about the care of their relatives and asked to sign a form saying so. This was the first time they had been asked about care plans and the first time they had been made aware of named nurses and key workers.

We saw evidence of one relative�s involvement in the plan of care, where it was documented that �currently no concerns about mum�s care�

Comments about mealtimes:

�if you don�t like something they will find you something else�

People told us that they are kept informed of changes. We found evidence that people had been informed of the transfer to hospital of their relative.

Another person told us about the involvement in their care of a specialist nurse from one of the local hospitals.

People told us that they felt safe at the service and able to speak to the manager and staff if they had any concerns.

People unable to express views about their care looked confident and comfortable in their surroundings.

We could see evidence of re-decoration and refurbishment at the service. There were no odours and all the areas we visited were clean.

We spoke with five people who lived in the home about their medicines and observed some medicines being given. One person said that the nurses looked after them really well and always made sure they took their medicines properly. Another person said care workers were kind and always made sure their creams were applied every day and this was done in a caring and sensitive way.

One person said staff always gave them their medicines on time and they always asked them if they had any pain. We observed a nurse asking several people if they were in pain and saw painkillers being given properly when people said they had any pain.

We observed parts of two medicines rounds and both were carried out in an unhurried and organised way. Medicines that needed to be given before food were usually given correctly apart from one recent course of antibiotics that was given wrongly after food so there was a risk that it would not work properly.

The manager showed us a recent report from the Primary Care Trust that said the home had made some good improvements in the way it handled medicines but some concerns remained that these improved standards might not be sustained.

People told us that there were new staff and the manager was always about instructing and guiding them in their roles.

People told us that the staff were kind and looked after them properly. They told us that the acting manager was �always around� telling staff how to do their jobs properly.

We spoke to a new senior member of the nursing staff who told us about the support provide to staff. She told us that the service was working to an action plan produced following the safeguarding issues which arose last year and that when she and the manager started working at the home in August/September last year �everything needed sorting�.

They told us that the care workers had not had clear guidance and therefore there was some poor practice. However, with improved communication and clear leadership they felt that things had improved.

People told us that they felt able to speak up if necessary to the staff or the manager if they had any concerns.

People told us that they felt the acting manager was trying very hard to improve the service.

Reports under our old system of regulation (including those from before CQC was created)