Oval House

Braunstone Firlands Nursing Home provides personal and nursing care for up to up to 24 older people, some of whom are living with dementia. At the time of the inspection there were 20 people in residence. The service was purpose built and has communal rooms and bedrooms on both the ground and first floor.

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

Family members told us their relatives were safe at the service, which they attributed to the kind and caring approach of all staff. They told us staff had a good understanding of their relative’s needs and spoke of staff’s patience and support in caring for those living with dementia. Family members told us they were kept informed as to the health and welfare of their relatives, and some were involved in the reviewing of their relative’s care plan.

People’s needs were risk assessed and kept under review. Any changes in people’s needs were responded to, which included seeking the advice of external health care professionals. Staff were aware of their responsibilities in reporting concerns to safeguard people. Medication was managed safely.

There were enough staff to meet people’s needs and checks were carried out as part of staff recruitment. Staff undertook training in topics related to the promotion of people’s safety, health and welfare. Staff were knowledgeable about their role in reporting concerns, both internally and externally.

Family members told us they had received information about the service’s approach and management of COVID-19 during the pandemic. Family members had maintained contact with their relatives, including visits in line with government guidance.

The service had a ‘visiting pod’ which provided independent access for family members to visit their relatives. All visitors to the service were required to follow government guidance for visiting people in care homes. Staff were seen to be wearing PPE (personal protective equipment), which included gloves, aprons and masks. Both people and staff were routinely tested for COVID-19, consistent with government guidance.

Family members spoke positively of the manager, and spoke of their supportive, friendly and helpful approach. They told us their views about the service had been sought, however not everyone could remember receiving feedback following the consultation process.

The manager had an open-door policy and staff told us the manager was supportive. Systems to support staff and seek their views included meetings, supervision and the completing of surveys.

A robust system of quality monitoring was in place, which included managerial oversight of the service. The findings of monitoring visits and audits were collated into a report, which included action plans, which were kept under review.

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 6 August 2018).

Why we inspected

We received concerns in relation to people’s nursing and personal care. As a result, we undertook a focused inspection to review the key questions of Safe and Well-led only.

We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the Safe and Well-led sections of this full report.

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.

We reviewed the information we held about the service. 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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Braunstone Firlands 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.

This inspection took place on two days 13 and 21 June 2018. The first day was unannounced, the second day was announced to ensure the registered manager was on duty.

Braunstone Firlands is registered to provide nursing and residential care and support for 24 older people with dementia and mental health needs. At the time of our inspection there were 20 people using the service.

Braunstone Firlands had 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.

People were cared for safely and protected from abuse by a well-informed team of staff. Medicines are administered safely and people are protected from acquired infections by an active and well-trained staff group.

People were provided with a choice of meals that met their dietary needs. Staff were aware of people’s dietary needs, and sought people’s opinions about the menu choices in order to meet their individual cultural preferences and dietary needs. A range of activities were provided by staff however this could be on a more regular basis. Staff had had access to information and a good understanding of people’s care needs. People were able to maintain contact with family and friends and visitors were welcome without undue restrictions.

Relatives we spoke with were complimentary about the registered manager and staff, and the care offered to their relations. People were involved in the review of their care plan, and when appropriate their relatives were included. We observed staff positively interacted with people at lunch, where people were offered choices and their decisions were respected. Staff had access to people’s care plans and received regular updates about people’s care needs. Care plans included changes to peoples care and treatment and people were offered and attended routine health checks, with health professionals both in the home and externally.

Staff were subject to a thorough recruitment procedure that ensured staff were qualified and suitable to work at the home. They received induction and on-going training for their specific job role, and were able to explain how they kept people safe from abuse. Staff were aware of whistleblowing and what external assistance there was to follow up and report suspected abuse.

Staff were aware of the reporting procedure for faults and repairs and had access to the maintenance contractors to manage any emergency repairs. The provider had a clear management structure within the home, which meant that the staff were aware who to contact out of hours if an equipment repair was necessary.

The provider carried out quality monitoring checks in the home supported by the registered manager and home’s staff. The provider had developed opportunities for people, their relatives and staff to express their views about the service. These included the views and suggestions from people using the service, their relatives and health and social care professionals.

We received positive feedback from the staff from the local authority with regard to the care and services offered to people at Braunstone Firlands.

Braunstone Firlands is registered to provide nursing and residential care and support for 24 older people with dementia and mental health needs. At the time of our inspection there were 22 people using the service.

Braunstone Firlands had 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.

Staff had a detailed knowledge of people’s care needs, though some documents within the care plan contained repeated terms and incorrect names.

We found there continued to be insufficient staff numbers to provide any level of meaningful activities for people to engage their time. The registered manager had identified appropriate activities and pastimes, and had purchased some games and reminiscence cards to enable staff to commence these activities. There was no documentary evidence to suggest a planned activity programme was in place to regularly meet people’s individual needs. There were enough staff to meet people’s basic personal care needs.

Staff were aware of the reporting procedure for faults and repairs and had access to the company maintenance personnel to manage any emergency repairs, however environmental audits were not detailed enough to reveal issues that we became aware of at the inspection.

Staff were employed in accordance with the provider’s recruitment procedures which ensured staff were suitable to work in the home. Staff received an appropriate induction and on-going training for their job role. Nursing staff were trained to administer medicines. Medicines were ordered, stored and administered safely.

Staff explained how they kept people safe from abuse, and knew what external assistance there was to report on suspected abuse. Staff were knowledgeable about their responsibilities and were trained to look after people and protect them from harm and abuse and were aware of whistleblowing. That ensured people were safe from abuse.

Staff had access to people’s care records and were knowledgeable about people’s needs that were important to them, which meant the care offered by staff met people’s assessed needs. Staff sought appropriate medical advice and support from health care professionals. Care plans included the changes to peoples care and treatment, and people were assisted to attend routine health checks.

Staff communicated with relevant professionals, to ensure people’s dietary intake protected them from the risk of losing weight. People’s care and support needs had been assessed and people were involved in the development of their plan of care. People were provided with a choice of meals that met their dietary and cultural needs. Staff were aware of people’s dietary needs.

People felt staff were kind and caring, and their privacy and dignity was respected in the delivery of care and their choice of lifestyle. Relatives we spoke with were also complimentary about the staff and the care offered to their relatives.

We observed staff speak with, and assist people in a kind, caring and compassionate way. We saw that people’s dignity and privacy was respected which promoted their wellbeing.

Where appropriate people were involved in the review of their care plan, and when appropriate were happy for their relatives to be involved. We observed staff offered people everyday choices and respected their decisions. People were able to maintain contact with family and friends as visitors were welcome without.

Staff told us they had access to information about people’s care and support needs and what was important to people. Care staff were supported and trained to ensure their knowledge, skills and practice in the delivery of care was kept up to date. Staff knew they could make comments or raise concerns with the management team about the way the service was run and knew it would be acted on.

The provider had developed opportunities for people to express their views about the service. These included the views and suggestions from people using the service, their relatives and health and social care professionals. People had access to the ‘manager surgeries’ and complaints process.

We received positive feedback from a visiting professional with regard to the care offered to people and professionalism of nursing staff.

The provider had a clear management structure within the home, which meant that the staff were aware who to contact out of hours. Nursing and care staff understood their roles and responsibilities and knew how to access support. Staff had access to people’s care plans and received regular updates about people’s care needs.

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at.

Is the service safe?

Relatives told us that they trusted staff and had no concerns about how people were treated. Staff received training which helped to ensure they understood their responsibilities in relation to safeguarding the vulnerable adults in their care. Staff were able to explain how they would recognise signs of abuse and they knew who to contact to report any suspicions of abuse. This helped to ensure that if the need arose action could be taken to safeguard people in a timely manner.

We saw that staffing numbers had not been planned in a way that took account of the needs and vulnerability of people who used the service. This meant that people did not always receive assistance in a timely and appropriate way.

We found that improvements were required to the way medicines were managed and administered. Staff administering medicines did not always have the protected time to ensure the risks related to this were sufficiently minimised.

We saw checks of the premises were carried out. However, these checks had not identified some key safety issues such as bedrooms without call bells and missing hammers to break glass at fire exits.

Is the service effective?

People who used the service told us that they received the care and support that they needed. We saw that people's needs had been assessed and care plans had been developed. However, these had not in all cases been kept up to date to reflect people's current care needs. This created a risk of inappropriate or unsafe care.

Records showed that one person had a pressure ulcer which had healed. This indicated good and effective care. However we saw this person was using a pressure mattress which had been set incorrectly. This increased the risk of pressure ulcers in the future.

Is the service caring?

We saw staff approach people in a caring manner and heard them speak to people in a respectful way. We saw that people's dignity was sometimes compromised by care practices such as shaving in the lounge when it was occupied by other people.

Is the service responsive?

Changes to people's care needs had not always been responded to, with some care plans not reflective of people's current care needs.

Is the service well-led?

We saw that the registered manager's ability to monitor and oversee the service was limited by the fact that when on shift, they were counted in the staffing numbers providing care. We found shortfalls across different aspects of the service, which showed a lack of robust monitoring and prompt action.

We looked at the care plans and records of four people who used the service. We found people's needs had been assessed and care plans had been developed which detailed the care and support people needed. Information within people's care plans provided clear guidance as to how staff were to support and care for people. Care plans were regularly reviewed. In some instances a Deprivation of Liberty Safeguard (DoLS) had been authorised by an independent Supervisory Body where it had been determined that a person did not have capacity to make an informed decision about their care. This showed that where people did not have the capacity to consent, the provider had acted in accordance with legal requirements.

We found people's nutritional needs were assessed through the services assessment process. Where the need for specialist diets had been determined these were provided. We asked people for their views about the meals provided. People were happy with the breakfast and teatime meals which were cooked and prepared by staff at Braunstone Firlands Nursing Home, however a majority of people spoke with raised concerns about the quality of meals provided at lunchtime, which were prepared by the providers 'central kitchen' off site and delivered in heated trolleys. We found the dining experience of people could be improved. People who used the service and staff were not aware as to what was on the menu for the lunchtime meal, and the menu for the day was not displayed in either of the dining rooms. We spent time with people on the first floor at lunchtime and we noted people's rights were not promoted in that people were not asked what they wanted to eat. We noted people who required assistance were given one to one support.

We toured the premises and found that the service was well-maintained and people's bedrooms had been personalised by them. Records were in place which showed that regularly maintenance checks were carried out.

The provider had a procedure for people to raise concerns or make a complaint. We noted a recent complaint had been recorded and the action taken, including the response to the complainant. We spoke with a visitor who told us they had raised a concern and this had been managed to their satisfaction.