Brantley Manor Care Home

Brantley Manor is a residential care home providing accommodation for persons who require nursing or personal care to up to up to 33 people. The service provides support to older people and people living with dementia. At the time of our inspection there were 26 people using the service. Brantley Manor provides accommodation in a single house across two floors.

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

The provider had quality assurance processes in place. However, there were shortfalls in medicines management, meaning systems and processes were not robust enough to identify issues in timely way.

We have made a recommendation about leadership and management oversight and accessible ways to feedback on quality and care delivery.

There was not always enough staff to meet the needs of people during the night. Staff had sufficient training to meet people’s needs. Safe recruitment systems were in place to ensure staff were suitable to work with people.

Infection control measures were in place and a housekeeping team completed daily cleaning tasks. However, due to poor environmental safety some areas of the home required repairs and refurbishment. This meant whilst cleaning was completed, the effectiveness of cleaning could not be maintained.

Care plans detailed how to support the person to ensure their assessed needs could be met. We found some care plans required further work to ensure they contained person centred information in regards of people’s medical conditions.

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.

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 20 April 2020)

Why we inspected

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 received concerns in relation to leadership and management of the service and staffing. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement and Recommendations

We have identified a breach in relation to medicines management and risks associated with environmental safety at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

The service had a system and process in place for checking the vaccination status of visiting professionals. Due to observing legislation around visiting professionals the service had on two occasions turned professionals away who were not able to evidence their vaccinations status.

The service had managed to ensure safe staffing levels despite staff isolating, as other staff had been able to cover shifts.

All staff had completed infection prevention and control (IPC) training including use of personal protective equipment (PPE) donning and doffing and hand washing. Regular refresher training sessions were facilitated by the registered manager who also completed regular competency checks.

The service had up to date policies and procedures in relation to COVID-19.

Brantley Manor is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. It provides accommodation for a maximum of 33 older people in a single house. At the time of our inspection there were 28 people living at the service.

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

Improvement was needed to the recording of the administration of people's medicines. The home was clean, and staff understood how to prevent and manage infections. There was a process in place to carry out quality checks. These were carried out on a regular basis.

There was enough staff to support people. Appropriate employment checks had been carried out to ensure staff were suitable to work with vulnerable people. Arrangements were in place to safeguard people against harm and staff were aware of these. People said they felt safe.

People enjoyed the meals and their dietary needs were catered for. This information was detailed in people’s care plans. Staff followed guidance provided to manage people's nutrition and pressure care. People were supported by staff who had received training to ensure their needs could be met. Staff received regular supervision to support their role.

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 had good health care support from external professionals. When people were unwell, staff had raised the concern and acted with health professionals to address their health care needs. People had access to a wide range of activities and leisure pursuits and were involved in planning these.

We saw evidence of caring relationships between staff and people who lived at the home. Staff were aware of people's life history and preferences and used this information to develop relationships. People felt well cared for by staff. Care records were personalised and were regularly reviewed. People had been involved in the development and review of their care plan.

The provider had displayed the latest CQC rating at the home and on their website. When required notifications had been completed to inform us of events and incidents, however the provider had failed to notify CQC of DoLS authorisations. These have now been submitted.

More information is in the detailed findings below.

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

Rating at last inspection

The last rating for this service was Good (published 2 September 2017). At this inspection the service remained Good.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Brantley Manor Care Home is situated on the outskirts of Lincoln. It is registered to provide accommodation and care for up to 33 older people, ranging from frail elderly to people living with dementia. On the day of our visit, there were 27 people using this service.

At the last inspection, the service was rated Requires Improvement. At this inspection we found the service was rated as Good.

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 and associated Regulations about how the service is run.

During our previous inspection we found that the provider had not followed their policy to ensure that where people required their medicines to be given in their meals (covert medicines) this was done safely. In addition, medication information sheets did not include information about people's allergies to medicines.

At this inspection we found that improvements had been made. Medication records had been completed to include people’s allergies. We also saw that where people required their medicines to be given covertly, best interest discussions had taken place with people’s GP and written plans were in place to support people to take their medicines.

We also found at the previous inspection that some people were sharing bedrooms where inadequate screening was in place. There were six shared bedrooms and people’s privacy had not always been adequately protected.

At this inspection we found that the provider had made improvements. At the time of this inspection only three of the six double rooms were occupied by two people, with the remaining rooms being used for single occupancy or were vacant. There were screens available in the rooms occupied by two people to ensure their privacy was maintained during personal care. In addition the registered manager showed us proposed plans to convert the six double rooms into single rooms with en-suite wet rooms. The registered manager told us they hoped this work would commence in the new year.

People felt safe. Staff had been provided with training to enable them to recognise signs and symptoms of abuse and they knew how to report any concerns. People had risk assessments in place to enable them to maintain their independence and keep them safe. Adequate staff with the appropriate skill mix were available to support people with their needs. Effective recruitment procedures were in place to ensure suitable staff were employed to work with people using the service.

Systems were in place to ensure that medicines were managed safely. This ensured that people received their medicines at the prescribed times.

Staff received appropriate training, supervision and support to enable them to carry out their roles and responsibilities effectively. People’s consent to care and treatment was sought in line with the principles of the Mental Capacity Act (MCA) 2005 legislation.

People were able to make choices about the food and drink they had and to maintain a healthy and balanced diet. If required, staff supported people to access a variety of health professionals including the dentist, optician, chiropodist, dietician and the speech and language therapist.

Staff provided care and support in a meaningful manner; and knew about people’s preferences and personal histories. People’s views were listened to and they were actively encouraged to be involved in their care and support whenever possible. Any information about people was respected and treated confidentially.

People’s needs were assessed before they commenced living at the service and the care plans reflected how their needs were to be met. Records showed that people and their relatives were involved in the assessment process and review of their care. There was a complaints procedure in place to enable people to raise complaints.

There was a culture of openness, transparency and inclusion at the service amongst staff and people using the service. A variety of quality audits were carried out, which were used to drive continuous improvement which was used to good effect in supporting people and staff to express their views about the delivery of care.

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.

On the day of our inspection staff interacted well with people and people were cared for safely. People and their relatives told us that they felt safe and well cared for. Staff knew how to keep people safe. The provider had systems and processes in place to keep people safe. Medicines were usually administered safely but the provider did not follow their policy for covert medicines, (these are medicines which are given in meals without people's knowledge). Medication administration sheets(MARS) were completed fully however information sheets did not include people’s allergies.

The provider acted in accordance with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. If the location is a care home the Care Quality Commission is required by law to monitor the operation of the DoLS, and to report on what we find.

We found that people’s health care needs were assessed and care planned and delivered to meet those needs. People had access to healthcare professionals such as the district nurse and GP and also specialist professionals. People had their nutritional needs assessed and were supported to eat enough to keep them healthy. People had access to drinks and snacks during the day and had choices at mealtimes. Where people had special dietary requirements we saw that these were provided for.

There were sufficient staff to meet people’s needs and staff responded in a timely and appropriate manner to people. Staff were kind and sensitive to people when they were providing support and people had their privacy and dignity considered. Staff had a good understanding of people’s needs and were provided with training on a variety of subjects to ensure that they had the skills to meet people’s needs. The provider had a training plan in place and staff had received regular supervision.

We saw that staff obtained people’s consent before providing care to them. People were provided with access to activities and leisure pursuits.

Staff felt able to raise concerns and issues with management. Relatives were aware of the process for raising concerns and were confident that they would be listened to.

Regular audits were carried out and action plans put in place to address any issues which were identified. Audits were in place for areas such as falls and infection control. Accidents and incidents were recorded. The provider had informed us of incidents as required by law. Notifications are events which have happened in the service that the provider is required to tell us about.

We considered the findings of our inspection to answer questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? This is a summary of what we found-

Is the service caring?

We observed care and saw how members of staff treated people. We saw care was delivered well and in a respectful way. We saw that staff were kind and attentive and encouraged people to be independent. We saw that staff showed patience and

gave encouragement when they supported people.

During our inspection we observed staff spoke with people on an individual basis and understood their particular needs. For example, we observed when staff provided care to people they chatted with them about things which were important to them such as their family.

We observed when staff supported people they did so at people's own pace and encouraged people to participate in their care. For example, when they supported people at meal times staff sat with people and asked them if they were ok. We saw when people were struggling to complete tasks staff were supportive and reassured people.

Is the service responsive?

We saw that people's individual physical, mental and social care and support needs were assessed and met. We saw evidence that care plans had been discussed with people. This also included people's individual choices and preferences as to how they liked to spend their day. For example, care plans detailed what time people liked to go to bed and what support they wanted during the night.

During our inspection we saw staff gave people choices and asked them what they would like to do before assisting them. For example, when offering drinks people were given choices about what drink they would like and if they would like a snack with their drink.

We observed staff obtained people's consent before they carried out any care. For example, staff asked people if they wanted support with a task.

Is the service safe?

Risk assessments regarding people's individual care needs, for example falls and mobility were carried out and measures were in place to minimise these risks. The service had risk assessments in place for areas such as the use of bed rails and refusal of care.

The home had policies and procedures in relation to the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS) in place. Mental Capacity Act (2005) and Deprivation of Liberty Safeguards are laws protecting people who are unable to make decisions for themselves.

When we spoke with the registered manager they gave us an example of when they considered making a DoLS application on behalf of a person to ensure the care they received was appropriate.

The service was safe, clean and hygienic. We saw that regular checks were made on the cleanliness of the building. Equipment was well maintained and serviced regularly therefore not putting people at unnecessary risk. We observed regular maintenance was carried out, for example on electrical and fire equipment.

Is the service effective?

Our observations found that members of staff knew people's individual health and wellbeing needs. We saw that people responded well to the support they received from staff members. Staff told us about situations when they required more support for people and they were able to obtain this, for example, a piece of equipment.

We observed care plans had been updated to reflect people's changing needs and where people had short term needs due to illness care plans were in place to ensure these were met.

We observed staff responded to people's needs and requests in a timely manner.

Is the service well led?

Staff said that they felt supported and trained to safely do their job. They told us they felt able to raise issues with the managers.

Quality assurance arrangements and checks were in place and people were listened to. We saw evidence learning took place following incidents and audits to ensure the continual improvement of the service were undertaken.

Records were accurate and reflected the care people required.

Overall we observed that people were supported by skilled and experienced staff who understood their roles and responsibilities.

We observed care and saw staff were responsive to people and interacted with them positively.

We saw from the care plans and observations people received care which was appropriate to their needs.

People told us, 'Very happy here' and 'Food's good.'

When we looked at the records we found they detailed the care people required and care was delivered to meet people's needs. We found gaps in the turn records we looked at and some inconsistencies in record keeping.

We knew the provider notified us of serious incidents appropriately.

We saw the provider had an up to date statement of purpose which detailed the service available to people.