Archived: Braeside Residential Care Home

A manager was in place who had not yet applied to be registered with the Care Quality Commission. 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 manager had very recently been appointed and staff felt they were open and approachable. The manager had many ideas they were introducing to ensure people received individual care that met all of their needs.

Due to their health conditions and complex needs not all of the people who used the service were able to share their views about the support they received. People appeared relaxed and comfortable with staff who supported them. We had concerns however that there were not enough staff on duty at all times to promote choice and provide individual care to people.

Not all areas of the home were clean and well maintained for the comfort of people who used the service. Communal areas, the kitchen and bathroom were showing signs of wear and tear.

People were protected as staff had received training about safeguarding and knew how to respond to any allegation of abuse. Staff were provided with other training to give them some knowledge and insight in order to meet people’s care and support needs. A system was in place for staff to receive supervision and appraisal and there were robust recruitment processes being used when staff were employed. Accidents and incidents were regularly reviewed and action taken as required to keep people safe.

People had access to some health care professionals to make sure they received appropriate care and treatment. People at risk of poor nutrition or with mobility needs did not have current advice and guidance from appropriate professionals to ensure their needs were met. Other people received a varied diet. People received their medicines in a safe and timely way.

Braeside Residential Care Home was meeting the requirements of the Mental Capacity Act 2005.

People did not receive person centred care that enabled them to live a fulfilled life in the community with opportunities to learn new skills to maximise their potential and independence. There were some limited activities and outings.

Staff were kind, caring and compassionate with people they supported. Staff had developed good relationships with people and treated people with respect. Regular staff knew most people’s care and support needs but accurate information was not available for new staff. Care records and risk assessments were not all up to date and did not accurately reflect people’s needs. They lacked detailed guidance for staff and evidence of regular evaluation and review to keep people safe and to ensure all staff were aware of their current individual care and support needs.

People and their relatives had the opportunity to give their views about the service. A complaints procedure was available.

The home had a quality assurance programme to check the quality of care provided. The new provider and manager had identified and prioritised several actions that needed to take place in the home to ensure people received safe and individual care and to ensure its smooth running. However, the systems used to assess the quality of the service had not identified all the issues that we found during the inspection to ensure people received individual care that met their needs.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to safe care and treatment, staffing, person centred care and good governance.

You can see the action we told the provider to take at the back of the full version of the report.

We considered all the evidence we had gathered under the regulations we inspected. We used the information to answer the five 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 saw that people were supported by caring staff who displayed patience and gave encouragement when supporting them, for example when assisting them with mobility or personal care. Our observations confirmed that staff promoted independence whilst ensuring that they offered assistance to people when required. One person's relative told us, "There are no negative aspects there, 'X' seems very good and is very happy there."

People's diverse needs had been recorded in their care records and staff were fully aware of people's care and support needs.

Staff and people's relative's told us, and our own observations confirmed that people pursued activities outside of the home. This showed the provider promoted people's well-being.

Healthcare professionals with whom we spoke told us they had no cause for concern about the care delivered by the provider and they had not been made aware of any negative feedback from third parties.

Is the service responsive?

The provider had arrangements in place to review people's care records regularly, to ensure they remained accurate and any issues were promptly addressed.

Staff told us, and records showed that where people required input into their care from external healthcare professionals, such as occupational therapists or doctors, or where, for example, their behaviours needed to be monitored, they received this care.

We saw that there was a complaints policy and procedure in place and complaints records showed that the provider had generally addressed concerns raised by healthcare professionals, staff or people's relatives promptly.

Is the service safe?

We found that people were treated with respect and dignity by staff. The care that we observed during our inspection was delivered safely and people's relatives did not express any concerns for the safety of their relations. We saw that appropriate and safe moving and handling techniques were used and any risks associated with people's daily lives had been assessed. Instructions were in place for staff to follow to ensure people remained as safe as possible in light of these identified risks.

We reviewed the arrangements in place for the management of infection and potential infection and we found that these were not in line with current up to date best practice guidelines. We have set a compliance action and asked the provider to tell us what they are going to do to meet the requirements of the law in relation to cleanliness and infection control.

We found the building was not well maintained and entry into the building was not secure. People were not accommodated in a safe environment. We have set a compliance action and asked the provider to tell us what they are going to do to meet the requirements of the law in relation to maintaining the safety and suitability of the premises.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We discussed the Supreme Court judgement handed down in March 2014 about what constitutes a deprivation of liberty. The provider was unaware of this ruling, but assured us that they would discuss this with their local authority safeguarding team for further advice on their responsibilities and the arrangements they now need to put in place for people in their care.

Is the service effective?

People's relative's told us they were happy with the staff who cared for their relations. One relative said, "It seems very good. They are keen on treating people as individuals." Another relative told us, "I have no issues, 'X' has not been well and they have dealt with everything very promptly." It was evident from speaking with staff and through our own observations that staff had a good knowledge of the people they cared for and their needs.

Healthcare professionals that we spoke with told us that they enjoyed a good relationship with the home and they felt that the provider kept them fully informed when people's needs changed or they required further input into their care.

Is the service well-led?

The provider of this service was also registered with the Commission as the manager of this location, in line with the requirements of their registration. Staff told us that the provider worked at the service every day during the week Monday to Friday, from approximately 8.00am to 4.00pm.

The provider had policies and procedures in place which gave direction and instruction to staff. Meetings for staff were held monthly and some audits were carried out regularly, in addition to some health and safety checks. However, we found that the provider's quality monitoring systems were not always effective as they did not always identify concerns, and when they did, the provider did not always proactively address these.

Where we have identified a breach of a regulation during inspection which is more serious, we will make sure action is taken. We will report on this when it is complete.

We spoke with relatives and healthcare professionals who visited the home regularly to find out their opinions of the care and support at the service. Relative's comments included, 'It's very good, he's well looked after and he's very happy there' and 'It's a relaxed atmosphere there, it's home from home.'

Healthcare professionals and people's relatives were complimentary about the care and treatment and we found that where people did not have the capacity to consent, the provider acted in accordance with legal requirements.

We found people's needs were assessed and care and treatment was planned and delivered in line with their individual care plans.

We contacted a number of health and social care professionals to find out their opinion of the service. These included a GP, a contracts manager and a care manager. Comments included, 'It's a lovely home, I have no concerns clinically.' We concluded that people's health, safety and welfare was protected because the provider worked in cooperation with others.

We found that people, staff and visitors were protected from unsafe or unsuitable equipment because the provider ensured that a maintenance timetable was in place.

We saw that people's personal records, staff records and other records relevant to the management of the home were accurate and fit for purpose.