We carried out a review of the data available to us about Brambling House on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Brambling House, you can give feedback on this service.
Brambling House is a residential care home providing personal care to 17 older people who may be living with dementia at the time of the inspection. The service can support up to 20 people in one large adapted house.
People’s experience of using this service and what we found
People indicated they were happy living at the service. They were smiling and laughing, they spent time with staff and gave them hugs.
Potential risks to people’s health, welfare and safety had been assessed and there was guidance in place to reduce risks. Accidents and incidents had been recorded and analysed, action had been taken to reduce the risk of them happening again. There were systems in place to protect people from the risk of discrimination and abuse.
People’s medicines were managed safely. Staff monitored people’s health and referred people to relevant health professionals and followed the advice given to keep people as healthy as possible.
Staff had been recruited safely and received training appropriate to their role. Staff received supervision and appraisal to develop their knowledge and skills.
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 met with the registered manager before they moved into the service to check staff could meet their needs. People had care plans detailing their choices and preferences and had been reviewed regularly.
People were supported to eat a balanced diet, people had a choice of meals. People had access to activities they enjoyed. People received information in ways they could understand.
People were treated with dignity and respect. People were supported to be as independent as possible. When expressed people’s end of life wishes were recorded. Staff worked with the GP and district nurses to support people at the end of their lives.
The registered manager completed checks and audits on the quality of the service and acted when shortfalls were found. There was an open and transparent culture within the service. Relatives told us they knew how to complain and were confident the registered manager would take action.
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 5 August 2017).
Why we inspected
This was a planned inspection based on the previous rating.
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.
Brambling House provides residential care for up to 20 older people, some of whom may be living with dementia. There were 16 people living at the service. The home benefits from having three communal spaces downstairs, one small lounge, a dining room and a large conservatory area. There is a flat garden leading from the conservatory with seating and flower beds. All parts of the home are accessible to people via a passenger lift. Accommodation comprises of 16 single rooms and two shared rooms and is situated in the village of Sheperdswell near Dover.
There was a registered manager in post. A registered manager is a person who is 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.
We last inspected the service in July 2016. We found significant shortfalls in the service. The provider did not have sufficient guidance for staff to follow to show how risks were mitigated when moving people and managing behaviours that might challenge. The provider had failed to ensure there were enough staff on duty at all times to meet people’s needs. The systems to monitor, identify and assess risks to the health and safety of people were not sufficiently effective and records were not completed accurately. The provider had failed to notify the Care Quality Commission (CQC) when an application to deprive someone of their liberty had been authorised, in line with current guidance.
We asked the provider to send us an action plan to explain how they were going to make improvements to the service. At this inspection we found that improvements had been made.
People told us and indicated that they felt safe and happy living at the service. Risks to people were identified and assessed and guidance was provided for staff to follow to reduce risks to people. People received their medicines safely and on time.
There were environmental risk assessments in place including fire risk assessment and personal emergency evacuation plans, so that people could be evacuated safely in the event of an emergency. Accidents and incidents were recorded and analysed to identify and patterns or trends to mitigate the risk of them happening again.
There were sufficient staff on duty. The registered manager ensured that extra staff were available at busy times, such as early morning and at mealtimes, to ensure that people’s needs were fully met.
Staff knew about abuse and what to do if they suspected any incidents of abuse. They were aware of the whistle blowing policy and the ability to take concerns to agencies outside of the service. Staff were confident that any concerns they raised with the management team would be investigated to ensure people were kept safe.
Staff were recruited safely, the registered manager followed the provider’s recruitment policy to make sure staff were of good character. New staff completed induction training and a training programme was in place to ensure that staff had the skills and knowledge to perform their roles. Staff had one to one meetings and a yearly appraisal with their line manager to discuss their training and further development.
Staff knew the importance of giving people choices and gaining people’s consent. People were supported to make decisions. When people lacked capacity to make specific decisions, systems were in place to enable a best interests meeting to take place with people who knew them well. The Care Quality Commission had been notified as required, when people had been deprived of their liberty in line with the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.
Each person had a care plan that centred on them and their choices and preferences. Care plans were regularly reviewed and updated when people’s needs changed. People’s healthcare needs were monitored and met. People were referred to specialist healthcare professionals when required. Healthcare professional spoke of a good working relationship with staff and that their guidance was followed.
People and relatives told us that the food was good. Staff were aware of people’s dietary needs and preferences, people were offered snacks and drinks throughout the day. People were encouraged to take part in a variety of activities which they enjoyed.
Staff encouraged people to be as independent as possible. People were treated with dignity and respect. Staff spoke to people in a kind and compassionate way. People and relatives knew how to raise concerns and felt confident that the registered manager would take appropriate actions to resolve any issues.
People and relatives knew the registered manager and felt they were approachable. Staff told us they felt supported by the registered manager, that they were available for advice and support. There were regular resident and staff meetings, so that suggestions could be made to improve the service.
There were systems in place to check the quality of the service being provided. Quality audits had been carried out; action plans were put in place to address any shortfalls found. Feedback was sought from people, relatives, staff and healthcare professionals involved in the service. People, relatives and healthcare professionals we spoke to were happy with the care being provided.
Staff understood their roles and responsibilities. The registered manager and staff shared a vision for the service and worked as a team to provide effective, person centred care.
We found that the provider had displayed their rating in the reception and on their website.
There was a registered manager in post. A registered manager is a person who is 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 told us and indicated they were happy living at the service. People told us the staff were always busy but usually around when they needed them. There were times during the day, such as early morning, evenings, and meal times that there was not enough staff on duty to ensure that people needs were fully met.
Potential risks had been identified but the measures to reduce these risk were not detailed enough to give staff the guidance to ensure people were safe. This included moving and handling risk assessments, environmental risk assessments and behaviour risk assessments.
Staff took appropriate action to support people when accidents occurred and sought medical advice if necessary. The registered manager analysed these for trends but further analysis would be beneficial to look at people’s behaviour and triggers to reduce the risk of further events
Each person had an individual personal emergency evacuation plan (PEEP) with guidance for staff about how to evacuate people from the building; however, additional information was required to give staff guidance to support people with their behaviour when an emergency arises.
Medicines were being administered safely, further guidance was required to ensure that ‘as and when’ medicines have clear guidelines and infection control procedures are being followed.
People were treated respectfully and with dignity however there were times during the day when dignity was compromised due to the lack of staff on duty to support people to eat their meals.
Care plans had been regularly reviewed, but some people’s needs had changed and the care plans had not been amended to reflect these changes.
Quality audits and checks had been carried out. Some action plans were in place, however not all of the shortfalls found at this inspection had not been identified.
The Care Quality Commission was not routinely informed as required when people had been deprived of their liberty in line with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).
People told us they felt safe living at the service. Staff had received training on how to keep people safe and how to raise concerns. They were aware of the whistle blowing policy and were confident that the registered manager would listen to their concerns.
The requirements of the MCA had been met. Staff supported people to make decisions. When people lacked capacity to make a specific decision, systems were in place to enable best interests meetings to take place with people who knew them well. Staff offered people choices of what they wanted to eat, or where they wished to sit.
Staff were recruited safely with all the necessary checks to ensure they were of good character. New staff received induction training and a training programme was in place to ensure that staff had the skills and knowledge to perform their roles. Staff received one to one meetings with their line manager and a yearly appraisal of their work performance to discuss their training and further development.
The staff were all aware of people's dietary needs and preferences. People and relatives told us the food was good. Due to the lack of staff on duty at meal times, people did not always receive the full support they needed to eat their meals.
People’s health care needs were monitored and met. Health care professionals spoke positively about their working relationship with the staff.
Staff were kind and caring and supported people when they became anxious or upset. They encouraged people to be as independent as possible.
People told us they looked forward to the activities, especially the music entertainment. There were links with the local community, such as the women’s institute choir and church.
The registered manager investigated and responded to people’s complaints. People knew how to raise any concerns and relatives were confident that the registered manager would take appropriate action to resolve their issues.
People and relatives told us the service was well led and the registered manager was supportive to the people and staff.
There were regular quality assurance checks carried out on the service being provided. Feedback was sought from people, relatives, staff and health care professionals involved in the service. People, relatives and health care professionals spoke positively about the service and were satisfied with the care being provided.
Records were not always completed accurately to provide staff with the information they needed to provide safe and consistent care to people.
We found a number of 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 the report.
Visitors told us that they were happy with the care provided to their relatives and told us that staff were, 'Kind and considerate'.
The atmosphere in the home was calm. Interactions we saw between staff, management and people who lived in the home were positive.
Staff understood the needs of the people who lived in the home and supported them appropriately. Staff were able to tell us about people's individual needs.
People enjoyed their meals and there was a range of snacks and drinks available throughout the day. There was a lack of choice available in relation to main meals and nutritional monitoring lacked some detail.
Staff knew what to do if they had any concerns about the people who lived in the home.
Staff had been suitably trained to meet the needs of the people who lived in the home.
There were systems in place to regularly assess and monitor the quality of service that people received. People and their representatives had been asked their opinion about the service but we found that no action had been taken with regard to this feedback.
We spoke with six people who received a service and two relatives. All of the people spoken with told us that they were satisfied with the service. People using the service said: "I could not be in a better place; I have been here a long time and have no complaints whatsoever". "The staff make sure I have everything I need here".
We saw that people using the service were receiving the care and support they needed. We found that medication was stored safely and people received their medication in a timely manner. Staff recruitment records showed that new staff had been thoroughly checked to make sure they were suitable to work with vulnerable people.
People and relatives told us they did not have any complaints but would not hesitate to speak to the manger or staff if they had any concerns.
Two people told us they were satisfied with their care. People were being supported to make decisions about their day to day lives. They were able to move around the home and choose where they wished to be. We spoke to three relatives who said that staff were polite and caring. They said that when required they had been included in their relatives care plan reviews. One person told us how she went out with her relatives on a regular basis.
There were checks in place to make sure the service ran smoothly and people were satisfied with their care. Relatives said that if they had any concerns they would not hesitate to speak to the staff or manager.