This inspection took place on 9 and 11 July 2018 and was unannounced.Brambling Lodge 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. Brambling Lodge is registered to provide care and support for up to 27 people who may be living with dementia. At this inspection there were 25 people living at the service.
The registered manager had left the service in January 2018. There was a manager in post who was in the process of registering with the Care Quality Commission. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the Health and Social Care Act 2008 and associated Regulations about how the service is run. Following the inspection the manager's registration was confirmed.
We last inspected the service in June 2017 and we found three breaches of regulations, the provider had failed to deploy sufficient staff to meet people’s needs and medicines management was unsafe. The provider had failed to use feedback to improve the service, audits had not been effective, records were not always accurate and complete. Following the last inspection, we asked the provider to complete an action plan to show what they would do to meet the regulations. At this inspection, improvements had been made and two of the previous breaches had been met. There was one continued breach and a new breach of regulation was identified. This is the second consecutive time the service has been rated Requires Improvement.
Potential risks to people’s health and welfare had not been consistently assessed. Some people’s health conditions had not been assessed and there was no clear guidance for staff to mitigate risks and recognise when people were unwell. Care plans had been reviewed but were not consistently accurate or did not reflect the care and support being given.
Audits had been completed on all areas of the service, any shortfalls found were rectified. However, the manager had not completed an audit on the care plans reviewed during the inspection and the shortfalls found had not been identified.
At the last inspection, the provider had failed to have sufficient staff to meet people’s needs. At this inspection improvements had been made. There were sufficient staff to meet people’s needs, call bells were answered quickly and staff were always available in the lounge to support people.
Previously, medicines had not been managed safely. At this inspection, improvements had been made. There were systems in place to monitor the administration of medicines and previous shortfalls had been rectified.
People’s needs were assessed before they moved into the service following current guidelines. Staff monitored people’s health and referred them to specialist healthcare professionals when needed. Staff followed the advice given to keep people as healthy as possible. People were supported to be as active and independent as possible. Staff worked with the GP and district nurse to respond to people’s healthcare needs. People’s end of life wishes were recorded and staff had received training to support people to be as comfortable as possible.
Staff received training appropriate to their role, they received supervision to discuss their development and skills. Staff knew how to keep people safe from abuse. The manager had reported and worked with the local safeguarding authority when required. Incidents and accidents were recorded and analysed to identify trends and patterns, action was taken and lessons learned to reduce the risk of them happening again.
People were encouraged to plan their care and express their views. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.
The provider had a complaints policy, this was displayed in the reception of the service. However, the policy was not available in other formats such as pictorial or easy read. This was an area for improvement.
Staff treated people with dignity and respect, people were encouraged to maintain relationships with people who were important to them. People had the opportunity to take part in activities they enjoyed.
There was an open and transparent culture, the manager had an open door policy and had developed relationships with people and relatives since starting at the service. Staff told us the manager was approachable and supported them.
People, relatives and staff attended meetings to express their views and suggestions for the service which were acted on. The manager worked with agencies and attended local groups and forums to improve their knowledge and skills.
Checks and audits had been completed on the environment and equipment that people used to make sure it was safe. The service was clean and odour free. The building met people’s needs and refurbishment was continuing.
Services that provide health and social care to people are required to inform the Care Quality Commission, (CQC), of important events that happen in the service. CQC check that appropriate action had been taken. The provider had submitted notifications to CQC in an appropriate and timely manner in line with guidance.
It is a legal requirement that a provider’s latest CQC inspection report rating is displayed at the service where a rating has been given. This is so that people, visitors and those seeking information about the service can be informed of our judgements. We found the provider had conspicuously displayed their rating on a notice board in the entrance hall. The service had displayed their rating on their website.
At this inspection a continued breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and an additional breach was identified. You can see what action we have asked the provider to take at the end of the report.