Brandreth Lodge Nursing Home

Brandreth Lodge is a residential care home providing personal care to up to 24 people. The service provides support to older people. At the time of our inspection there were 16 people using the service. The home is set over 2 floors and had good sized communal areas and gardens for people to use.

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

Risks to people’s health and safety were not always adequately assessed and mitigated, and changes were required to improve the safe management of medicines.

Improvements were required to the overall governance and risk management of the service; training and staff supervisions were overdue.

People were kept safe from the risk of abuse and the risk of mistakes being repeated was minimised. There were enough staff to care for people and the home was kept clean.

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.

We found a positive culture and the service had a ‘homely’ atmosphere. Staff enjoyed their jobs and said they had good support from the management.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 14 September 2021) and there was a breach of regulation in relation to assessing, managing and monitoring risk. At this inspection we found the provider remained in breach of regulations.

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 undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions safe and well-led which contain those requirements.

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 remained requires improvement. This is based on the findings at this inspection.

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

Enforcement

We have identified breaches in relation to assessing risk, managing medicines, and governance of the service.

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Brandreth Lodge Nursing Home is registered to provide accommodation and nursing care for up to 24 people. There were 17 people living in the home at the time of the inspection. The home is set in its own grounds in a residential area of Parbold.

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

People told us they felt comfortable and happy living in the home. The registered manager and staff understood their responsibilities to raise concerns and report incidents or allegations of abuse. Apart from the kitchen, the home had a satisfactory standard of cleanliness. There were sufficient staff deployed to meet people’s needs. Whilst Police checks and references had been obtained prior to new staff working in the home, we noted there were gaps in two staff members’ history of employment. The registered manager assured us this issue would be addressed.

Individual risks associated with people’s care had been recorded and reviewed as part of the electronic care planning system. However, not all environmental risks had been assessed and mitigated. We noted risks associated with a working freezer and an unused cooker stored in the dining room, the conditions in the kitchen and the uneven driveway had not been assessed.

Staff maintained appropriate records for the administration of medicines. However, the controlled drugs register did not accurately reflect the quantity of controlled drugs stored in the home.

Since the last inspection, the provider had installed new boilers and we noted kitchen fitters visited the home during our inspection. The provider had arrangements to check the safety of appliances, installations and equipment. All safety certificates were complete and up to date.

The registered manager had carried audits to monitor the quality of the service, however, we found some shortfalls during the inspection. People and staff were complimentary about the leadership and management of the home. They told us the registered manager was caring, supportive and approachable.

Following the inspection, we asked the provider to send us evidence of their oversight of the service. Whilst the information received demonstrates the provider had carried out some checks, our findings demonstrated risks to people’s health and safety had not always been assessed and mitigated.

Rating at last inspection

The last rating for this service was good (published 13 March 2018). We also carried out an unrated targeted inspection to look at the infection prevention and control measures in place (published in 16/02/2021).

Why we inspected

The inspection was prompted following concerns identified by the local council’s food safety officer. Three areas were identified as requiring improvement and the home’s food hygiene rating was decreased. As a result, we undertook a focused inspection to review the key questions of safe and well-led. 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.

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.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection. We have found evidence the provider needs to make improvement. Please see the safe and well-led sections of this full report.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

During this inspection, we have identified a breach in relation to Regulation 17 – Good governance.

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

We found the following examples of good practice.

The home had comprehensive policies and procedures to manage any risks associated with the Covid-19 pandemic. This included the management of people with a COVID-19 positive diagnosis. The policies and procedures were updated regularly following any changes in national guidance. Regular infection prevention and control (IPC) audits were undertaken

The registered manager contacted the infection prevention team for advice and guidance as required to ensure safe services were provided to people living in the home.

A programme of regular Covid-19 testing for both people in the home and staff was implemented, and appropriate action taken to mitigate the risk to others when an infection was identified.

All the people living in the home had received the first dose of Covid-19 vaccine. Most staff had received this also, however some staff had refused and the registered manager following discussion was going to undertake risk assessments with these staff members.

Staff had all received training in infection prevention and control, handwashing and the wearing of personal protective equipment (PPE). We observed staff to be wearing the correct PPE throughout the inspection.

The home had made arrangements for people to receive visitors safely in a purpose built visiting pod. Personal family contact plans were in place for people who needed the additional support and reassurance of these. People could use the telephone and tablets were available to allow for video calling.

This inspection took place on 29 January 2018, and was unannounced.

Brandreth Lodge Care Home is situated just outside the small rural village of Parbold in Lancashire. The home can accommodate up to 24 people requiring support with their nursing or personal care needs. Permanent or short term placements are available. The home has a small private car park.

This service was registered by CQC on 3 October 2016, and this is the first time a rating has been given to the service since registration.

A registered manager was not in post at the service, however, the manager of the home had applied for registration with the Care Quality Commission, and their application was being processed at the time of this inspection. 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 was passionate about ensuring people at the service had a good quality of life and were supported safely. They had worked well with outside professionals and took on board advice and guidance to make a positive difference to the support people received. They used information from mistakes and incidents to learn lessons and improve safety.

There was an open culture at the service which meant staff felt able to raise concerns freely and know that something would be done as a result. People and families told us the registered manager was approachable and visible.

The whole staff team had received refresher training in areas such as manual handling and skill levels were good.

Staff had received training on ensuring people were kept free from harm and abuse. They were confident in management dealing with any issues appropriately.

Good risk assessments and emergency planning were in place. Accidents and incidents were monitored and we noted that these had lessened in this service.

We saw that staffing levels were suitable to meet the assessed needs of people in the service. Staff recruitment was thorough with all checks completed before new staff had access to vulnerable people. The organisation had robust disciplinary procedures in place.

Medicines were well managed. People had their medicines reviewed by their GP and specialist health care providers.

Staff were trained in infection control and supported people in their own environment. Staff we spoke to displayed a caring attitude. They understood how to support people and help them maintain their dignity and privacy.

There were regular internal and external audits of all aspects of the service. Changes were put into place after evaluation of the service. Good recording systems were in place and these covered all the support needs of the people in the service.