Branston Court Care Home

Branston Court provides accommodation with personal and nursing care for up to 45 people who may have a mental health condition such as dementia. At the time of this inspection there were 38 people using the service.

We found the following examples of good practice

• The provider had sent personalised letters to people’s family members to support them to keep in touch with their relatives. Staff also used technology to help family and friends keep in touch, such as video calls.

• Staff used pictures to support people’s understanding where they had difficulty as staff were wearing masks.

• All staff changed into their uniforms on site and before leaving the service, and they had been given tote bags (donated by the local community) to carry their uniform in and out of the home to avoid potential infection transmission.

• The service had purchased plastic coverings for the clean clothes trolley to reduce the risk of cross contamination.

• Discussions were held with staff to reduce their anxieties and also with high risk groups such as BAME staff to ensure their safety when supporting people. The provider had a counselling service for staff to access if required.

Further information is in the detailed findings below.

People’s experience of using this service:

At our last inspection in March 2018, the manager had not registered with the Commission. After the inspection they submitted an application and registered with us.

At this inspection the provider did not have a registered manager in post but appropriate arrangements were in place to ensure the service provided to people was not affected.

At our previous inspection people had raised concerns about insufficient staffing levels. At this inspection people were supported by sufficient numbers of staff who had been recruited safely.

People who made decisions on behalf of their relative did not always have power of attorney. People were supported by staff to make their own decisions. People were assessed to ensure they received a service specific to their needs.

People were cared for by staff who were skilled and supported in their role by the manager. People were provided with a choice of meals and were supported by staff to eat and drink sufficient amounts to promote their health. Access to relevant healthcare services ensured people received the appropriate treatment when needed. The environment was suitable to meet people’s needs.

People could be confident that staff would know how to safeguard them from the risk of potential abuse. Risk assessments were in place to mitigate the potential risk of harm to people.

People were assisted by skilled staff to take their medicines as directed by the prescriber. Medicines were stored and recorded appropriately to ensure the safe management of medicines. Appropriate systems and practices promoted good hygiene standards to reduce the risk of people contracting avoidable infections. Lessons were learned when accidents occurred and corrective measures were taken to reduce the risk of a reoccurrence.

People were supported by staff who were kind, compassionate and attentive to their needs. Where possible people were encouraged by staff to be involved in planning their care. People’s right to privacy and dignity was respected by staff.

The assessment of people’s needs ensured they received the appropriate care and support. People were supported by staff to engage in social activities of their choice. People could be confident that their complaints would be taken seriously and acted on. At the time of our inspection no one was receiving end of life care.

The provider had systems in place to review and monitor the quality of service provided. The provider worked with other agencies to ensure people received a seamless service.

Rating at last inspection: The service was rated Requires Improvement at the last inspection in March 2018.

Why we inspected: This was a scheduled inspection based on the previous rating.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner. More information is in Detailed Findings below.

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

This inspection took place on 12 March 2018 and was unannounced.

Branston Court Care Home is a care home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Branston Court Care Home is registered to accommodate 45 people. At the time of our inspection 28 people were using the service. The service accommodates people in one building and support is provided over two floors, both have separate adapted facilities with a lounge area and dining area on each floor and a smaller lounge also available on the ground floor. A garden and enclosed patio were also available that people could access.

Since the 31 January 2018 the provider of this home has changed from Bupa Care Homes (CFC homes) Limited to HC-One Oval Limited.

The service did not have 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 about how the service is run. A manager was in post and confirmed they had commenced the process to register with us.

Our last comprehensive inspection was undertaken in February 2017 and the service was rated as good. Following concerns identified regarding the safety of people using the service, the local authority commenced a large scale enquiry (LSE) in June 2017. We undertook a focused inspection on 24 July 2017 and the service was rated as requires improvement. This was because we found improvements were needed regarding the management of people’s medicines. We also found people’s welfare had been placed at risk and improvements were ongoing to address this. Improvements were also needed to ensure people’s therapeutic needs were met and that quality assurance checks were effective in identifying where improvements were needed. We asked the provider to complete an action plan to show what they would do and by when to improve the key questions is the service safe, responsive and well led to at least good.

At this comprehensive inspection we found that improvements had been made since our last inspection. Although we did not identify any breaches of regulations at this inspection; some further improvements were needed to ensure good outcomes for people were maintained. This is the second consecutive time the service has been rated overall as 'Requires Improvement'. Providers should be aiming to achieve and sustain a rating of 'Good' or 'Outstanding'. Good care is the minimum that people receiving services should expect and deserve to receive.

Improvements had been made to the management of medicines and people had received their medicines as prescribed. However improvements in communication were needed to ensure people’s medicines were readily available when needed and to ensure that staff were available to provide timely support to people.

Improvements had been made to provide activities to support people’s social integration and further improvements were being made to ensure people received information in an accessible format.

People’s safety was enhanced as risks to people were managed and recruitment practices checked staff’s suitability to work with people. People were protected by staff that understood their responsibilities to report any concerns.

Assistive technology was in place to support people to keep safe and the premises and equipment were maintained to promote people’s safety. Systems were in place to ensure the prevention and control of infection was minimised.

People and their relatives contributed to the assessment and development of their care plans and relatives felt able to report any concerns they had. People were supported by trained staff and they encouraged people make their own decisions.

People received meals met their requirements and preferences and they were supported to maintain their health care needs.

People were treated with kindness and were supported to make choices and maintain their dignity and be as independent as possible. People’s family and visitors were welcomed by the staff team to support people to maintain relationships that were important to them.

Systems were in the process of being implemented to monitor the quality and safety of the service. We saw that some areas for improvement were needed and these were being addressed by the provider.

People and their representatives were consulted and involved in the running of the service. The provider understood their responsibilities and regulatory requirements and had resources available to them; including partnership working with other agencies that ensured people’s needs were met.

Branston Court Care Home provides accommodation and nursing care for up to 45 older people living with dementia. The accommodation is provided over two floors. The Trent unit is on the ground floor and the Dove unit on the first floor. Both floors have their own lounge and dining area. There were 41 people living at the home on the day of this inspection.

We inspected this service on 24 July 2017 following concerns received about people’s safety and the management of the service. This inspection was focused and only covers the domains, safe, responsive and welled. We previously inspected this service in February 2017 and rated the service as Good.

This report covers our findings in relation to the identified concerns. It also covers related information gathered as part of this inspection visit. You can read the report from our last comprehensive inspection visit, by selecting the ‘all reports’ link for Branston Court Care Home on our website at www.cqc.org.uk

The registered manager that was in post at our last inspection was no longer employed and was in the process of cancelling their registration. 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. At the time of this inspection the regional support manager was managing the service and had been in post since the 10 April 2017. The regional director confirmed a new manager had been appointed and would undertake their induction with the support of the regional support manager.

Improvements were needed to ensure that when people required medicines to be hidden in food or drink, their capacity regarding this was clearly recorded. Other areas regarding medicines management were needed to ensure clear records were maintained to demonstrate that people received their medicine as prescribed or if not the reason why. People’s prescribed medicines were not always made available to them as prescriptions were not sent to the pharmacy in a timely way. Records were not consistently recorded to ensure room and clinical fridges were maintained at the recommended temperatures for storing medicine.

Staff understood their role in protecting people from the risk of harm. We saw that actions had been put in place to monitor and protect people from harm. However, this required further improvement to ensure people that were cared for in bed were protected from other people that used the service that may enter their bedrooms. The provider had acknowledged this and actions were being taken to provide a secure area for people that were at higher risk of harm from others living at the home.

Some people demonstrated behaviours that put themselves and others at risk. The provider was using agency staff to enable sufficient staffing levels to be maintained but some agency staff were not always reliable in turning up for their agreed shifts. The regional support manager was addressing this issue with the agency used at the time of this inspection. We saw that other staff employed were used, such as housekeeping staff that were trained to provide care, when there was a deficit in the staffing levels. A recruitment drive had been undertaken to increase the staffing levels in place and new staff were on induction at the time of this inspection. Safe recruitment practices were in place to check staff were suitable to support people.

People were supported by staff who knew them well but their therapeutic needs were not always met to enhance their well-being. The provider was taking action to address this with the support of specialists in dementia care that were employed by them.

The environment did not support people living with dementia. Plans were in place to improve the environment and specialist advice was being sought to achieve this. Additional training and guidance had been organised for staff regarding supporting people with dementia and people that demonstrated behaviours that put themselves and others at risk. Staff confirmed that clear improvements had been made under the management of the regional support manager and told us they felt supported and listened to.

The quality assurance checks had not been effective in identifying where improvements were needed. Actions had been taken to address this and improvements were ongoing at the time if this inspection. People’s representatives had been consulted regarding the areas that required improvement and were encouraged to share their opinions about the quality of the service to enable the provider to make improvements. People’s representatives and the staff team told us the regional support manager was effective and approachable. The provider’s complaints policy was accessible to people’s representatives.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We inspected this service on 6 February 2017. This was an unannounced inspection. The service provides accommodation and nursing care for up to 45 older people living with dementia. There were 41 people living at the home on the day of our inspection.

At our previous inspection on the 6 January 2016 the provider was meeting all the regulations relating to the Health and Social Care Act 2008, but we saw that some improvements were needed. This was because there was insufficient staff available at specific times of the day, for example to supervise people at the lunch time meal. The environment did not offer sufficient orientation to support people’s memories and reduce confusion At this inspection we found improvements had been made. The staffing levels had increased and improvements had been made to the environment to support people living with dementia.

There was no 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 about how the service is run. The previous registered manager had left in December 2016 and a new manager was in post and they told us they were in the process of registering with us.

People felt safe and staff understood their role in protecting them from the risk of harm. People received their medicines at the right time and medicines were managed safely. People were supported by staff who had the knowledge and skills to provide safe care and support and there was sufficient staff available to meet their identified needs. Checks were carried out prior to staff starting work to ensure their suitability to work with people

People were supported to eat and drink what they liked. Where concerns were identified, people received support from health care professionals to ensure their well-being was maintained. Health concerns were monitored and people received specialist health care intervention when this was needed.

The staff were kind and caring when supporting people and supported them in the way they wanted. Staff knew people’s likes and dislikes and care records reflected how people wanted to be supported and how care was provided. There were regular reviews of people’s care to ensure it accurately reflected their needs.

People were able to take part in social activities. People told us that they liked the staff and we saw that people’s dignity and privacy was respected by the staff team. Visitors told us that the staff made them feel welcome and were approachable.

Quality monitoring checks were completed by the provider and when needed action taken to make improvements. The provider sought the opinions from people and their representatives to bring about changes. The provider understood their responsibilities around registration with us. Staff were supported in their job and had opportunities to give their views. People knew how to complain and we saw when complaints were made these were addressed.