Bramwell

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people were safe and protected from avoidable harm.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The home had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice. The registered manager had cultivated a culture of learning rather than one of blame. They thoroughly investigated and analysed incidents to identify any themes and areas for improvement. For example, following an incident they introduced a new policy for when a person became agitated at night, a floating staff member would support them 1:1 for the rest of the night, this approach ensured people were kept safe during the night.

Staff said, “Usually, if a mistake has happened at Bramwell, the manager immediately calls for a staff meeting. This helps a lot because some of the people will also learn from other people's mistakes. [The registered manager] then supervises and monitors us all in their own time to check on lessons learnt.” Another told us that this approach “allows us to reflect, learn from the situation and improve practice.”
 

Staff worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

External healthcare professionals told us that staff at the home worked well with them to achieve the best outcomes for people. Staff knew what to do in the event of a person needing an emergency admission to hospital, including providing necessary documentation and sending “an escort of staff member with them to support in a different environment.”

Family spoke positively about how Bramwell worked closely with other healthcare partners to ensure a good system of care. One family member also described how following a period of increased need their family member needed to be cared for elsewhere but after a period of time they were able to move back to Bramwell and stated it was “a really good transition back”.

Staff worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The registered manager shared concerns quickly and appropriately.

A family member told us, “We are delighted with the care know that [loved one] is safe and well fed.” A person told us, “I certainly feel safe here.” Staff could clearly explain how they would recognise and report, both internally and externally, any potential safeguarding concerns. All staff were able to tell us how they would recognise and report any potential safeguarding concerns and escalate appropriately to ensure the safety of people.

Staff were trained in safeguarding and the Mental Capacity Act (MCA) Deprivation of Liberty Safeguards. Policies were in place and the registered manager had made handy flash cards with the principles of safeguarding, MCA and DOLS which were given to all staff. Staff were well informed and said “I offer choices and encourage independence. If a resident does not have capacity for a specific decision, we involve family members and professionals to make decisions in the resident’s best interest.”

Appropriate DoLS were in place however we did find some MCA assessments were not completed in detail, which the registered manager addressed promptly following feedback.

Staff worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Proactive staff were consistently observing people and gently supported people to avoid incidents, for example ensuring they had their mobility equipment positioned correctly and was accessible, empowering people to remain independent in a safe way.

Staff described to us how they would explain the risks of people’s actions, for example refusing food, personal care or medicines and encourage them to make the right decisions whilst respecting their choices.

A clinical risk register was kept ensuring the registered manager had oversight on risks related to people’s health and wellbeing, this was regularly reviewed to make sure it was up-to-date and reflected people's current needs.

The home involved visitors and families in risk management through meetings and signage. For example, there was a visitor notice asking them to speak with staff before bringing in food and drinks, this was due to any potential choking risks.

The registered manager ensured potential risks were detected and controlled in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Appropriate checks were carried out on the environment, for example checking water temperatures to avoid risks posed such as scalding or water borne infections.

Fire checks and drills were regularly carried out to ensure the safety of people in the event of a fire.

The registered manager made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

People told us, and our observations confirmed, there were enough suitable staff to support people safely. A person told us, “I use my buzzer if I need staff and they come pretty quickly.” Family told us, “any buzzer going off you see staff move quickly when we are there,” “Definitely got enough staff, it is a real team approach there,” and “Staffing levels are very good, they are very attentive, around always, attentive to us as well with [named loved one], we mix up the days we go including weekends, staffing is always the same.”

Staff all felt there were enough of them to support people safely and take time with people. They said, “Staffing levels are arranged according to the dependency and needs of residents, which allows us to provide safe, person-centred care,” and “there is always 1 staff with people in the lounge they are never left alone, staff are ensuring the safety of vulnerable people by not leaving them unattended.”

Staff told us of the support they received, “I have regular supervision with my manager, which helps me reflect, improve, and feel supported in my role.” Staff were trained in a vast range of relevant topics to ensure they were competent to support people safely.

The provider thoroughly assessed and managed the risk of infection. They always quickly detected and controlled the risk of it spreading and always shared concerns with appropriate agencies promptly.

People and families told us, and our observations confirmed, the home was kept very clean which reduced the risk of infection. Family said, “No funny smells, it is immaculately clean.” A person told us, ““Staff are in here every day cleaning, a chap does all the toilets. They pop in again later in the day. It’s kept very well.”

The housekeeping staff attended daily team meetings were infection prevention and control (IPC) concerns and outbreaks were discussed to ensure the safety of people living at the home.

All staff had received training on IPC and a comprehensive policy was in place. In addition, the home had IPC champions in place, whose responsibility it was to support the monitoring and learning around IPC.

Staff understood best practice to follow if an outbreak occurred. Staff said, “In an event of an infection outbreak, I do follow the practice of barrier nursing, as for examples of diarrhoea or chest infection, I will isolate people with infection to their rooms, by wearing PPE in their room and after assisting them removing all the PPE and washing hands before coming out of the room. Also, I will encourage them to drink more fluids and will record it.”

Staff made sure medicines and treatments were safe and met people’s needs, capacities and preferences.

Staff said, “I always check the Medication Administration Record (MAR) chart, confirm the resident’s identity, check for allergies, follow infection control procedures such as hand hygiene, ensure the resident takes the medication safely and record administration immediately. Any refusals, errors or concerns are reported and documented according to the medication policy.

A person told us, “They bring my medicines in. I know what I need to take. They bring them in at the right times.”

Medicines were stored, administered and managed safely by competent staff who were appropriately trained.