Bracebridge Court

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

The provider 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.

Staff told us learning or changes in practice following incidents or accidents in the home were shared through ‘lessons learned’ memos. One staff member told us, “We have the paperwork to read through and sign to say we understand what has been going on." Another staff member told us there was a positive culture of learning from adverse incidents rather than blaming individual staff practice. This staff member commented, “There is no blame; if something has gone wrong, we all work as a team to learn from it and rectify it. If I have done something wrong, I don’t think any of the management team or staff would be nasty and say I blame them for that.”

The regional operations director said they took opportunity to improve their practice and knowledge. During our onsite inspection, we shared some of the improvement actions we identified. Before we visited on the second day, the regional operations director had taken action to improve staff practice for medicines management and record keeping for food and fluid monitoring.

Where people had fallen, people’s care plans were updated where required following an accident or incident. The home manager reviewed accidents and incidents at the home and regular analysis was carried out to see if there were any patterns or trends where actions could be taken. Where additional measures were needed to manage incidents through falls, specialist equipment was used to support people. This included alarm mats that notified staff when a person at risk when mobilising. However, on the first day of our visit we saw some alarm mats were not in the correct place to alert staff to a person’s movement. The regional operations director reminded staff to make sure call alarm mats were in the right place to remain effective.

The provider 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.

Relatives felt engaged in the systems and process to assess people’s needs and whether Bracebridge Court was right for them. One relative said, “We looked at a few homes and chose this one, it was the right choice. We were all involved when [Relative] was referred. I was happy with the way it was handled, couldn’t fault it’. They explained everything fully.”

The provider’s systems recorded personalised information about risks to people’s health, their medication and wishes for future care. This information was shared with other healthcare professionals if they were admitted to hospital. Discharge information was reviewed to ensure any changes in care or medication were identified and shared with the GP for actioning.

Staff or family members accompanied people to external healthcare appointments to ensure continuity of support and effective sharing of information. One staff member explained, “We will send a member of staff unless a family member is going with them. It is a familiar face, and we need to make sure the person has got to the appointment and we have the information that is fed back from the consultant they are seeing. It is comfort for the resident and for information."

The provider did concentrate on improving people’s lives to protect their rights for making decisions in people’s best interests. People did live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider did work well with people and healthcare partners to understand what being safe meant to them and how to achieve that.

Without exception people felt safe. Comments included, “There’s nothing to feel unsafe about, it’s very secure.”, “I chose it because it’s good here” and “The staff are very nice, I feel quite safe with them.”

Staff understood what safeguarding meant and their responsibility to report any concerns that put people at risk of harm or injury through poor practice. One staff member told us, “I would go to management and bring it up as a safeguarding.” When we discussed the importance of reporting concerns, another staff member commented, “It is the safety and welfare of the residents, and we have a duty of care to uphold." A third staff member told us they would not hesitate to escalate concerns if managers failed to take the right action. They explained, "I would go higher - [to] the CQC or the police if I needed to and the local authority." Information about the local safeguarding processes was displayed and accessible for staff, people and visitors within the home.

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Staff assessed risks to people’s health, safety and welfare and care plans described the action to be taken to manage those risks. Some risk management plans were very detailed, but others would have benefited from more information. For example, 1 person’s catheter care plan directed staff to monitor for signs of infection but did not detail what those signs were. Another person had sustained some skin damage, but their care plan had not been updated to reflect the strategies that had been implemented to mitigate the risks.

During our visit, we saw some people identified at risk of falling had alarm mats that, when placed near to them, would alert staff to a person mobilising so staff could go to them to minimise the risk of falls. However, we saw the alarm mats in 2 people’s rooms were not placed near to the person so if the person began to mobilise, the alarm might not be triggered to alert staff. Before we concluded our onsite inspection, the provider had initiated actions to improve practice so assessed risks had better oversight and scrutiny.

The provider did not always detect and control potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Health and safety and environmental checks on water quality, water temperature equipment, the environment and maintenance issues were completed. However, we found some environmental risks were not always managed. During our inspection we found some items of food and drink left in communal kitchenettes were not always dated when opened or discarded when items had passed their use by date. In another kitchenette area we found some cleaning products that could be harmful, were not in a locked cupboard. This could put people at risk if ingested or misused. We shared these concerns with the manager who took action to make people safe before we concluded this inspection.

People raised no concerns with us about the environment. One person said, “I like my room and I prefer to stay in it. I can get myself to bed and I use the shower in the bathroom myself.” People’s rooms were personalised for them with their own personal possessions. The entrance hallway of the home was decorated for Christmas. This theme continued into other communal areas of the home. People could access the communal areas, and corridors were wide which made it easier for people using mobility equipment to navigate to areas of the home. A lift meant people could access other floors. There was an outside space people could use and this could be accessed by people with limited mobility.

The provider 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 and relatives felt staffing levels were sufficient. One person said, “The staff are enough for my needs.” One person explained to us how the staffing met their needs. This person said, “They (staff) are all really nice to me. I ask them the night before for a shower and they come and help me in the morning. They are very flexible if I wanted to lie in I could and the staff are always there if you need them.” A relative said, “Everything seems fine they don’t seem to rush at all.”

Staff told us there had recently been some changes in the staff team which had meant an increased use of agency staff. One staff member told us, “There has been a high turnover (of staff) recently, but it has corrected itself. We had agency but they tend to use the same agency so they get to know the residents." Another staff member commented, "It has been a struggle with the staffing levels if I am honest, but I have never felt it was unsafe. We have been having a lot of agency staff but the agency are really good and regular. We are nearly fully staffed, and it is a much better environment now." Whilst staff said extra support would be helpful, they told us they had enough time to safely provide the care outlined in people’s care plans.

The provider used a dependency tool but from reviewing the monthly calculation tool with the home manager to assess the care hours required, we were not confident people’s assessed level of risks were accurate. The home manager agreed some people’s risk levels that determined care hours needed to be changed. However, they were satisfied people received their care when needed.

Staff had an induction when they started working at Bracebridge Court which included training and working alongside more experienced staff. Staff told us training was regularly refreshed and spoke positively about their training opportunities. One staff member described the training as, “extensive”, adding, “I have had a lot of training, both online training and practical training. It is good and it is necessary." Another staff member told us how they learnt about different types of dementia and how dementia could affect each person differently. The provider completed necessary recruitment checks prior to staff starting work to ensure the suitability of staff before they commenced employment. Recruitment checks included references and Disclosure and Barring Service (DBS) checks. DBS checks provide information including details about convictions and cautions held on the Police National Computer. This helps providers make safe recruitment decisions. Staff felt they had the right training that was relevant and necessary for their role.

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

Relatives felt protected and good infection control practice was followed. One relative said, “There was Covid-19 a few weeks ago everyone was wearing masks, they (staff) told me immediately and I left, there were signs on the doors as well. They gave me 3 masks.”

Bracebridge Court presented as clean and maintained. Signage was in communal bathrooms to inform and remind people and visitors about good hygiene practice. Foot-operated bins helped reduce contact points to limit risk of cross infection. However, we found some disposable glove dispensers in communal bathrooms did not have disposable gloves available in all sizes and a paper towel dispenser was empty. Despite dispensers being empty, we did see enough personal protective equipment (PPE) in cupboards throughout the home. Staff were observed wearing appropriate PPE around the home.

Whilst we saw infection control measures were in place, we saw some food and drinks in communal areas and people’s rooms had not always been labelled with the date of opening in accordance with good food hygiene practices. Housekeeping staff understood their role in promoting good infection control practices. One member of domestic staff described how they used different coloured cleaning equipment in specific areas of the home to prevent cross-contamination.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

People told us they received their medicines and relatives were satisfied their family members received medicines from staff at the times needed. Staff told us they had medicines training and their competency to administer medicines safely was checked throughout a 12-month period.

Most medicines were stored correctly and as and when medicines were managed safely because staff followed protocols that gave them the information to do this safely. However, we found improvements were required in the way some people’s medicines were administered and recorded. For those people, we found people had not come to harm, but we could not be confident those people received their medicines safely and as prescribed. For example, we found some patch medicines for pain management were not applied correctly to the skin. When a medicated pain patch is not applied as directed, it may not deliver the right dose of medication, potentially leading to a loss of pain relief or, in some cases, an overdose. Speaking with staff, they were not aware they had to rotate where certain patch medicines were applied on the person’s body. We checked 2 people’s medicines records and found staff did not do this in line with manufacturers’ guidelines. We also found staff had not recorded the date of opening on some topical creams, and thickener used in drinks. These medicines had to be used within a certain time period which made it difficult for staff to know when they had to stop using them.

We found some medicines were not stored safely. Daily refrigerator temperatures were taken and were within safe ranges. However, some medicines that were required to be stored at room temperature once opened, for example eye drops and suppositories, were stored in the refrigerator. Speaking with staff, they had not identified this. Before we left site, the regional operations director took action to improve staff practice and knowledge.

Processes to make sure people received their medicines were completed, such as regular audits and actions to address medicine errors at the earliest opportunity. However, these were not always effective in identifying the issues we found.