Archived: Branksome House

Branksome House is a residential care home, registered to provide personal care for up to nine adults with mental health, learning disabilities and/or autistic spectrum disorder needs. At the time of the inspection, four people were living at the service.

Following refurbishment, Branksome House can accommodate up to seven people over three floors, in one adapted building. The service has wheelchair accessible bedrooms with en-suites on the ground floor. First floor bedrooms have en-suites and there is a communal bathroom on the first floor. The first and second floor bedrooms are accessed via stairs. People had access to the lounge and an enclosed accessible rear garden and were supported to access the dining room and kitchen by staff.

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

People felt safe and supported at Branksome House and had chosen to live there over other alternatives. People's health related risks had been assessed and timely referrals to health and social care professionals were made when people’s needs changed. Care records included recommendations by health care professionals. Improvements had been made since our last inspection to ensure choking and infection control risks were managed in line with health professionals’ recommendations, provider policies and national guidance.

The provider continued to develop and improve their governance and monitoring systems which included tracking systems to ensure their required checks were completed. Audits had been completed and an action plan was in place. People's feedback had been sought.

People looked healthy and were well cared for. They were supported to express their individuality through their personal choices. People were supported by staff who had received appropriate training and support and whose competency in key areas had been checked.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Based on our review of the Effective and Well-Led domains, we found the service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. The service was situated in a residential street, close to local amenities. People's choices were supported and they were involved in setting goals to increase their independence. People were treated with care and dignity and their right to privacy was respected. Positive changes in one person’s needs and well-being since moving into the service were evident.

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. People's capacity to make decisions had been assessed. Where restrictions were needed to keep people safe, Deprivation of Liberty Safeguards (DoLS) applications had been made to authorise these. People's wishes were established through a variety of communication techniques, including use of signing.

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 10 December 2021) and there was a breach of regulation. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced inspection of this service on 8 November 2021. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment.

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 of Effective 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 changed from Requires Improvement to Good. 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 Branksome House on our website at www.cqc.org.uk.

Follow up: We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Branksome House is a residential care home, registered to provide personal care for up to nine adults with mental health, learning disabilities and/or autistic spectrum disorder needs. At the time of the inspection, four people were living at the service.

Following recent extensive refurbishment, Branksome House can accommodate up to seven people over three floors in one adapted building. People have access to communal areas including a lounge, dining room, kitchen and an enclosed accessible rear garden. The service has wheelchair accessible bedrooms with en-suites on the ground floor. First floor bedrooms have en-suites and there is a communal bathroom on the first floor. The first and second floors are accessed via stairs.

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

People felt safe and supported at Branksome House and had chosen to live there over other alternatives. People's health related risks had been assessed and timely referrals to health and social care professionals were made when their needs changed. Care records were accurate and complete and included recommendations by health care professionals. However, we found staff were not always following people’s support plans in relation to managing choking risks. Also, provider policies had not always been followed, to manage infection prevention and control related risks, when people were admitted to the service. There had been no choking incidents or COVID-19 outbreaks affecting people at the service.

The provider had continued to develop and improve their governance and monitoring systems since our last inspection. Audits had been completed and an action plan was in place. People’s feedback had been sought.

People looked healthy and were well cared for. They were supported to express their individuality through their personal choices. People were supported by staff who had received appropriate training and support and whose competency in key skills and knowledge areas had been checked.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Based on our review of the Effective, Caring and Well-Led domains, we found the service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. The service was situated in a residential street, close to local amenities. People’s choices were supported and they were involved in setting goals to increase their independence. People were treated with care and dignity and their right to privacy was respected. Staff valued the people they supported and worked inclusively to ensure people’s views were heard. This had enabled one person to build confidence in the short time since moving into the service.

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. People’s capacity to make decisions had been assessed. Where restrictions were needed to keep people safe, these were minimal and Deprivation of Liberty Safeguards (DoLS) applications had been made to authorise these. People’s wishes were established through a variety of communication techniques, including use of signing.

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 22 October 2020) and there was one breach of regulation 17 (Good governance) in record keeping. We issued a requirement notice in relation to this breach. The provider completed an action plan after the last inspection to show what they would do to improve and by when.

At this inspection we found significant improvements had been made to records and the provider was no longer in breach of the regulation we found at the previous inspection. We did however find a breach of Regulation 12 (Safe care and Treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to managing choking risks and prevention of spread of infection. The service remains rated Requires Improvement.

Why we inspected

We carried out an announced targeted inspection of this service on 15 September 2020, to follow up on previous requirements and enforcement from our inspection in November 2019. While legal requirements on existing breaches had been met, a new breach of legal requirements (record-keeping) was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. We also looked at two domains rated requires improvement in 2019 which had not been included in the 2020 inspection. This report only covers our findings in relation to the Key Questions Well-Led, which contain those requirements, Effective and Caring.

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 ratings from the previous inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The last rating for this service was requires improvement (published 22 October 2020). The service remains rated requires improvement. This is based on the findings at this inspection. This service has been rated requires improvement for the last three consecutive inspections.

We have found evidence that the provider needs to make improvements. Please see the Effective and Well-Led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Further to our feedback, the provider took immediate robust action to ensure people’s safety at the service. The provider told us they would address performance issues that had led to this shortfall and implemented enhanced monitoring of the service in the interim.

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

Follow up

We will request an action plan for 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.

Branksome House is a residential care home providing personal care for up to nine adults with learning disabilities and/or autistic spectrum disorder needs. At the time of the inspection seven people were living there and receiving care.

The service was developed and designed before Registering the Right Support came into existence. Despite this, the service was managed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

The provider’s quality assurance processes had improved and were effective in driving in improvements across the service. This was evident in the premises, fire safety and review of incidents and accidents, to ensure people received a safe service. People received their medicines as prescribed. Some improvement to people’s records was still needed and the provider had started making these improvements during the inspection.

The registered manager provided good support for staff to be able to do their job effectively. Staff knew people well and the support they required. People, relatives and staff were positive about the provider and the support people received from staff.

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.

Following our previous inspection the outcomes for people using the service had improved and reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible and staying in contact with loved ones. The service was a hub of activity with friendly staff providing care and support in a way people liked and enjoyed. Positive interactions took place between people, staff and each other throughout our visit.

There were effective infection prevention and control systems in place to ensure the risk of infection was managed. Staff followed appropriate infection control procedures, during the COVID-19 pandemic.

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 7 February 2020) and there were four breaches of regulation in Regulation 9 (Person centred care), Regulation 15 (Premises and Equipment), regulation 12 (Safe care and Treatment) and Regulation 17 (Good Governance).

Following our last inspection, we served two Warning Notices on the provider. We required them to be compliant with Regulation 12 (Safe care and treatment) and Regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 by 25 March 2020. We issued requirement notices for Regulation 9 (Person Centred Care) and Regulation 15 (Premises and Equipment).

The provider completed an action plan after the last inspection to show what they would do to improve and by when.

At this inspection we found significant improvements had been made and the provider was no longer in breach of the regulations we found at the previous inspection.

We did however find a new breach of Regulation 17 (2) (c) (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to people’s records.

The service remains rated Requires Improvement.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. We also 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 coronavirus and other infection outbreaks effectively.

This report only covers our findings in relation to the Key Questions Safe, Responsive and Well-led which contain those requirements.

We reviewed the information we held about the service. 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 have found evidence that the provider needs to make further improvements in the ‘Well-led’ section. Please see full report for detail.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Branksome House 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 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. We have identified one breach in relation to good governance at this inspection.

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.

About the service

Branksome House is a residential care home providing personal care for up to to nine adults with learning disabilities and/or autistic spectrum disorder needs. At the time of the inspection seven people were receiving care.

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

The new provider’s quality assurance systems to assess, monitor and improve the quality and safety of the service were not operated effectively. Shortfalls in the service had therefore not always been promptly identified and addressed.

At the time of the inspection the local authority was working closely with the provider to make the required improvements. The provider kept us updated of the action they were taking to address the risk and quality concerns.

The service did not always consistently apply the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people did not fully reflect the principles and values of Registering the Right Support for the following reasons:

People were supported by staff who had been recruited safely. People received their medicines as prescribed. However, not all practices were safe enough.

Risks associated with people's care needs were not always appropriately assessed and information for staff on how to provide safe support to people were not always documented or reviewed following safety incidents.

People were not always adequately supported to keep their homes well maintained and cleaned.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. The service had not always maintained a current record of people’s capacity to make decisions.

Sufficient numbers of staff were available during the inspection to keep people safe. The provider was taking action to improve the support to staff to enable them to meet the needs of people living at Branksome House.

People did not always receive person centred care that reflected their personal preferences and met their social needs. Care records did not always show the support people required and had received.

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

Rating at last inspection

This was the first inspection of the service under the new legal entity. The service was last inspected under the old provider and was rated Good.

At this inspection, we found the service had deteriorated to be Requires Improvement. We have found evidence that the provider needs to make improvements. Please see the Safe, Effective, Caring, Responsive and Well-led sections of this full report.

Why we inspected

The inspection was prompted in part due to concerns received from local authority commissioners about areas of concern such as the management of people’s medicines, infection control, staffing and risk assessments. A decision was made for us to inspect and examine those risks.

Enforcement

We have identified breaches in relation to Regulations 9, 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Please see the action we have told the provider to take at the end of this report. We issued two warning notices to the provider informing them they must be compliant with both regulations.

Follow up

The provider started taking immediate action during our inspection to address the shortfalls we found and to mitigate the risks.

We will request to 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 request an action plan for 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.