Bramble Lodge

Bramble Lodge Care Home is a residential care home providing personal and nursing care to 51 people aged 65 and over at the time of the inspection. The service can support up to 63 people. The home is split onto separate floors, each of which has communal lounges and dining spaces. There are also large accessible outdoor spaces.

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

Overall medicines were managed well, however we have made a recommendation about the management of some medicines.

Systems were in place to protect people from abuse. People’s risks had been assessed and reviewed regularly. There were enough safely recruited staff to meet people's needs. Infection control measures were in place to keep people protected.

Staff were knowledgeable about people’s healthcare needs and appropriate monitoring was in place using nationally recognised tools. The home worked in partnership with healthcare professionals and ensured timely referrals when appropriate.

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.

Staff were kind and caring and respectful of people’s privacy, dignity and independence. Staff knew people’s needs well and what was important to them. People and relatives were involved in, and supported to understand, decisions about their care.

Care was personalised and considered people’s personal preferences. There was a range of different activities for people living there to get involved in and people were supported to have contact with friends and relatives.

There was a positive culture within the home and staff were passionate about providing high quality care. People had opportunities to give feed back and felt listened to. There was a governance system in place that monitored the quality of the service and the provider had plans in place to drive forward improvements.

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

Rating at last inspection

This service was registered with us on 4 November 2019 and this is the first comprehensive inspection. We completed an infection prevention and control (IPC) inspection which was not rated, this report was published on [23 May 2021] and we issued a warning notice. We inspected the service again in relation to IPC and found the provider had met the warning notice, again we did not provide a rating and published the report [4 September 2021]. The last rating for the service under the previous provider was requires improvement published on [1 May 2019].

Why we inspected

This was a planned inspection based on the provider not having received a comprehensive inspection since registration. It was also prompted in due to concerns received about staffing levels and the care support people received.

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 found no evidence during this inspection that people were at risk of harm from this concern.

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

Follow up

We will continue to monitor information we receive about the service until we 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.

¿ Visits were restricted in accordance with current government guidelines to reduce the risk of transmission of infection. People were supported to keep in contact with family through the use of video calls.

¿ Signage was clearly visible for all visitors advising of safe practice for testing, hand washing and use of personal protective equipment (PPE).

¿ People were supported in zones and cohorts within the home. Individual risk assessments were completed to ensure minimum disruption to people’s lives whilst keeping them safe.

¿ Personal emergency evacuation plans had been updated for people who had moved rooms as part of the cohorting safety measures implemented .

¿ Measures to improve social distancing had been taken. For example, the number of chairs in the lounge and dining areas had been reduced with additional space between them.

¿ Following the recent outbreak the management team were planning changes to further improve social distancing by altering the use of communal areas such as the activity room and downstairs lounge.

¿ One to one activities with people were taking place.

¿ Staff wore PPE correctly, following current government guidelines.

¿ Staff followed guidelines to safely put on and take off PPE at designated areas with foot operated waste bins available.

¿ There was full engagement by people and staff with whole home testing.

¿ The cleaning schedule in place included enhanced deep and spot cleaning guidelines. Cleaning products were used were appropriate and diluted to meet guidelines.

¿ The management team worked with the NHS infection prevention and control (IPC) team to develop safe practices and reduce risks to people and the transmission of infection.

¿ IPC audits were completed monthly. Issues were identified and actioned. For example, damaged flooring to toilet and bathroom areas had been replaced to enable effective cleaning.

¿ The management team had made space available to support safe social distancing during staff break times. The number of staff on a break at any one time was also reduced.

¿ The provider had used the learning from the current outbreak to consider changes and improvements. This were able to provide assurance in relation to safe IPC practice.

Bramble Lodge is a residential care home providing accommodation and personal care for 57 people aged 65 and over at the time of the inspection. The service can support up to 65 people. The accommodation is across three floors with a selection of communal areas on two of the floors. There are also large, accessible gardens.

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

The service had not had any known outbreaks of COVID-19, however, arrangements for the management of infection prevention and control was not suitable. Personal Protective Equipment (PPE) was not always worn safely and arrangements for putting on and removing PPE was not in accordance with best practice guidance.

Cleaning products were not diluted correctly to ensure all areas of the home were effectively cleaned. There were some areas of flooring which needed attention to ensure these could be suitably cleaned. Arrangements to oversee the quality of the service were not always effective and timely actions had not been completed where improvements had been identified.

The environment and care practices had not been reviewed to ensure people could socially distance and reduce the risk of transmission of infection.

People had good relationships with staff and relatives felt people were supported well. They were able to keep in touch with people whilst there were restrictions on visiting the home.

The staff worked with care professionals to ensure where concerns were identified with their care, these were investigated to keep people safe.

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

Rating at last inspection.

This service was registered with us on 05/11/2019 and this is the first inspection under this provider.

The last rating for the service under the previous provider was Requires Improvements (published on 01/09/19).

Why we inspected

We undertook this targeted inspection to check on a specific concern we had about the management of infection prevention and control and safeguarding concerns.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We have found evidence that the provider needs to make improvements. Please see the Safe section of this report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Bramble Lodge 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 to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified a breach in relation to how infection, prevention and control is managed at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.