Background to this inspection
Updated
9 October 2018
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
This inspection site visit took place on 30 August 2018 and was announced. The inspection was carried out by a single inspector.
Before the inspection we reviewed all the information we held about the service. This included notifications the home had sent us. A notification is the means by which providers tell us important information that affects the running of the service and the care people receive.
We used information the provider sent us in the Provider Information Return. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make.
We received feedback from two relatives and one person who lived at the service. We also spoke with the area manager the registered manager, two nurses and two care staff. We reviewed three people's care files, three Medicine Administration Records (MAR), policies, risk assessments, health and safety records, incident reports, consent to care and treatment and quality audits. We looked at two staff files, the recruitment process, complaints, and training and supervision records.
We walked around the building and observed care practice and interactions between care staff and people.
Updated
9 October 2018
The Brambles provides respite for adults with a learning disability and/or physical disability, in the South Yorkshire area. At the time of this announced inspection on 30 August 2018 there were four people who used the service. We announced our inspection to make sure that someone was available.
There is a registered manager in place who had been registered since September 2016. 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 Brambles is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The service was previously inspected in August 2017 and was rated requires improvement. We found there was one breach of the regulations. These referred to care records, risk management plans, capacity assessments and best interest decisions. We asked the provider to complete an improvement plan to show what they would do and by when, to improve the key questions of Safe, Effective, Responsive and Well-Led.
At this inspection, we found sufficient improvements to meet the previously breached regulation for good governance and have rated The Brambles as ‘good.’
People using the service appeared to feel safe and were comfortable in the presence of staff. Staff had received training to enable them to recognise signs of abuse and they felt confident in how to report any concerns. People had risk assessments in place to enable them to be as independent as possible whilst also remaining safe. Staff knew how to manage risks to promote people's safety, and balanced these with people's rights to take risks and remain independent. There were sufficient numbers of skilled staff on duty to support people to have their needs met safely. Effective recruitment processes were in place to ensure only suitable staff were employed.
Medicines were given to people as prescribed and disposed of safely by properly trained staff. Auditing processes were effective in identifying and addressing any medicines shortfalls. The storage, recording and stock control was robust and in line with guidance.
New staff were required to complete an induction and initial training. Training was regularly refreshed. Supervisions, annual appraisals and staff meetings enabled staff to raise any issues or suggestions.
There were enough staff deployed with the right experience and skills mix, to provide effective care and support to meet people's needs, although relatives did not always think staff deployment was effective. Staff were enabled to develop and maintain the necessary skills to meet people's needs.
Staff applied the principles of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards in their day to day care practice. For example, people were involved in best interest decisions about their care, to ensure their human and legal rights were protected.
People's needs were assessed before they moved into the service. These needs were met by staff who had the skills and knowledge to deliver effective support. People were supported to eat and drink enough to have a balanced diet, including those with associated health needs. People were supported to have healthier lives by having timely access to healthcare services. People lived in an environment which was suitable for their needs.
People received a service which was caring, they were treated with dignity and respect. Staff were compassionate and caring. Staff treated people's private information confidentially. People, where possible, made decisions about how their care was provided and were involved in reviews of their care together with people important to them.
Care was personalised to people's individual needs and preferences. Activities were available for people to participate in if they wished and people enjoyed spending time with staff, although one relative believed activities were not regular. Staff knew people's interests and needs well. There was a complaints policy available to people. Staff were open to any complaints and understood that responding to people's concerns was a part of good care. One relative found responses to complaints could be slow.
Staff were positive about the culture of the service and people felt the staff team were approachable and polite. The staff team worked with other organisations to make sure they followed current good practice. Maintenance records for equipment and the environment were up to date. Policies and procedures were up to date and available for staff to refer to. Staff said they were encouraged to suggest improvements to the service.
The provider had sent CQC notifications in a timely manner. Notifications are changes, events or incidents that the service must inform us about.
Quality monitoring systems were in place. A variety of audits were carried out and used to drive continuous improvement and ensure shortfalls in service delivery were identified and rectified.