Brackendale House

People’s experience of using this service:

People living at Brackendale House participated in activities and involvement in the local community. Staff showed kindness and compassion and placed value on their caring role and involvement in people’s lives. People were offered a choice of meals and staff closely monitored people assessed to be at risk of poor food and fluid intake.

The service had completed end of life care training to ensure people received high standards of care and support and were involved in the planning of their care at that stage of their life. The service had good working relationships with the local GP practice and mental healthcare professionals.

The service worked in partnership with people and encouraged feedback on the care provided. We received mainly positive feedback from people about the staff and service received. Staff told us they enjoyed working at Brackendale House and spoke highly of the support and encouragement provided by the registered manager.

People had their care and support needs met by sufficient numbers of suitably trained staff. The care environment was clean and comfortable throughout. Some decoration was tired, but the service had a rolling refurbishment plan in place. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; policies and systems in the service supported this practice.

The service had good governance arrangements in place and completed internal quality checks and audits. Findings from these were regularly reviewed by the registered manager and provider.

Rating at last inspection: Brackendale House was rated overall Requires Improvement, with Requires Improvement for effective, responsive and well-led, and good for the remaining two key questions. The report was published June 2018.

The service was in breach of regulations 9 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service sent us an action plan to provide assurances on how the service would address the breaches. This action plan was reviewed as part of this inspection.

Why we inspected: This was a scheduled, comprehensive inspection, completed in line with our inspection schedule for services rated as Requires Improvement.

Follow up: We will continue to monitor this service and will reinspect in line with our schedule for those services rated as Good.

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

Brackendale House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Brackendale House accommodates up to 14 people in one adapted building. On the day of our inspection there were 14 people living in the service.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.” Registering the Right Support CQC policy

The service had a registered manager. 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.’

At our previous inspection in October 2016 we found that the provider was in breach of Regulations 10, 12, 17 and 18 of the Health and Social Care Act (Regulated Activities) Regulations 2014. The provider had addressed some of the concerns and was no longer in breach of Regulations 10, 12 and 18. This was because improvements had been made to the premises and to staffing levels. However, we identified a breach of Regulation 9 and a continued breach of Regulation 17.

People were not given the opportunity to be involved in the development and review of their care plan. Care plans were not always reflective of people’s current needs. Information relevant to people’s care and support was not always included in the care plan. Documentation relevant to people’s mental capacity was sometimes contradictory and the decision making process was not always documented.

The provider had audits and quality assurances in place. However, when deficiencies were identified action to address these was not taken in a timely way with the allocation of appropriate resources. This was a concern which had been identified at the previous inspection.

We have made a recommendation about end of life care planning.

Since our last inspection the provider had made improvements to the environment with the installation of new sanitary ware, curtains and window blinds. This meant that care and support was provided in a way which supported people’s privacy and dignity.

People were protected from abuse and avoidable harm. People living at the service confirmed they were kept safe and had no concerns about their safety and wellbeing. Policies and procedures were being followed by staff to safeguard people. People received their medication as they should. Risks to people were identified and managed to prevent people from receiving unsafe care and support. People were protected by the registered provider’s arrangements for the prevention and control of infection.

People’s nutritional and hydration needs were met and they received appropriate healthcare support as and when needed from a variety of professionals and services. The service worked together with other organisations to ensure people received coordinated care and support.

People were supported to be as independent as possible and engaged in activities both inside and outside the service. Medicines were administered safely and appropriately.

The service had a registered manager in post. 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.

This inspection found that the provider was in breach of four regulations. These related to safe care and treatment, staffing, dignity and respect and governance.

People did not live in a consistently safe environment because there were not enough staff to manage safety hazards appropriately and ensure the premises were always clean and hygienic.

Identified risks to people’s safety were recorded on an individual basis and there was guidance for staff to be able to know how to support people safely and effectively. However, there were not always enough staff to ensure the guidance to minimise risks was followed consistently.

The manager and staff in the home cared about the people they supported and treated people with respect. However, some aspects of the home’s environment did not always promote people’s dignity and self-respect.

There were a number of systems in place to monitor the quality of the service. Regular audits were also carried out by the manager and provider, in order to identify any areas that needed improvement. However, some of the improvements identified as required were taking a long time to complete and some audits were not effective.

Medicines were managed and administered safely in the home and people received their medicines as prescribed. We identified that some topical medicines such as creams and drops, did not show the dates they had been opened. However, the manager rectified this completely during our inspection.

People were supported by staff who were skilled and knowledgeable in their work and new members of staff completed an induction. Staff were supported well by the manager and the manager was being supported well by their direct line manager. There had been an increase in the level of support from the provider, in respect of improving and maintaining the service, although provider level decisions and subsequent improvement actions were slow.

People were helped to keep safe by staff who knew how to recognise signs of possible abuse and knew the correct procedures for reporting concerns. In addition, staff received training that was relevant for their roles and appropriate recruitment checks were carried out before staff began working in the home.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005, Deprivation of Liberty Safeguards (DoLS), and to report on what we find. The manager and staff understood the MCA and ensured that consent to care and treatment was sought in line with legislation and guidance.

People had enough to eat and drink and made choices about their meals. People’s intake of food and drinks was monitored and recorded when needed, although there were gaps in some of these records. When any needs or concerns were identified, appropriate action was taken and referrals were made to relevant healthcare professionals.

Assessments were completed prior to admission, to ensure the service could meet people’s needs. People were involved in planning their care so they could receive care and support that was individual to their needs. However, there were not always enough staff to consistently provide individualised support to people.

People living in the home were welcome to have visitors and people were encouraged to be as independent as possible. People were able to voice their concerns or make a complaint if they felt they needed to. Staff listened to people and appropriate responses were given and action was taken where possible.

The manager was well intentioned. People’s needs were being met to the best of the manager and staff’s ability, with the resources available to them. Communication between the manager, staff and people living in the home was frequent and effective.

We looked at the care records for four of the people who used the service. Each record showed evidence that people's wishes had been taken into account when care was planned. However, these care records did not have a space allocated for the person's signature to indicate that they consented to the plans. This meant that it was not possible to verify the person's consent without speaking with the person.

Each care plan was based on comprehensive risk assessments and on a detailed assessment of the person's individual needs. The plans took account of people's wishes and preferences where possible and were aimed at enabling people to be as independent as possible. People told us that they were happy living at Brackendale House and with the care and support staff gave them. One person told us 'The staff are ever so good at looking after me.' Another told us that 'The shops are just around the corner. It's so handy.'

The premises were safe and accessible. They promoted the wellbeing of the people who used the services. The provider's recruitment policy showed that they took steps to recruit appropriately skilled and experienced staff. The records we examined, including care plans and maintenance records, were complete. They could be accessed easily by staff and were stored securely.