Archived: Bramble Lodge Care Home

Updated 21 September 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 checked 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 unannounced comprehensive inspection took place on 25 July and 31 July 2018 and was carried out by one adult social care inspector.

Prior to the inspection we contacted the commissioners of the relevant local authority, the local authority safeguarding team, the fire service and other professionals who had worked with the service to gather their views on the service being provided at Bramble Lodge Care Home. We used the 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 us some key information about the service, what the service does well and improvements they plan to make.

Before the inspection we reviewed all the information we held about the service, which included notifications submitted to Care Quality Commission (CQC) by the provider. Notifications are changes, events or incidents the provider is legally obliged to send us within required timescales.

During the inspection we spoke with five people who used the service and four relatives of people using the service. We reviewed a wide range of records, including four people’s care records and four people’s medicines records.

We looked at four staff recruitment files, including supervision, appraisal and training records, records relating to the management of the service and a wide variety of policies and procedures. We spent time observing people in the communal areas of the service.

We spoke with 13 members of staff, including the manager, the deputy manager, seven care staff, a lifestyle support worker who arranged activities, the chef, the maintenance person and the provider’s operations manager.

Updated 21 September 2018

This inspection took place on 25 and 31 July 2018. The first day of the inspection was unannounced, which meant that the staff and provider did not know we would be visiting. The second day was announced.

This service provides support and accommodation for up to 41 people who are assessed as requiring residential or nursing care. This includes support for people living with dementia and/or mental health conditions. At time of our inspection there were 19 people living at Bramble Lodge Care Home.

Bramble Lodge Care Home 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 home is a purpose built, detached building in a residential area of Middlesbrough. It is set out over two floors.

At our last inspection in January 2017 we found that there were continued gaps in records in all areas looked at. Audits had not highlighted any of the concerns which we found during inspection. Staff completed records for people when they had not been involved in their care and care records were not completed in a timely manner. A safeguarding alert for neglect had been upheld in respect of record keeping. We issued a warning notice for this breach of Regulation 17 (HSCA RA) Regulations 2014 in relation to Good governance. We asked the provider to make improvements in this area.

Whilst improvements had been made to quality assurance systems within the service, audits had not identified issues we found with staff training and the fire procedure. We have made a recommendation about provider audits.

We also found at the last inspection that people’s care records did not show if they were subject to a ‘Deprivation of Liberty Safeguard,’ (DoLS). Care plans did not contain any information about people’s capacity to consent or their level of understanding in each of their identified care needs. Staff displayed limited knowledge and understanding of DoLS and best interest decision making had not been carried out when needed. This was a breach of Regulation 11 in relation to the need for consent. We asked the provider to make improvements in this area and this action had been completed.

When we inspected the service, the manager was going through the process of becoming a registered manager having taken up their position in February 2018. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered person’s'. 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.

We found during this inspection that the fire evacuation procedure was not clear. Information provided by staff was inconsistent and contradicted information on notices displayed throughout the building. The manager sent us information following the inspection showing that the fire procedure had been rewritten and that liaison with the fire brigade had taken place. They also provided us with the dates that staff would be trained in the new procedure.

Nursing staff had not always received training or refresher training to develop and maintain their clinical skills in areas such as catheter care. The manager had ensured that care staff were scheduled to have or had received training to be able to carry out their role, including training in areas the provider deemed as mandatory such as health and safety, safe food handling and falls prevention. However, there was no evidence that staff had received face to face people movement training, only an online version. This meant that their competency in this area may not have been thoroughly assessed. The manager sent us a plan following this inspection which set out how the training issues identified would be addressed.

People’s files contained the information staff needed to support them. General risk assessments were in place and regularly reviewed. Risks to individuals were also documented with information available for staff in how to manage these in order to reduce the risks to people.

We found that whilst medicines were administered appropriately the administration of medicines was not always recorded correctly.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

The environment was clean and staff knew how to help control the spread of infection. Equipment checks were undertaken to help ensure the environment was safe. We did however identify that wardrobes had not been secured to walls creating a risk to people living with dementia. Emergency contingency plans were in place.

Policies and procedures were in place to support staff in protecting people from harm, such as safeguarding and whistleblowing polices. Staff knew how to identify and report suspected abuse. People and their relatives felt the service was safe.

There were sufficient numbers of care staff on duty to ensure people’s needs were met. Safe recruitment practices were in place. Pre-employment checks were made to reduce the likelihood of employing staff who were unsuitable to work with vulnerable people.

Staff said that they were supported through regular supervision and that they felt they could approach the management team if they had any issues.

People had access to a range of healthcare services such as GPs, hospital departments and dentists.

People’s nutritional needs were met and they enjoyed a diet that met their preferences. People told us they enjoyed the food.

The premises were spacious and tidy however some areas required updating to ensure they were suitable for people living with dementia.

People were supported by a regular team of staff who were knowledgeable about their likes, dislikes and preferences. Visitors told us that they were made welcome.

Staff members were kind and caring towards people. People’s privacy, dignity and independence were respected. The policies and practices of the service helped to ensure that everyone was treated equally. Care plans included information about people as individuals including their preferences. End of life care procedures were in place.

Staff encouraged people to access a range of activities and to maintain personal relationships.

Meetings for staff took place regularly. Meetings for relatives and people living at the service were not well attended. The manager was considering how this could be improved.

The service worked with a range of health and social care professionals to ensure individual’s needs were being met. Feedback was sought to monitor and improve the service.

Staff were positive about the management team. They confirmed they could raise concerns. Learning took place following reviews of accidents and incidents where themes and trends were addressed. A clear complaints policy and procedure process was in place.

This is the fourth consecutive time the service has been rated Requires Improvement.