Archived: Brendoncare Park Road

We found the following examples of good practice:

• Visitors were tested for Covid 19. If negative, visitors could prearrange a visit appointment where they had to wear PPE and use hand sanitiser. A visitor’s room had been created with direct access from the outside. Social distancing was maintained due to the layout of the room. Visits were co-ordinated and managed by a designated staff member and were for half an hour with time before and after for a thorough clean and disinfect of the room. Letters were sent to relatives to inform them of any changes to procedures. People were encouraged and supported to have video and phone calls with their relatives.

• Risk assessments had been carried out for people and appropriate action taken to shield or measures put in place to mitigate the risks. The home was split into three ‘households’. People stayed in their own areas of the home with regular staff and went to the activities room with people from their own area of the home.

• People’s temperatures were taken twice daily and observations for other signs were carried out using Restore 2, a standardised assessment tool for monitoring health.

• A whole home testing system was in place. Staff were tested every week. Staff testing positive or symptomatic isolated for 14 days. People were tested every 4 weeks. If tested positive or symptomatic, they would be isolated in their rooms and barrier nursed. Risk assessments had been carried out for all staff. Staff had been supported to shield where necessary. The company topped up any wages above the 80% furlough payment to support staff financially.

People’s experience of using this service:

• People were safely supported with personal care, medicines, health, wellbeing and nutrition.

• Staff received regular safeguarding training and could recognise signs and symptoms of possible abuse.

• Regular checks of the premises ensured risks from such as legionella minimised environmental risks to people.

• The premises were clean and staff were trained in infection prevention and control.

• Care plans were devised with people and reviewed with them each month.

• Staff were safely recruited and completed an in-depth induction and mandatory training before working in the service.

• Staff were supported by their line managers and received regular supervisions and annual appraisals.

• Regular GP visits and other healthcare professionals such as dentists enabled people to maintain health and well-being.

• The provider worked to the principles of the MCA 2005.

• Staff were warm and caring and supported people with empathy. There was a warm, homely atmosphere in the service.

• A range of activities were provided and the service was actively reviewing these to ensure they were appealing to people.

• Staff had recently completed a recognised end of life care training course and were cascading their learning to the rest of the team.

• The registered manager completed a range of audits to ensure care was provided safely and as planned.

• There were plans in place to re-provision the service to a different location in Winchester where a purpose-built home is planned.

• The service met the characteristics of Good in all areas. More information is in the full report.

Rating at last inspection: Brendoncare Park Road was rated as Requires Improvement at the last inspection on 17 January 2018.

Why we inspected: The inspection was a scheduled inspection based on the previous rating.

Follow up: We will continue to monitor the service and inspect again as per our re-inspection schedule.

We carried out an unannounced inspection of this home on 17 and 18 January 2018. At this inspection we found some of these concerns had not been addressed. Risks associated with people’s care had not always been identified and actions taken to mitigate these. Care records lacked order and were not always an accurate reflection of people’s needs. However, care plans were more person centred and audits in the home had improved although timely actions had not always been taken to address issues identified. There were sufficient staff available to meet people’s needs.

Brendoncare Park Road 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. Brendoncare Park Road accommodates up to 46 older people in one adapted building. There were 29 people living at the home at the time of our inspection. Accommodation is arranged over two floors with access to all areas by stairs and lift.

A registered manager was 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.

Risks associated with people’s care had not always been identified and assessed to ensure actions were taken to mitigate these.

Medicines were administered, stored and ordered in a safe and effective way. However some risks associated with medicines had not been identified.

Whilst care plans were person centred and held information on peoples likes, dislikes and preferences these lacked consistent, accurate and orderly information to support staff in meeting the needs of people.

The registered provider had a robust system of audits in place to ensure the safety and welfare of people. However, the action from audits of care records had not been completed in a timely way.

Staff had a good understanding of how to protect people from the risk of infection and policies and procedures were in place for the management of infection control.

People were supported by staff who had a good understanding of how to keep them safe, identify signs of abuse, discrimination and harassment and report these appropriately. Robust processes to check the suitability of staff to work with people were in place. There were sufficient staff deployed to meet the needs of people and they received appropriate training and support to ensure people were cared for in line with their needs and preferences.

Incidents and accidents were clearly documented and investigated. Actions and learning were identified from these and shared with all staff.

People were encouraged and supported to make decisions about their care and welfare, although this was not always clearly documented. Where people were not able to consent to their care, staff sought appropriate guidance and followed legislation designed to protect people’s rights and freedom.

People received nutritious meals in line with their needs and preferences, in an environment which provided a calm and relaxing dining experience for them. Those who required specific dietary were supported to manage these.

Staff were calm, kind and gentle in their interactions with people and supported them to remain independent whilst maintain their safety and welfare. People’s privacy and dignity was maintained and staff were caring and compassionate as they supported people. Staff knew people in the home very well and involved them and their relatives in the planning of their care although this was not always documented.

The home worked with a multidisciplinary team of health and social care professionals to ensure people’s individual needs were met.

The registered manager promoted an open and honest culture for working in the home. Staff felt supported in their roles and reflected the home’s philosophy of care that, “Residents should be able to make decisions for themselves and choose how to spend their time” in the care and support they provided. People and their relatives spoke highly of the registered manager and all their staff team.

Effective systems were in place to monitor and evaluate any concerns or complaints received and to ensure learning outcomes or improvements were identified from these. Staff encouraged people and their relatives to share their concerns and experiences with them.

At our last inspection of Brendoncare Park Road in December 2016 we found this service Required Improvement. Actions were required to address several areas including staffing levels, the monitoring of risk in the service and record keeping. At this inspection, whilst some improvements had been made in these areas, we identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see details of these breaches at the end of the full version of this report.

Brendoncare Park Road to be referred to as the home throughout this report, is a home which provides residential and nursing care for up to 49 older people who have a range of care and nursing needs. The home is situated close to the town of Winchester. The home comprises of three units one of which is over two floors in the original Brendon House. All other rooms are at ground floor level and facilities include two dining rooms and two lounges with a secure rear garden. At the time of the inspection 41 people were using the service.

The home has 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.

People and their relatives told us they felt the service was safe most of the time. We received some feedback about occasions when people had not felt safe.

Risks to people’s safety had been assessed and guidance was provided for staff to manage these risks appropriately. However, the information staff were required to record so that risk management plans could be evaluated was not always completed to show people had received the care and treatment they required. This included: records to confirm people’s food and fluid intake when they were at risk of poor hydration and nutrition and records to confirm people had received their topical medicines (prescribed creams and lotions applied to the skin) to prevent a deterioration in their skin integrity. Some equipment such as air flow mattresses used to prevent pressure sores developing were not set at the correct setting according to the person’s weight. People’s repositioning needs had not always been recorded as carried out as required. This meant there was a risk people could experience deterioration in their health when actions to reduce risks were not recorded or monitored as carried out so people’s treatment could be effectively evaluated.

Information available to staff at handover about people’s needs and risks was not fully completed or effectively communicated to all staff. This meant there was a risk that staff who did not know people well would not be fully briefed about people’s needs and risks.

People’s medicines were safely managed and administered appropriately with the exception of those medicines that are prescribed to be given at a specific time to help people manage their symptoms. We found these were not always given at the prescribed time which could result in less effective treatment for the person.

The registered manager took prompt action to address these concerns however more time was required for these improvements to be fully embedded into practice.

Most people we spoke with said there were not always enough staff readily available, staff were hurried at times and could take a long time to respond to call bells. Some staff told us staffing levels were ‘stretched’ and they did not always have time to spend with people to meet their emotional or social interaction needs. Some actions had been taken to improve staffing levels and more actions were planned, however; more time was required to implement and embed these improvements across the service.

Staff understood and followed the provider’s guidance to enable them to recognise and address any safeguarding concerns about people. Recruitment procedures were completed to ensure people were protected from the employment of unsuitable staff.

People were supported by staff who had relevant up to date training available which was regularly reviewed to ensure staff had the skills to proactively meet people’s individual needs.

People, where possible, were supported by staff to make their own decisions about their care and treatment. Staff were able to demonstrate that they complied with the requirements of the Mental Capacity Act 2005 when supporting people during their daily interactions. This involved making decisions on behalf of people who lacked the capacity to make a specific decision for themselves.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager was carrying out a review to ensure that people had been appropriately assessed as to whether they could consent to living at the home prior to applications being submitted. Some authorisations had been granted by the relevant supervisory body to ensure people were not being unlawfully restricted.

People spoke positively about the food available in the home. People confirmed they were offered a choice of meals and their dietary needs and preferences were catered for. People who required assistance to eat or who received their nutrition via a tube into their stomach were appropriately supported by staff.

When required people’s health needs were assessed by a range of visiting specialist healthcare professionals. This enabled nursing staff on site to deliver people’s planned healthcare treatment in line with specialist guidance.

People and their relatives told us staff were kind and caring and treated people with dignity and respect. Staff did not feel they always had enough meaningful time to spend with people outside of task focused care. However, staff we spoke with were able to tell us about the people they supported and people told us their care was delivered in line with their preferences once they had got to know them.

People’s decisions were respected by staff and this included people’s wishes and decisions for their end of life care. We saw that people’s relatives and loved ones had sent written compliments to the home to thank the staff for the ‘care and kindness’ people had received at the end of their life.

People or their relatives were not always involved in developing their care, support and treatment plans. Care plans were not always personalised with the detail of people’s individual preferences for their care and their personal history. The registered manager told us care plans were in the process of being further developed to reflect people’s personalised needs and information.

Activities were provided in the home by an activities coordinator and a team of volunteers. People spoke positively about the group activities available to them. People who chose not to or were unable to attend group activities received some individual support. However, there were not always enough staff resources to enable people to receive the level of social interaction they would prefer. This meant some people’s social and companionship needs were not met.

The provider had a complaints procedure in place and records confirmed complaints had been managed and responded to in line with these procedures.

There was a positive culture in the home and people and staff agreed it was ‘homely’ and ‘friendly’ place to live and work. Relatives told us the registered manager was a confident and effective leader. Staff were supported by management to carry out their responsibilities through the process of supervision and appraisal.

Some staff had identified shortfalls in effective communication between managers and staff and staff meetings were poorly attended. The registered manager had taken action to address this but not all staff felt this had improved sufficiently at the time of our inspection.

The quality assurance system in place was not always effective in assessing, monitoring and improving the quality and safety of the service people received, for example; the actions identified in a pharmacist audit and a provider quality assurance visit to improve the recording of topical cream administration had not addressed sufficiently to ensure this was rectified. Whilst people’s views had been sought on the quality of the service, it was not evident the information had been used to drive continuous improvement to the service.

The registered manager fulfilled their legal requirements by informing the Care Quality Commission (CQC) of notifiable incidents which occurred at the service. Notifiable incidents are those where significant events happened. This allowed the CQC to monitor that appropriate action was taken to keep people safe.

Care plans were person centred and documented people's wishes in relation to how their care was provided. Staff members understood how people expressed their needs and wishes about how they wanted to be supported with their care. Staff knew exactly how each person communicated which meant people's wishes were understood and respected. A family member told us "since he has been here he has improved dramatically. He is happy settled and safe here and we feel the same".

People chose how to occupy themselves in the service. We observed that people were spending time in the communal areas singing with staff and interacting with each other. During our inspection we observed people spending time in their bedrooms listening to music and talking to family members. We also saw one person spending time in their room completing crosswords and another knitting.

Staff were seen supporting people to eat and were patient and went at their pace. During the inspection one person declined the choices that were offered for lunch. The person was asked what they would like and requested an omelette which was prepared by the chef. This showed that people's wishes and choices were respected and acted upon.

People were given clear information about the home before they moved in to help them to make an informed decision about whether the service would be appropriate for them.

People's health care and welfare needs were recorded accurately and staff had a good understanding of the support that people required. Staff told us that the training that they received enabled them to do their job effectively.

People said that they felt safe at the home and said that they were confident that any concerns that they had would be addressed. There were good quality monitoring systems in place which meant that the service was operating effectively to manage the needs of the people using the service.