Braemar Lodge Residential Care Home

Braemar Lodge Residential Care Home is a residential care home providing accommodation and personal care for 14 people at the time of the inspection. The service can support up to 17 older people and people living with dementia.

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

At our last inspection the provider had not ensured the systems to monitor and improve the quality and safety of the service were reliable and effective. At this inspection we found some improvements had been made however, the provider remained in breach of regulations.

The provider's quality monitoring system was not effective in assessing and improving the quality of the recruitment processes and the administration of ‘as required’ medicines was not managed in line with the individual’s protocols. Staff administered people’s medicines calmly and safely making sure people were not rushed. The medicine rounds were evenly spaced out throughout the day to help ensure people did not receive their medicine doses too close together or too late. Staff had been trained in the safe administration of medicines and had their competency assessed to ensure they remained competent to undertake this task safely.

The provider’s quality monitoring had failed to identify where short-term actions to promote the safety of one person had not been assessed or reviewed to find alternative options suitable to promote the safety and wellbeing of all people using the service. Staff and management did not always recognise how their actions or the environment impacted negatively on people’s privacy and dignity. Facilities provided for people to use were not always maintained in a way that promoted their dignity.

Some facilities such as a bath hoist and a commode chair were damaged and therefore posed a potential infection control risk. The registered manager was aware of these issues but only took the necessary action after the inspection. The provider’s infection prevention and control policy was up to date and visitors were welcomed at any time without restrictions imposed and in line with current government guidance.

The provider had systems to monitor accidents and incidents, the actions taken, and lessons learnt and were shared across the team as a result. The provider and registered manager gathered views and opinions about the service by surveys, meetings and ongoing communication with people and their relatives.

People were protected from the risk of abuse because the entire staff team had now received training and demonstrated a clear understanding on how to recognise and report abuse. People’s care plans and risk assessments had been reviewed since the previous inspection and transferred onto a digital system so that staff had access to the up-to-date information they needed to care for people safely.

Accidents and incidents were monitored and environmental risk assessments, were in place. The provider operated a robust recruitment and induction process where all the appropriate pre-employment checks were undertaken. Staff felt well supported by the management team.

The registered manager had a good understanding of their responsibilities towards the people they supported. They promoted an open culture where everyone’s views and opinions were valued. People, relatives and staff said they would be confident to approach a member of the management team should they wish to raise a concern.

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

Rating at last inspection and update

The last rating for this service was requires improvement. (Published 30 June 2022). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for two consecutive inspections.

Why we inspected

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 carried out an unannounced comprehensive inspection of this service on 11 May 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and management oversight.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service remains requires improvement. This is based on the findings at this inspection.

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

Enforcement and Recommendations

We have identified breaches in relation to dignity and management oversight at this inspection.

Please see the action we have told the provider to take at the end of this report.

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 meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Braemar Lodge Residential Care Home is a residential care home registered to provide personal care to up to 14 people. The service provides support to older people and people living with dementia over two floors. At the time of our inspection there were 17 people using the service.

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

People’s care plans and risk assessments were not always detailed and documentation relating to both fluid charts and medication was not always completed. People did not always receive care from enough competent staff who had received appropriate training.

There were not robust processes for oversight of the service. Training compliance was not well managed, and audits did not identify all issues. Cultural issues had been addressed but there remained concerns among some staff.

People were cared for by staff who were caring and knew them well. People and their relatives were positive about the care and support provided.

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.

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

Rating at last inspection

The last rating for this service was good (published 12 July 2019).

Previous recommendations

At our last inspection we recommended that the provider seek guidance in relation to health and safety within a care home and consult guidance in infection control and prevention and apply it. We found these recommendations had been met.

Why we inspected

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 received concerns in relation to staffing levels, training, unsafe practices and potential neglect. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Braemar Lodge Residential Care Home 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 service and will take further action if needed.

We have identified breaches in relation to safeguarding, risk assessments, staff training and competency, medication documentation and quality monitoring systems at this inspection.

Please see the action we have told the provider to take at the end of this report.

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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Braemar Lodge is a residential care home providing personal and nursing care to 12 people aged 65 and over at the time of the inspection. The service can support up to 14 people.

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

The provider had missed some areas within the environment that posed a potential risk to people’s safety, and fire safety arrangements needed strengthening. We have made a recommendation for the provider to seek guidance in relation to health and safety within a care home and apply it.

The premises were clean but there were no facilities or arrangements in place to support effective cleaning of commode pans and urinals. We have made a recommendation for the provider to consult guidance in infection control and prevention. The provider informed us the day after the inspection what action they were taking to address these issues.

The atmosphere in the home was warm and welcoming and staff were friendly and considerate. They had formed positive and trusting relationships with people they cared for and were responsive to their needs. Staff had a full awareness and understanding of abuse and their responsibilities to protect people. The provider carried out safe recruitment practices. There were enough numbers of staff with the right skills and competencies to meet the current needs of people using the service.

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 treated people with kindness and respect; they understood each person’s needs, preferences, and what was important to them.

People’s wellbeing was promoted; staff provided a range of group activities which encouraged engagement and stimulation. We have made a recommendation about promoting an enabling environment for people living with dementia.

The staff worked well with external health care professionals and people were supported to access a range of health services as and when they were needed. People received their medicines as they should, in a safe and supportive way.

The service was well led, the registered manager provided clear and consistent leadership. People and staff felt well supported. Systems were in place to monitor the quality and safety of the service. The provider had an improvement plan in place which they were progressing to address and improve the quality and safety of the environment.

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

Rating at last inspection

The last rating for this service was Good (30 September 2017).

Why we inspected

The inspection was prompted in part due to concerns received about poor care practices and low staffing levels. A decision was made for us to inspect and examine those risks.

We did not find people were at risk from poor care practices or that staffing levels were insufficient. We have found evidence that the provider needs to make improvements. Please see the safe section of the full report.

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.

Braemer Lodge provides accommodation and personal care for up to 13 people some of whom may be living with dementia. At the time of our inspection 13 people were living at the service.

At our last inspection the service was rated as Requires Improvement. At this inspection we found the service Good.

The service was safe. Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. People were cared for safely by staff who had been recruited and employed after appropriate checks had been completed. People’s needs were met by sufficient numbers of staff. Medication was dispensed by staff who had received training to do so.

The service was effective. People were cared for and supported by staff who had received training to support people to meet their needs. The registered manager had a good understanding of their responsibilities in relation to the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. People were supported to eat and drink enough as to ensure they maintained a balanced diet and referrals to other health professionals were made when required.

The service was caring. Staff cared for people in an empathetic and kind manner. Staff had a good understanding of people’s preferences of care. Staff always worked hard to promote people’s independence through encouraging and supporting people to make informed decisions.

The service was responsive. People and their relatives were involved in the planning and review of their care. Care plans were reviewed on a regular basis and also when there was a change in care needs. People were supported to follow their interests and participate in social activities. The registered manager responded to complaints received in a timely manner.

The service was well-led. Staff, people and their relatives spoke very highly of the registered manager. The service had systems in place to monitor and provide good care and these were reviewed on a regular basis.

The service was last inspected in February 2016 were the Commission highlighted and number of concerns and we imposed conditions on the service of no further admissions could be made to the service. The provider wrote to us with actions they had taken since to improve the service. The service was previously rated inadequate overall and in special measures. Although vast improvements had been made since our last inspection, at this inspection the service has been rated as requires improvement as the provider will have to show sustained improvement and continued good care for the rating of the service to be changed following another inspection.

The service is required to have a registered manager; the manager was in the process of completing their application to become 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.

The service had made improvements to ensure staff delivered support that was effective and caring and this was in a way which promoted people’s independence and wellbeing, whilst people’s safety was ensured. Staff were recruited and employed upon completion of appropriate checks as part of a robust recruitment process. Sufficient numbers of staff enabled people’s individual needs to be met adequately. Trained staff dispensed medications and monitored people’s health satisfactorily.

Staff understood their responsibilities and how to keep people safe. People’s rights were also protected because management and staff understood the legal framework of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

The manager and staff ensured access to healthcare services were readily available to people and worked with a range of health professionals, such as social workers, community mental health nurses and GPs to implement care and support plans.

Staff were respectful and compassionate towards people ensuring privacy and dignity was valued. People were supported in a person centred way by staff who understood their roles in relation to encouraging independence whilst mitigating potential risks. People were supported to identify their own interests and pursue them with the assistance of staff. Person centred social activities took place within the service.

Systems were in place to make sure that people’s views were gathered. These included regular meetings, direct interactions with people and questionnaires being distributed to people, relatives and healthcare professionals. The service was assisted to run effectively by the use of quality monitoring audits carried out by the manager and provider, which identified any improvements needed and actions were taken. A complaints procedure was in place and had been implemented appropriately by the management team.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The service had a registered manager in post, however was no longer the manager of the service and was now working as part of the care team. A cancellation application from the registered manager has since been received in the Commission. A new manager had been promoted to this position and was in their first few days of managing the service when we carried out our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered Managers, 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.

Views about staffing levels were mixed and some people felt that there was not enough trained and experienced staff available to meet their needs. We also found that people or their families were not fully involved in planning and making decisions about their care. We found the service not to be responsive in identifying and meeting people’s individual care needs.

The manager and Provider could not demonstrate how the service was being run in the best interests of people living there.

Arrangements in place to keep the provider up to date with what was happening in the service were not effective. As a result there was a lack of positive leadership and managerial oversight. Systems in place to identify and monitor the safety and quality of the service were ineffective as they either did not recognise the shortfalls or when they did there was a lack of action to rectify them.

Staff did not have the skills and experience, and they were not deployed effectively to meet the needs of people. We found that staff did not always have enough time to spend with people to provide reassurance, interest and stimulation. There was a lack of knowledge around supporting and caring for people living with dementia including understanding how it affected people differently and how each individual should be cared for to promote their wellbeing as far as possible.

Medicines were securely locked away however the manager and Provider could not demonstrate that people received their medication as and when they needed it and/or as it had been prescribed. In addition the service did not monitor the room temperature of were the medication was stored which would help to ensure its quality and integrity.

The dining experience was varied as it did not meet all the people’s individual nutritional needs. As a result the manager and Provider were unable to demonstrate that people had enough to eat and drink to support their overall health and wellbeing.

Although relatives told us that staff treated people with kindness and were caring, we found the way the service was provided was not consistently caring. Staff did not always demonstrate a caring attitude towards the people they supported and some failed to promote people’s dignity or show respect to individuals. The majority of interactions by staff were routine and task orientated and we could not be assured that people who remained in their bedroom received appropriate care to meet their needs. This also meant they were socially isolated as opportunities provided for people to engage in social activities were limited.

Whilst we were concerned that some staff did not always recognise poor practice, suitable arrangements were in place to respond appropriately where an allegation of abuse had been made. There was a system in place to deal with people’s comments and complaints however we found the service needed to be more open and transparent in their responses.

You can see what action we told the provider to take at the back of the full version of the report.

We saw that care and support for each person was planned and reviewed with their involvement and consent as far as possible. Risks to the health, welfare and safety of people using the service were identified and managed. The service was responsive to people's changing needs and caring in their approach.

People enjoyed the food provided at the service and were able to exercise choice about what they ate and drank. Everyone was complimentary about the food and made comments such as, "The food is wonderful," "There is always plenty of choice," and, "They know what you like." People's welfare in relation to their nutrition was monitored to ensure their wellbeing.

There was sufficient specialist equipment such as hoists available to ensure that the service could meet people's individual needs safely. Equipment in place was kept serviced and maintained to ensure that it was fit for purpose.

People told us that they liked and got on well with all the staff working at Braemar Lodge. Staff were adequately trained and supported to care for people properly and to keep them safe.

The service was well managed and led. There were effective systems in place for monitoring and improving the quality and safety of the service, taking into account the views and suggestions of people living there.

We saw that works to improve the environment for people using the service had taken place and were ongoing. This was positive. However works had also created extra space and the provider was found to be accommodating too many people in the service. This meant that they were not complying with conditions applied to their registration with the Care Quality Commission.

Steps have now been taken to rectify this situation. An application is being processed to increase the number of people that can be accommodated at Braemar Lodge.