Brambling Lodge

Brambling Lodge is a residential care home providing personal care to 25 older people who were living with dementia at the time of the inspection. Brambling Lodge can support up to 27 people in one adapted building.

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

People appeared to be happy and feel safe living at the service. Relatives told us they thought their loved ones were supported to remain as safe as possible. Potential risks to people’s health, welfare and safety had been assessed and there was guidance in place to reduce risks.

Accidents and incidents had been recorded and analysed to identify patterns and trends to reduce the risk of them happening again. The registered manager and staff understood their responsibility to keep people safe from abuse and discrimination.

There were enough staff who had been recruited safely to meet people’s needs. Staff received training, supervision and appraisal to develop their skills to support people in a person-centred way.

Medicines were managed safely. Staff monitored people’s health and referred people to relevant healthcare professionals when required. Staff followed health professional guidance to keep people as healthy as possible.

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.

Each person had a care plan that contained detailed information about people’s choices and preferences. The care plans had been reviewed regularly, where possible, people had been involved.

People met with the registered manager before they moved into the service to check that staff would be able to meet their needs. People were supported to eat a balanced diet, people had a choice of meals, people’s preferences and dietary needs were catered for.

People were treated with dignity and respect. People were supported to be as independent as possible and express their views about the service. People’s end of life wishes were recorded. Staff worked with the GP and district nurses to support people at the end of their life.

There was an open and transparent culture within the service, people and staff were asked for their views and opinions about the service and these were acted on. There had been no formal complaints in the last year, relatives told us they knew how to complain. People received information in a way they could understand.

The provider and registered manager completed checks and audits on the quality of the service and acted when shortfalls were found. The provider supported the registered manager and staff to improve their skills to continue to improve the service.

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 14 August 2018) and there were multiple breaches of regulation. 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 improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

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.

Brambling Lodge 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. Brambling Lodge is registered to provide care and support for up to 27 people who may be living with dementia. At this inspection there were 25 people living at the service.

The registered manager had left the service in January 2018. There was a manager in post who was in the process of registering with the Care Quality Commission. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the Health and Social Care Act 2008 and associated Regulations about how the service is run. Following the inspection the manager's registration was confirmed.

We last inspected the service in June 2017 and we found three breaches of regulations, the provider had failed to deploy sufficient staff to meet people’s needs and medicines management was unsafe. The provider had failed to use feedback to improve the service, audits had not been effective, records were not always accurate and complete. Following the last inspection, we asked the provider to complete an action plan to show what they would do to meet the regulations. At this inspection, improvements had been made and two of the previous breaches had been met. There was one continued breach and a new breach of regulation was identified. This is the second consecutive time the service has been rated Requires Improvement.

Potential risks to people’s health and welfare had not been consistently assessed. Some people’s health conditions had not been assessed and there was no clear guidance for staff to mitigate risks and recognise when people were unwell. Care plans had been reviewed but were not consistently accurate or did not reflect the care and support being given.

Audits had been completed on all areas of the service, any shortfalls found were rectified. However, the manager had not completed an audit on the care plans reviewed during the inspection and the shortfalls found had not been identified.

At the last inspection, the provider had failed to have sufficient staff to meet people’s needs. At this inspection improvements had been made. There were sufficient staff to meet people’s needs, call bells were answered quickly and staff were always available in the lounge to support people.

Previously, medicines had not been managed safely. At this inspection, improvements had been made. There were systems in place to monitor the administration of medicines and previous shortfalls had been rectified.

People’s needs were assessed before they moved into the service following current guidelines. Staff monitored people’s health and referred them to specialist healthcare professionals when needed. Staff followed the advice given to keep people as healthy as possible. People were supported to be as active and independent as possible. Staff worked with the GP and district nurse to respond to people’s healthcare needs. People’s end of life wishes were recorded and staff had received training to support people to be as comfortable as possible.

Staff received training appropriate to their role, they received supervision to discuss their development and skills. Staff knew how to keep people safe from abuse. The manager had reported and worked with the local safeguarding authority when required. Incidents and accidents were recorded and analysed to identify trends and patterns, action was taken and lessons learned to reduce the risk of them happening again.

People were encouraged to plan their care and express their views. 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 provider had a complaints policy, this was displayed in the reception of the service. However, the policy was not available in other formats such as pictorial or easy read. This was an area for improvement.

Staff treated people with dignity and respect, people were encouraged to maintain relationships with people who were important to them. People had the opportunity to take part in activities they enjoyed.

There was an open and transparent culture, the manager had an open door policy and had developed relationships with people and relatives since starting at the service. Staff told us the manager was approachable and supported them.

People, relatives and staff attended meetings to express their views and suggestions for the service which were acted on. The manager worked with agencies and attended local groups and forums to improve their knowledge and skills.

Checks and audits had been completed on the environment and equipment that people used to make sure it was safe. The service was clean and odour free. The building met people’s needs and refurbishment was continuing.

Services that provide health and social care to people are required to inform the Care Quality Commission, (CQC), of important events that happen in the service. CQC check that appropriate action had been taken. The provider had submitted notifications to CQC in an appropriate and timely manner in line with guidance.

It is a legal requirement that a provider’s latest CQC inspection report rating is displayed at the service where a rating has been given. This is so that people, visitors and those seeking information about the service can be informed of our judgements. We found the provider had conspicuously displayed their rating on a notice board in the entrance hall. The service had displayed their rating on their website.

At this inspection a continued breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and an additional breach was identified. You can see what action we have asked the provider to take at the end of the report.

Brambling Lodge is a large detached residence, providing accommodation and care for up to 27 older people, some of whom may be living with dementia. Accommodation is set over two floors. There is a lift to assist people to get to the first floor. Bedrooms are situated on the ground and first floor and there are separate communal areas. It is located in the village of Shepherdswell on the outskirts of Dover. At the time of the inspection there were 23 people living at the service.

There was no registered manager working at the service. 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 and associated Regulations about how the service is run. We were supported during the inspection by the manager, operational director and the quality and compliance manager for the provider. The current manager had started working at the service in November 2016 and had just started the process of applying to be the registered manager with the Care Quality Commission.

We last inspected the service in September 2015. We made a recommendation that the provider use dependency assessments to ensure that enough staff were deployed effectively. At this inspection, there were not enough staff on duty, to provide effective and person centred care. Staff were not always available to provide support to people when they needed it, for example at meal times.

Staff spoke with people in a kind and compassionate way; there was a warm and caring relationship between people and staff. Staff knew people well and how to support them if they were anxious or upset. However, people were not always treated with dignity and respect due to not having sufficient numbers of staff on duty.

People’s medicines were not managed and recorded accurately. People did not always receive their medicines when they needed them.

When people lacked mental capacity to make decisions, the principles of the Mental Capacity Act (MCA) 2005, were not always followed. When a person lacks capacity to make a decision, any decisions should be made in the person’s best interests and be the least restrictive available. Decisions had been made when people lacked capacity but there was no evidence that best interests meeting had taken place or why the decisions had been made and if it was the least restrictive option.

The staff asked people for their consent before providing them with care and support. The manager understood their responsibility to gain authorisation to restrict people’s liberty under the MCA and Deprivation of Liberty Safeguards (DoLS), applications had been made in line with current guidance.

Staff knew and understood their roles and responsibilities. Staff had received training relevant to their roles; however, this needed to be updated. Staff had not received regular, planned one to one supervisions to discuss their training and development. Regular staff meetings gave staff the opportunity to voice their opinions. Staff were recruited safely.

Staff told us that they had not always felt supported by the manager; however, this was improving as the manager was settling into their role. Staff told us that the manager was approachable and listened to them.

People and relatives told us they felt safe at Brambling Lodge. Systems were in place to protect people from harm and abuse and staff knew who to report any concerns to if they felt they were not being dealt with. Accidents and incidents were reported and analysed to identify any patterns or trends to help reduce the likelihood of the incident or accident happening again. Staff completed checks on the environment and equipment to ensure people were kept as safe as possible.

Care plans and risk assessments were detailed and person centred. The care plans included people’s preferred routines, wishes, preferences and abilities. Staff knew people well and understood different people’s needs and how to keep people as safe as possible. Care plans were reviewed and if people became unwell or their health deteriorated the staff contacted their doctor or other health professionals.

People told us that they liked the meals. People had a choice of meals and specialist diets were catered for. People were supported to eat a healthy, balance diet. Staff understood people’s likes and dislikes and dietary requirements.

There was an activity programme for people to enjoy; however, not everyone was able to take part. Some people were not always supported to maintain their interests. People and their relatives said they had no complaints but felt they were able to raise complaints with the staff and manager. There were systems in place for monitoring the quality of the service and an action plan had been developed for any shortfalls identified.

Staff told us that they worked as a team and felt that the manager was now starting to lead the team. Staff were aware of their roles and responsibilities. The staff had worked as a team for a long time and had a clear vision of the person being at the centre of everything they do. However, they felt that the lack of staff meant that they were not always doing this and people were not always getting the support they needed.

Services that provide health and social care to people are required to inform CQC of important events that happen in the service. CQC check that appropriate action had been taken. The registered manager had submitted notifications to CQC in an appropriate and timely manner in line with CQC guidelines.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We found that staff were engaging with people each time they walked past. We saw that staff were encouraging people to participate in the activities and their daily routines. Staff listened to people and took their views seriously and answered their questions in a way that they could understand.

Individual personalised care plans were in place to make sure people were receiving the care they needed. We found that there were systems in place to make sure people were receiving their medication safely.

Relatives told us that staffing levels were satisfactory and we saw that staff attended to people promptly when they needed attention.

Systems were in place to monitor the service that people received to ensure that the service was satisfactory and safe.

Relatives and people using the service told us they did not have any complaints but would not hesitate to speak to the manger or staff if they had any concerns.