Brambling Lodge

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

The key question of safe was rated as good at our last inspection and continues to be rated good following this assessment. The service has continued to keep people as safe as possible and involves people in developing strategies to manage risk. There continues to be enough staff to meet people’s needs who have received training and support to maintain their skills. Staff had been recruited safely, received an induction, and had their competency checked before they worked independently. Staff understood their responsibility to report any concerns of abuse to the local authority.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

Staff, including ancillary staff, confirmed they had completed safeguarding training. They were confident to raise any concerns they had with the management team and were assured the would be addressed. A staff member told us, “They take it seriously”. They knew how to raise concerns outside of the service if needed, including with the local authority safeguarding team. The registered manager understood their role to report any concerns to the local authority and to work with them to keep people safe and reduce the risk of incidents happening again.

There were systems and processes in place to keep people safe from abuse and discrimination. The registered manager had responded to concerns raised by staff and taken appropriate action. The registered manager had been transparent and reported any concerns raised to the local authority.

People felt safe at the service. Relatives told us they felt their loved ones were safe at the service and they did not worry about them. A relative told us their loved one was, “very safe” and the care they received was “outstanding”. Everyone told us they were confident to raise any concerns they had with the staff and concerns raised had been addressed. A relative said, "I can ask if I have an issue with anything. They always listen and act on it”. People told us they trusted the staff and management team. A person said, “There is no one here I couldn’t trust. I can talk openly friend to friend with them”.

We observed staff making sure people were protected against abuse as much as possible. Staff supported people when they were becoming anxious reducing risks of them expressing themselves non verbally towards others causing distress. For example, one person was supported to sit on their own with a coffee while staff monitored them from a distance while they calmed down.

Potential risks to people's health and welfare had been assessed and there was guidance for staff to mitigate the risk. People's preferences to manage risk had been recorded. People and their relatives had been involved in developing risk assessments and these were reviewed when people's needs changed. Care plans contained guidance for staff about how to support people when they were unwell or distressed. Accidents and incidents were recorded and analysed for patterns or trends. When patterns had been identified, action was taken such as medicines reviews, to reduce the risk of them happening again.

People were supported to take risks and remain independent. One person was at risk of falling, their relative told us staff had identified the risk and supported the person to remain safe. This included using an alert mat to let staff know when they were walking around in their bedroom. Staff supported people to use mobility aids to reduce the risk of them falling. Another relative explained how staff had facilitated a medicines review by the GP and a reduction in medication had significantly reduced their relatives risk of falling. A third relative told us, “They have done everything they can to prevent them falling”. Care was planned to reduce the risk of people developing skin damage. A relative told us staff had quickly noted a red area on their loved one’s skin and contacted the district nurses who had provided treatment. They told us staff regularly repositioned their relative and had used prescribed creams, pressure relieving equipment and pillows to manage the risks. This had been effective and the person’s skin was healthy.

We observed staff encouraging people to take risks. For example, one person was anxious when walking, staff reassured them saying, “You’re going well”. The person was pleased and thanked the staff. When a person came out of their room without shoes or slippers on, staff quickly reminded them and supported them to put on appropriate footwear to reduce the risk of them falling. One person did not want their meal at lunchtime. Staff offered them a number of alternatives and the person chose a cheese and pickle sandwich, which they enjoyed. The person was concerned about a sandwich for their relative and staff assured them they would make a fresh sandwich for their relative when they arrived. The person remained calm and ate their lunch. Another person was reluctant to eat their lunch. We observed staff supporting them in a kind and gentle way, going back several times to check if the person had changed their mind. Staff knew the person liked sweet foods and offered them an alternative. The person accepted this and staff assisted them at their own pace, offering them small spoonful. The person accepted the support and ate two puddings. We observed meals and drinks were prepared in line with guidance from Speech and Language Therapists, to reduce the risk of people choking.

Staff understood how people communicated their emotions and described the techniques they used to help people remain calm. People were offered decaffeinated drinks to support them to remain calm. Some people needed support from staff to move around. Staff knew the equipment each person used, including hoists and personalised slings. Staff understood the risks of people developing skin damage and described how these risks were managed. This included applying prescribed creams to keep skin well moisturised, supporting people to move regularly and raising any concerns about changes in the colour or texture of people’s skin. They knew the equipment people used to manage risks including pressure relieving mattresses and cushions. They encouraged some people to rest on their bed in the afternoon or elevate their feet to further reduce the risks. Staff knew how to manage risk of weight loss. For example, they offered people foods that they new they liked, such as sweet things and offered them extra portions and snacks they liked.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

People told us there were enough staff to meet their needs. People's comments included, “The staff are very entertaining. We have a good old chat”, “Staff are very friendly. I never have any problems with them” and “They have provided light moments on a dark day”. A relative told us the “love and care” from staff had supported their loved one to make significant improvements following a long stay in hospital and the staff were “marvellous”. They told us the staff provided care ‘as well as family can”. Relatives told us there were enough staff at the service during the day and at night. A relative told us there was always an experienced senior carer on shift and staff checked on their loved one every half an hour during the night while they were unwell. A relative told us they had worked closely with the registered manager to plan their loved one’s care. They told us, “(Registered manager) is a wealth of knowledge and I feel informed about what will happen”. People told us the staff had the skills they needed to meet their needs. Comments included, "The care is second to none, the staff are very caring”.

Staff were recruited safely. There were processes in place to check staff were of satisfactory character to support vulnerable people. The registered manager used a dependency tool to calculate the number of staff needed to support people. Staff rotas showed the number of staff available each shift were above the number calculated. Staff had completed training appropriate to their role to meet people's needs. New staff received an induction and their competency checked before they worked independently. Staff received regular supervision to discuss their role and identify any development needs.

Staff, including ancillary staff, knew people well. We observed staff chatting to people and using their names. Kitchen staff checked people had finished their meal before clearing their plates and offered them a hot drink. They knew what people preferred and checked to make sure this was what they wanted on that occasion. When a person required support, staff kindly asked, “Do you want to come with me?”. The person said yes and they walked together at the person’s pace.

Staff told us they received enough training and confirmed they completed practical, moving and handling, first aid and fire evacuation training. Staff were supported to complete recognised qualifications in care if they wished. They told us they had discussions about their development and had been supported to develop their skills and knowledge and gain promotions. Staff confirmed they received regular supervision with the registered manager. They also told us they chatted with the registered manager and had catch ups when ever they were needed. Staff told us they had the opportunity to make suggestions at regular staff meetings. They also told us they were kept informed of any changes to people’s care during team meetings or at shift handovers. All the staff we spoke with told us they worked as a team and supported each other, this included ancillary staff including the house keeper and kitchen assistant. Staff told us they felt supported by the registered manager.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.