Brendoncare Stildon

At our last inspection we rated the service Good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection the service remained Good.

People felt safe at the home. There were processes in place for reporting and responding to allegations of abuse. Staff had a good understanding of their roles and responsibilities and knew how to access policies and procedures regarding protecting people from abuse.

Risks to people were assessed, monitored and updated as and when necessary. Action was taken to reduce the risk of incidents and information about risks to people were documented in their care records so that staff were aware.

People liked the layout of the building and felt it was suitably adapted to meet their needs. The building was well maintained and there were systems in place for ensuring that regular checks of the environment and equipment, including fire procedures were carried out.

Staffing levels were assessed regularly and amended if people’s needs changed. There were arrangements in place for covering if staff were unable to come to work at short notice. There were out-of-hours arrangements in place to provide additional support to staff if needed. There were robust recruitment processes in place and all relevant checks such as Disclosure and Barring Service checks and the right to work in the UK were carried out.

Medicines were managed safely and staff administered them in line with recommended guidance. There was an electronic system for recording and monitoring that medicines had been administered safely.

Incidents were investigated and the provider learned from them and made changes as a result. Analysis was carried out to identify any patterns which could prevent any future incidents.

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

People were supported to maintain balanced diets and have input into menu’s and meal choices. People had specialist equipment to assist with maintaining independence when eating. Staff were aware of special dietary requirements and were able to cater for them.

Staff were trained and supported to obtain qualifications to enable them to assist people safely. Staff received regular supervision and were supported to develop in their roles. Staff had received training in specialist areas such as end of life care and mentoring. Clinical staff were supported to keep up their professional registrations through regular clinical updates and training.

People told us that staff were caring and kind. Staff spoke to people respectfully and encouraged people to remain independent with staff assisting when people needed them to. People were involved in their care plans and were supported to access additional services such as mental health services if they needed to.

People were kept informed about what was happening in the home on a daily basis and were able to choose what they wanted to do. People were supported to maintain their religious beliefs and participate in activities that they enjoyed.

There was an accessible complaints process in place which people knew how to use if they needed to, however, they told us hadn’t needed to.

The provider respected people’s wishes when they reached the end of their life. The registered manager worked with other services such as GPs and hospices to ensure that people were as pain free as possible. The service has been accredited with the Gold Standards Framework for providing end of life care.

Staff thought highly of the provider and registered manager. The vision and values of the organisation were visible within the home and staff were proud to work at the service. People and their relatives told us that they thought the service was well managed.

People and staff were asked for their opinion about the service and implemented suggestions that were put forward such as what activities were planned.

There were formal processes in place for assessing and monitoring the quality of the service provided such as audits. Where areas for improvement were identified, actions were carried out to address the issues.

The provider worked with other healthcare providers to ensure that people received care that met their needs and that they were aware of best practice and updates that were relevant to how the service was run.

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 and associated Regulations about how the service is run.

People were happy and relaxed with staff. They said they felt safe and there were sufficient staff to support them. One person told us, “A very good safe home, like my own home”. When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector. Staff were knowledgeable and trained in safeguarding adults and what action they should take if they suspected abuse was taking place.

Medicines were managed safely and in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.

People were being supported to make decisions in their best interests. The registered manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

Accidents and incidents were recorded appropriately and steps taken to minimise the risk of similar events happening in the future. Risks associated with the environment and equipment had been identified and managed. Emergency procedures were in place in the event of fire and people knew what to do, as did the staff.

Staff had received essential training and there were opportunities for additional training specific to the needs of the service, including the treatment of pressure damage and the care of people with Huntington's disease. Staff had received both one-to-one and group supervision meetings with their manager, and formal personal development plans, such as annual appraisals were in place. One member of staff told us, “It is clear when you have to have training, it is all organised for us. I came here with an NVQ and they’ve put me forward for an NVQ 3 course (National Vocational Qualification)”.

People were encouraged and supported to eat and drink well. There was a varied daily choice of meals and people were able to give feedback and have choice in what they ate and drank. One person told us, “Lovely food here. The chef comes round and asks us what we would like”. Special dietary requirements were met, and people’s weight was monitored, with their permission. Health care was accessible for people and appointments were made for regular check-ups as needed.

People chose how to spend their day and they took part in activities in the service and the community. People told us they enjoyed the activities, which included quizzes, singing, word games, exercises, bingo, arts and crafts and themed events, such as celebrations for Chinese New Year and Seafood Week. One person told us, “I enjoy singing. There are nice things to do here”. People were also encouraged to stay in touch with their families and receive visitors.

People felt well looked after and supported. We observed friendly and genuine relationships had developed between people and staff. One person told us, “Like my new family here. Happy people looking after us”. Care plans described people’s needs and preferences and they were encouraged to be as independent as possible.

People were encouraged to express their views and had completed surveys. Feedback received showed people were satisfied overall, and felt staff were friendly and helpful. People also said they felt listened to and any concerns or issues they raised were addressed.

Staff were asked for their opinions on the service and whether they were happy in their work. They felt supported within their roles, describing an ‘open door’ management approach, where managers were always available to discuss suggestions and address problems or concerns. The provider undertook quality assurance reviews to measure and monitor the standard of the service and drive improvement.

We found that people's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. Care plans were kept up to date and nursing support was provided as stated in care plans.

There were robust systems in place to ensure that people were cared for in a clean and hygienic environment. All parts of the home were clean and free from odour. Staff were aware of infection control guidelines and had received appropriate training.

We found that there were enough qualified, skilled and experienced staff to meet people's needs. Staffing levels were related to the dependency levels of people at the home. Staff were knowledgeable about the needs of people at the home and said they liked working there. One staff member said "It's a good staff team".

There were effective systems to regularly assess and monitor the quality of service that people receive. The manager had a good overview of how the home operated and what improvements needed to be made.

During our observation we saw that staff interacted well with people when they were supporting them. We saw that staff were knowledgeable about people's needs and preferences. We found staff were respectful and maintained people's dignity, privacy and independence. For example staff knocked on people's door before entering and they checked on how they wanted their care to be provided before doing so. We saw that activities were altered to suit individual needs.

We were shown examples of person centred care records which were well organised into separate sections. This provided clarity for staff. These had been developed for each individual and documented their wishes and preferences in relation to how their care was provided. A relative's assistance was sought with this where the person was unable to fully contribute themselves.

Equality and diversity had been considered in the service by looking at each individual's needs. Any equipment or adaptations needed were provided.