Brownscombe Residency

Brownscombe Residency is a care home registered to provide accommodation and personal care for up to 55 older people. At the time of our inspection there were 39 people living at the service. Some people using the service were living with dementia.

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

People felt safe using the service because they were supported by staff who knew their needs well and knew how to manage risks associated with their care. Staff understood their responsibilities in terms of keeping people safe from abuse and avoidable harm. Action had been taken to reduce the risk of the spread of infection and the provider had ensured practices were updated according to national guidance during the COVID-19 pandemic.

People's needs and choices were assessed and planned for, and their preferences had been considered. Staff were safely recruited and inducted. They had access to training and supervision to ensure they had the skills to support people effectively.

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 supported people to access healthcare services as required. People were supported by staff who knew them well and had the information required to meet their needs. People and relatives were all consistently positive about the staff and the support they received.

The registered manager provided clear direction and positive leadership. Staff felt valued and supported and were confident that people received good care. Systems and processes for monitoring quality and safety were effective.

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 15 July 2019).

Why we inspected

We received concerns in relation to staff training and access to healthcare services. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. We found no evidence during this inspection that people were at risk of harm from this concern.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

Follow up

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

People’s experience of using this service:

People were positive about living at the service. Comments include, ““[The service is] very comfortable” and the staff are, Very kind.” People had a variety of support needs and the staff team had provided person-centred care.

Risks to people’s safety had been assessed and measures implemented to keep them safe. Staff were aware of their responsibilities to safeguard people and showed good knowledge in identifying different safeguarding concerns and how to manage concerns quickly.

Staff had received training and support with regards to people’s individual health needs. Even when staff were busy they maintained a relaxed attitude and this meant there was a warm, comfortable atmosphere in the home, people always had the support they required and staff always made the time to speak to people living in the home.

People received a personalised service and were involved in developing their care plans. Staff knew people’s life histories, preferences and routines. Activities were based around people’s choices and people were supported to take part in the running of their home.

People were supported to have maximum choice and control of their lives and staff them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

There was a positive culture within the service where people, staff and relatives felt listened to. The registered manager felt supported by the provider and this flowed through the service. Quality assurance systems were in place which ensured high standards were maintained.

Rating at last inspection: The rating at the last inspection was Good. The report of the last inspection was published on 22 December 2016.

Why we inspected: This was a planned comprehensive inspection to confirm the service remained Good.

Follow up: We will continue to monitor all intelligence received about the service to ensure the next planned inspection is scheduled accordingly.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Brownscombe House on our website at www.cqc.org.uk.

There was a registered manager at the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. 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.

We inspected Brownscombe House Nursing and Residential Home on 29 November 2016. The inspection was unannounced. The service was last inspected in September 2014 when it was found to be meeting the requirements of the regulations.

People told us they felt safe at the service and with the staff who supported them. People told us, “Yes I feel very safe,” and a relative told us, “Oh yes, it is very good here, excellent really. There is consistency so (my relative) feels safe as he sees the same team.”

People told us they received their medicines on time. Medicines administration records were kept appropriately and medicines were stored and managed to a good standard.

Staff had been suitably trained to recognise potential signs of abuse. Staff told us they would be confident to report concerns to management, and thought management would deal with any issues appropriately.

Staff training was delivered to a good standard, and staff received updates about important skills such as moving and handling at regular intervals. Staff also received training about the needs of people with dementia.

Recruitment processes were satisfactory as pre-employment checks had been completed to help ensure people’s safety. This included written references and an enhanced Disclosure and Barring Service check, which helped find out if a person was suitable to work with vulnerable adults.

People had access to medical professionals such as a general practitioner, dentist, chiropodist and an optician. People said they received enough support from these professionals.

There were enough staff on duty and people said they received timely support from staff when it was needed. People said call bells were answered promptly and we observed staff being attentive to people’s needs.

The service had a programme of organised activities, and an activity organiser was employed. These activities included activities such as board games, manicures, trips out, and sing-alongs. Some external entertainers such as musicians and singers visited.

Care files contained information such as a care plan and these were regularly reviewed. The service had appropriate systems in place to assess people’s capacity in line with legislation and guidance, for example using the Mental Capacity Act (2005).

People were very happy with their meals. Everyone said they always had enough to eat and drink. Comments received about the meals included, “The meals are very good and nutritious,” and people said they had a choice. People said they received enough support when they needed help with eating or drinking.

People said if they had any concerns or complaints they would feel confident discussing these with staff members or management, or they would ask their relative to resolve the problem. They were sure the correct action would be taken if they made a complaint.

People felt the service was well managed. We were told, “The manager is very nice.” There were satisfactory systems in place to monitor the quality of the service.

We found that action had been taken and as a result people's care and safety had improved.

People were treated with respect and staff asked their permission before they delivered care and explained to people what they were doing during that care. One person said, "The staff are lovely they always help me and ask me what I want". Another person said, "The girls are so kind they ask me before they do anything and they come when I need them". We observed the staff asking someone's permission before they helped them to move from one room to another and then kindly explaining each step of the process so the person was reassured. We heard this person thanking the staff after they were made comfortable.

People's needs had been assessed and planned and staff were delivering the care that people required and preferred. The care plans had been reviewed and updated and people or their relatives had been asked to contribute their opinions and agreement to their plan of care. The staff had read people's care plans and they knew each person's needs and how to care for them.

Staff had been recruited and trained appropriately and people were being cared for by enough staff with suitable qualifications and skills.

The acting manager had submitted their application to register with the commission and this was in the process of being considered. The acting manager had completed audits to assess and monitor the quality of the service and an action plan was being completed to make the required improvements. The provider's representative was supporting the acting manager to ensure the improvements were sustained.

If you wish to see the detailed evidence supporting our summary please read our full report.

We considered our inspection findings to answer questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

Is the service safe?

People were not protected from the risk of inappropriate or unsafe care. This was because the provider failed to have effective systems in place to assess, plan, review and monitor the care and support provided to people who used the service. In addition procedures were not in in place to identify, assess and manage risks to the health, safety and welfare of people and others in relation to activities and incidents. People did not have access to choice or to remain in control of decisions about their care and lives.

Relatives of people who used the service commented that the lack of staff effected people's care. One relative said, "People can call out for the toilet for a long time." Another relative said, "People have to wait for help." We found that the staff did not understand the care individual people required or preferred. This was partly due to the lack of recorded information but also because some staff had never worked in the home before and had not had time to read the information that was available about how to meet people's needs. Our observations confirmed that the lack of adequate staff numbers affected the care the staff could provide and meant people were at risk of unsafe or inappropriate care.

The two permanent members of staff we spoke with had a clear understanding of how to report any concerns related to safeguarding and protecting people form abuse and we saw form the records they had completed a training course in safeguarding.

We saw that emergency equipment was in place and staff had been trained to use this. There was a plan for staff to follow in the event of an emergency.

Is the service effective?

People's care needs had not been assessed effectively and care had not been planned to take into account people's needs, preferences, likes and dislikes. People had not always been involved in planning their care and the staff were unaware of peoples' needs. We observed ineffective care being delivered at times which meant people were at risk. This particularly related to manual handling practices which were unsafe.

Not all the staff had received training to meet the needs of the people who used the service. The agency staff who were working in the home had not worked there before. They had not been trained to use the equipment or to deliver appropriate care to people and they relied on being told what to do by more experienced staff. We observed times when they delivered care without guidance from permanent staff.

We spoke with five people and three relatives of people who used the service. They were complimentary about the care and kindness of the staff apart from comments related to a lack of adequate staff numbers and the care provided by one member of staff. One person we spoke with said, 'The staff are kind and caring." One relative said, "There are not enough staff to help although the staff do an exceptional job considering."

All of the people who used the service were registered with a local GP practice and we saw that when a G.P had visited this had been recorded. People told us that they could relay on staff to call a doctor when this was needed.

We asked staff about one person and was told they had received dental treatment recently but there was no record of this despite them having continued dental health problems. It was not clear that further advice had been sought or that the continuing problem had been reported to senior staff as it had not been documented. Therefore, people could not be assured that there was a plan to protect their health or to ensure health advice was followed.

Is the service caring?

People were generally supported by kind and caring staff. We witnessed interactions between people and staff which were caring and compassionate. However, we also witnessed interactions where staff provided care without explanation to the person. On one occasion we saw care was provided for 15 to 20 minutes without the member of staff speaking to the person they were with.

Is the service responsive?

The service had a number of systems in place to monitor care quality including audits and visits by the provider's representative. Although these systems were in place they had not been used effectively to identify shortfalls or to make improvements to the service.

People and their relatives had opportunities to share their views at meetings but these had not always been responded to or acted upon.

Is the service well-led?

At the time of the inspection there was no registered manager in post. The acting manager had been employed for five months. The staff all told us that they lacked leadership and support. The provider's representative told us they were surprised to hear our feedback following the inspection because they had not been alerted to the failures by the acting manager. The provider's representative told us that they had met with the manager regularly and visited the service at least eight weekly. This meant that people could not be assured that the registered provider was operating an effective system to monitor the quality or safety of the service.

We spoke with four members of staff who told us they all enjoyed caring for people and worked well as a team. 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 that day before doing so.

We were shown examples of person centred care records which were organised into separate sections. This provided clear guidance 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.

We found the interactions between staff and people who used the service to be positive, sensitive and friendly. People told us they were happy with the care and support they receive. People told us that they were treated with respect and their privacy and dignity was maintained.

One person said, "Staff treat me well and I have no concerns. I would not like to live anywhere else".

Another person said, "I like living here, it is very homely and comfortable and i wouldn't change a thing".

We spoke with with staff who told us that they were very happy working in the home. They told us the home had a relaxed and happy atmosphere. They felt supported in their work and felt the management was open and supportive.