CQC report explained · a residential care home
What the CQC found at Bramble House
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, March 2020
Rated Good; inspectors found that safety, medicines records and management had improved since the previous inspection.
This was an unannounced focused inspection on 25 and 26 February 2020. Two inspectors spoke with staff, the provider, the manager, one person living at the home, three relatives and two healthcare professionals. They reviewed care records, medicines records and other information.
The inspectors found that people received their medicines safely, risks were assessed, staffing levels were sufficient and the home was clean. They also found that people were treated with kindness, staff knew people well and managers responded quickly when health needs changed.
The home had improved since the previous inspection, when it was rated Requires Improvement and had two breaches of regulation. The provider had introduced regular checks, improved records and used feedback to make changes. The home was no longer in breach of those regulations.
The overall rating was Good. However, this inspection only assessed Safe and Well-led. The ratings for Effective, Caring and Responsive were carried forward from the previous comprehensive inspection.
Medicines managed safely
The home had improved its medicines systems. Staff recorded the support given and had training and competency checks.
“People received their medicines as prescribed. Care staff kept a clear record of the support they had provided people regarding their prescribed medicines.” from the report
Risks were assessed
Care plans gave staff guidance about falls, mobility, distressed behaviour and malnutrition. Staff worked with healthcare professionals when people's needs changed.
“Comprehensive risk and care assessments provided staff with clear guidance on how to manage risks such as distressed behaviours, mobility and malnutrition and meet people's needs.” from the report
Enough staff
Inspectors found enough staff to meet people's needs. The home used a dependency tool and tried to use agency staff who knew the home.
“There were enough staff to meet peoples care needs.” from the report
Kind and welcoming culture
Relatives said staff were caring and knew people well. Inspectors observed a warm culture and found that people and relatives could speak with managers.
“We observed a caring and warm culture within the service.” from the report
Better oversight
The provider and manager had introduced regular audits covering medicines, health and safety and care plans. These checks were used to update an improvement plan.
“Since our last inspection the provider and registered manager had implemented a range of audits and quality monitoring systems which they completed on a regular basis.” from the report
Inspectors raised no specific concerns in this report.
- 01How do you now check that medicines are recorded correctly and that staff remain competent to administer them?
- 02How are care plans and risk assessments updated when a person's health, mobility or behaviour changes?
- 03How do you decide how many staff are needed on each shift, and how often are agency staff used?
- 04How do you check that the audits and quality monitoring systems continue to identify and fix problems?
- 05What was the rating and the main findings for Effective, Caring and Responsive at the previous comprehensive inspection?
This was a focused inspection of Safe and Well-led only; the ratings for Effective, Caring and Responsive carried over from the previous comprehensive inspection. This explanation was written from the published report of 24 March 2020 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, November 2019
Rated Requires Improvement; inspectors found kind, effective care, but serious problems with medicines, care records and quality checks.
This was an unannounced, comprehensive inspection on 25 and 27 June 2019. Inspectors spoke with people living at the home, relatives, staff and health professionals. They reviewed care records, medicines records, staff files and management records.
People generally said staff were kind, respectful and knew them well. The home provided good support with choices, meals, activities, healthcare and people's independence. Infection control, fire safety, equipment checks and some falls monitoring had improved since the previous inspection.
However, medicine records were not always complete or checked properly. Risk assessments and care records were sometimes blank or out of date. The provider did not always investigate missed medicines or pressure ulcers promptly, so people were at risk of harm.
The overall rating was Requires Improvement. Safe and Well-led were Requires Improvement, while Effective, Caring and Responsive were Good. The home had received Requires Improvement at the previous inspection and had been rated this way for three consecutive inspections.
Kind and respectful staff
People and relatives said staff were friendly, polite and respectful. Inspectors observed staff protecting people's privacy and dignity.
“People and their relatives told us staff were friendly and polite towards them and they respected people's dignity and privacy.” from the report
Training and safeguarding
Staff had training relevant to their roles and understood how to recognise and report abuse. New staff received an induction and probation period.
“Staff had received appropriate training and had a good understanding of safeguarding policies and procedures.” from the report
Choice and personalised support
People were supported to make choices about meals, activities, daily routines and their rooms. Staff knew people's preferences and communication needs.
“People were involved and were able to make decisions about their social and leisure time and were able to communicate this to staff.” from the report
Improved cleanliness and infection control
The home had improved its cleanliness and infection control arrangements since the previous inspection. Staff used protective clothing appropriately and audits were in place.
“Following our previous inspection, action was taken to ensure the home was clean and effective infection control and prevention procedures were being followed.” from the report
Medicine recording
seriousLiquid medicines were not always dated when opened, and handwritten medicine records were not always double signed. One missed dose had not been identified or investigated by staff.
“good medicine recording practices were not always followed which increased the risk of medicine errors occurring.” from the report
Incomplete care and risk records
seriousRisk tools, care plans and daily records were not always completed or reviewed. This meant staff and health professionals might not have had the information needed to keep people safe.
“people's records did not always provide sufficient information to support staff to manage individual risks to people's safety and welfare.” from the report
Slow action after incidents
seriousThe provider did not always investigate pressure ulcers or medicine omissions promptly, or check whether lessons had been learned. This left people at risk of harm.
“The provider failed to ensure there were effective systems and processes in place to monitor, manage and mitigate risks to people's health and welfare placed people at risk of harm.” from the report
Complaints were not always heard
needs fixingSome relatives did not feel listened to when raising concerns. The provider said it would speak with relatives to understand their experiences better.
“some relatives told us they did not always feel listened to.” from the report
End of life plans incomplete
needs fixingThe home was working on recording people's end of life wishes and preferences. This work needed to be completed so people's future care would be personalised.
“This needed to be completed to ensure people would always receive personalised care at the end of their life.” from the report
- 01How are you now checking that liquid medicines are dated and that handwritten medicine records are double signed?
- 02How do you monitor repositioning, nutrition, hydration and skin care for people at risk of pressure ulcers?
- 03What happens when a medicine dose is missed or a person develops a pressure ulcer, and how do you make sure lessons are acted on?
- 04Have all care plans and risk assessments been completed and regularly reviewed since this inspection?
- 05What has changed in how relatives' complaints and concerns are listened to and followed up?
This was an unannounced comprehensive inspection covering all five key questions and followed up concerns from the previous inspection. This explanation was written from the published report of 14 November 2019 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Bramble House
5 rated inspections over 3 years: the service has held its Good rating throughout.
- March 2020Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- November 2019Requires improvementstayed Requires improvementSafe: Requires improvementWell-led: Requires improvement
- March 2019Requires improvementstayed Requires improvementSafe: Requires improvementWell-led: Requires improvement
- June 2018Requires improvementdown from GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- March 2017GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- October 2014
Report published without a new overall rating.
- June 2013
Report published without a new overall rating.
- January 2013
Report published without a new overall rating.
- September 2011
Report published without a new overall rating.
- July 2011
Report published without a new overall rating.
- December 2010
Registered with the Care Quality Commission on 7 December 2010.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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38 live-in carers within about an hour of Gloucestershire
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
Most charge £1,030 to £1,360 a week. 31 can care for a couple. 12 years' experience on average.
“She was very caring, kind and patient to all his needs, she built up a wondetful rapport with him, she was dedicated and was there for him through good times as well as through the tough times”
Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.