CQC report explained · a nursing home
What the CQC found at Branksome Heights
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, March 2019
Rated Good; inspectors found safe, kind and personalised care, with some records and notification issues addressed during the visit.
Inspectors visited without warning on 6 and 12 March 2019. They spoke with people, relatives, staff and professionals, reviewed care and staff records, checked audits, and observed care.
The home was rated Good overall and Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. People were described as safe, treated with dignity, supported to eat and drink, and helped to access healthcare.
The home had improved since the previous inspection in January and February 2018, when it was rated Requires Improvement. Medicines, risk assessments, consent arrangements and quality checks had improved.
Inspectors identified some issues. One possible abuse allegation had not been notified to CQC until the inspection, and some care records were not accurate on the first day. Both matters were addressed during the inspection.
Safe medicines
Medicines were managed consistently and safely. Staff had appropriate training and competency checks, and records and stock balances were accurate.
“Medicines were now managed consistently and safely in line with national guidance.” from the report
Personalised support
Care plans recorded people's preferences, and staff understood how people liked to spend their time and with whom they wanted to socialise.
“People received personalised support which was responsive to their needs and wishes.” from the report
Improvement since the last inspection
The provider acted on problems found in 2018. The ratings for Safe, Effective and Well-led improved from Requires Improvement to Good.
“The provider had taken on board all feedback from our previous inspections and ensured the required improvements were made to the home.” from the report
Activities and social life
People had a range of activities and were supported to follow their interests. The home also took steps to reduce isolation for people who stayed in their bedrooms.
“People were supported to follow their interests and live fulfilling social lives.” from the report
Safeguarding notification
needs fixingOne possible abuse allegation was not reported to CQC at first. It was notified during the inspection after the deputy manager discussed the decision with inspectors.
“One recent allegation of possible abuse had not been notified to the CQC.” from the report
Some records were inaccurate
needs fixingRecords covering some aspects of care were not accurate on the first day of inspection. The manager was told and changes were made immediately.
“Records relating to some aspects of care delivery were not accurate on the first day of our inspection.” from the report
Recent leadership changes
minorThe home had experienced unsettled leadership. The registered manager had not been in post long, although staff said they understood the manager's vision and felt supported.
“The home had been through a period of unsettled leadership.” from the report
- 01What safeguards are now in place to make sure every allegation of possible abuse is reported to CQC promptly?
- 02What changes were made to the electronic recording system, and how do managers check that care records remain accurate?
- 03How will you maintain stable leadership following the period of unsettled leadership?
- 04What activities and dementia support would be available for my relative, including if they prefer to spend time in their bedroom?
- 05How would you support my relative's food, healthcare, consent and end-of-life care preferences?
This inspection looked at the overall quality and safety of the care home and rated all five key questions; the previous inspection in January and February 2018 had rated the service Requires Improvement. This explanation was written from the published report of 26 March 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.
What inspectors found, April 2018
Branksome Heights was rated Requires Improvement; inspectors found kind and responsive care, but serious problems with medicines, decision-making and management checks.
This was the home's first inspection. It was unannounced and took place on 18 January and 6 February 2018, with further calls on 7 and 9 February. Inspectors observed care, spoke with people, relatives, staff and health professionals, and checked care, medicines and management records.
People generally felt safe and said staff were kind. Inspectors found enough staff, suitable recruitment checks, clean areas, activities that reflected people's interests and support at the end of life. The caring and responsive parts of the service were rated Good.
However, some people did not receive medicines as prescribed. Health information was not always recorded or shared properly. Mental Capacity Act and Deprivation of Liberty Safeguards processes were not always followed. Quality checks had not found these problems. The provider started action during the inspection, but inspectors had not yet checked whether the improvements would last.
Kind staff
People and relatives spoke positively about staff. Inspectors saw staff being patient, gentle and respectful during care and meals.
“We observed all staff interacting with people in a caring, respectful and compassionate manner.” from the report
People felt safe
People said they felt safe. Staff understood individual risks, including falls, eating and drinking risks, and skin damage.
“People told us they felt safe and relatives also shared this view.” from the report
Enough staff and recruitment checks
Inspectors found enough staff to meet people's needs, and recruitment records included appropriate checks.
“There were enough staff on duty to meet people's needs.” from the report
Activities and listening
People took part in group and individual activities based on their interests. People and relatives felt listened to and complaints were handled within the provider's stated timescales.
“People were involved in a range of activities that reflected current events.” from the report
Medicines and pain relief
seriousSome people did not receive medicines as prescribed. Inspectors found gaps in pain relief, medicine stock, records and guidance, creating a risk of unsafe or ineffective treatment.
“Medicines administration was not effective or safe and that this had resulted in people not receiving appropriate pain relief.” from the report
Health information was not shared
seriousInformation about health advice, emergencies and treatment was not always recorded in care notes or handovers. This meant staff did not always know what support people needed.
“People did not always receive their medicines as prescribed and people were at risk of not receiving safe care and treatment because staff did not record and communicate their needs.” from the report
Mental Capacity Act and DoLS
seriousSome care decisions did not have the required capacity assessment or best-interests decision. Deprivation of Liberty Safeguards applications were not always made, and one condition was not followed.
“DoLS applications had not been made where appropriate.” from the report
Management checks
seriousAudits and quality checks had not identified the problems found by inspectors. New handover and oversight arrangements were introduced, but their lasting effectiveness had not been checked.
“We found that these had not been effective in identifying the on going medicines errors, the use of disrespectful language in records, communication and recording errors” from the report
Care records and nutrition guidance
needs fixingSome care records did not contain current professional advice, and staff did not always have a consistent understanding of people's nutritional or swallowing needs. Inspectors also saw an inaccurate fluid record.
“Care plans and records were not reflective of all current information and we saw that guidance from other professionals was not added in a timely manner.” from the report
Dementia-friendly environment and record language
minorThe building did not fully reflect good practice for people living with dementia, and some records used disrespectful descriptions of people. The home was asked to review both areas.
“The colour scheme was neutral throughout which did not support people's orientation in the building.” from the report
- 01What changes have been made to ensure every person's medicines, including pain relief and topical medicines, are given and recorded as prescribed?
- 02How are health advice, emergencies and treatment changes now recorded and shared with every staff member who needs to know?
- 03Have all required Mental Capacity Act assessments, best-interests decisions and Deprivation of Liberty Safeguards applications been completed and reviewed?
- 04Who is currently managing the home, and how are audits checking that the earlier medicines, recording and communication problems have not returned?
- 05What has been done to make the environment easier for people living with dementia to understand and navigate?
This was an unannounced first inspection that looked at the overall quality of the care home, including premises and care, with evidence gathered through visits, calls, observations, discussions and records. This explanation was written from the published report of 6 April 2018 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 Branksome Heights
2 rated inspections over a year: the service has improved, from Requires improvement to Good.
- March 2019Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- April 2018Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- February 2017
Registered with the Care Quality Commission on 14 February 2017.
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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