Brandon House

During our assessment of this key question, we found the provider was failing to meet their legal requirements and were in breach of regulation 12. We found concerns around the safe delivery of care, the management of risk and medicines management. You can find more details of our concerns in the evidence category findings below. The systems in place to report and learn from accidents and incidents required improvements to ensure they were effective and to safeguard people from avoidable harm. However, people told us that they felt able to speak about their concerns. We received mixed feedback from people about feeling safe in the home. Not all of the management team were clear on their responsibilities and duties to identify and report safeguarding concerns. Not all safeguarding incidents had been reported to CQC as required. There was no evidence that safeguarding incidents had been audited or any evidence of lessons learnt. Most people we spoke with told us there were not enough staff to meet their needs and that agency staff were often used. Systems were not effective in ensuring staff were recruited safely. People told us they felt the home was clean and well maintained. However, we found some areas of the home required re decoration and further maintenance. We saw staff followed safe practices to prevent and control the spread of infection.

During our assessment of this key question, we found people’s care plans were not always person centred and changing needs were not assessed as required. Care plans and risk assessments often lacked details to ensure people’s need could be met. People we spoke to said they were not involved in their care planning, changes and/or reviews. Feedback from people was mixed about their experiences of accessing support from health care professionals. Some people told us their treatment had been effective with positive outcomes and others told us staff did not understand their needs. Consent to care and treatment had been assessed and recorded however, staff and people living in the home said their wishes were not always respected.

People provided mixed feedback about how staff treated them. Some people found staff to be caring whilst others said they were not always focused on their job. We observed staff treating people with kindness and respected people’s privacy and dignity. People told us staff treated them as individuals and made sure their care, support, treatment needs and preferences were met. However, we found people’s records lacked information to support people with their preferences for religion and culture. The management told us they put people's dignity and independence at the centre of the care provided. Staff also informed us they put peoples, choice, dignity and independence at the centre of everything they do. People told us not all staff understood their needs, views and wishes. During our observations we found call bells were not always accessible to people and staff were not responding to people immediately due to people not been able to call for assistance. Management told us they care about and promote the wellbeing of their staff and supported staff to always deliver person centred care. However, staff told us the atmosphere was not always nice.

Care plans and risk assessments were not always person centred. People said they were not involved in care planning and information was not always informative or tailored to their needs. People told us they were able to share feedback and raise complaints. However, there was no evidence of people being involved in decisions about their care or in other aspects of the home. Although there was the opportunity for people to give their feedback there was no evidence of this being actively sought. End of life care plans were in place, but these were not detailed. People told us they were involved in activities and participated in community ventures.

During our assessment of this key question, we found the provider was failing to meet their legal requirements and were in breach of regulation 17. You can find more details of our concerns in the evidence category findings below. The provider failed to ensure they operated good governance and leadership roles were ineffective to consistently monitor, identify and drive improvement. We found a number of significant concerns at this assessment and were not assured that the providers governance ensured people always received safe, effective, good quality care. Staff told us the culture in the home was negative and as they did not feel supported by the management team. We received mixed feedback from people in relation to the management team with some people feeling listened to and others not.