Brunswick House

Brunswick House is a care home providing personal and nursing care to up to a maximum of 41 people. The service provides support to older people including people who may live with a dementia type illness. At the time of our inspection there were 38 people using the service.

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

The staff team supported some people with complex needs. There was evidence of collaborative working and good communication with other professionals to help meet people's needs. A relative commented, “The nursing care in this home is excellent. The staff are very in tune with [Name]’s needs. While doing their personal care, they chat and have fun, this brightens [Name]’s day. I don't have to worry about their care, it is the best.”

People and relatives were very positive about the caring nature of staff and had good relationships with them. They trusted the staff who supported them. A relative told us, “The staff at this home are friends and family to us. They care beautifully for [Name] and also have time to care for me. I think I would describe our relationship with the home as warm and very caring.”

There were sufficient staff to support people safely. People said they felt safe with staff support. A relative commented, I know [Name] is very safe at the home. Staff give me that confidence when I watch them looking after [Name] and other residents.” Staff recruitment was carried out safely. Staff followed effective processes to assess and provide the support people needed to take their medicines safely.

People's diversity as unique individuals with their own needs was well-respected by staff. The regular staff team knew people well and provided support discreetly and with compassion. A relative commented, “With most of the staff the care afforded for [Name] is excellent. I think agency staff do not have the same connection with the residents.” People’s privacy was respected, and people were supported to maintain contact with relatives and friends.

Records provided guidance to ensure people received safe and effective care. Risks were assessed and mitigated to keep people safe. Staff contacted health professionals when people’s health needs changed. People’s nutritional well-being was monitored to support their nutritional health.

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.

There was a strong and effective governance system in place. People, relatives and staff were confident about approaching the registered manager if they needed to. They recognised that their views and feedback were valued and respected and used to support service development. A relative told us, "When I came to visit the home I was given a very warm welcome by the registered manager. When [Name] came to the home all the staff knew their name and this made [Name] feel comfortable from day one. Good management skills." Strong processes were in place to manage and respond to complaints and concerns.

Staff followed good infection control practices and the home was clean and well maintained. A relative commented, “This home is very well-maintained and clean.”

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 outstanding (published 4 February 2020).

Why we inspected

We received concerns in relation to the management of medicines, staffing and people’s care. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led.

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

The overall rating for the service has remained outstanding based on the findings of this inspection.

We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe, effective and well-led sections of this report.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

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

Follow up

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

Brunswick House is a residential care home providing accommodation and personal care to up to 41 older people, some of whom have nursing needs. There were 39 people living at Brunswick House at the time of this inspection.

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

People received exceptional support from caring staff, who knew them very well. Staff were extremely respectful and fully protected people’s privacy and dignity. Independence was strongly encouraged, and people were thoroughly involved in making decisions about their care.

The provider had exceptionally caring values which encouraged staff to put people at the heart of the service. The provider had fully invested in innovative technology and equipment to provide people with a high-quality service which reduced risks and improved their quality of life. The provider was committed to being involved in research projects to drive up standards throughout their organisation and across the care industry.

The registered manager was extremely passionate and dedicated to providing person-centred care. They led the staff team very well, providing motivation and inspiration. Staff were well supported by the senior management team to deliver high quality, person-centred care to people.

Staff were very proactive and responsive to meeting people’s changing needs. Staff provided extensive support which significantly enhanced people’s lives and helped them to achieve positive outcomes. Staff quickly sought additional help from external professionals with whom they worked in very close partnership with.

A wide variety of activities were arranged, which supported people to pursue their own interests and hobbies as well as encouraging socialisation amongst those who lived at Brunswick House, their families and the local community.

There was a robust quality assurance process embedded throughout the service. Regular checks and audits were carried out to monitor the safety and quality of the service. The senior management team achieved high standards through continuous improvements and developments to the service and the wider organisation.

People felt very safe living at Brunswick House and relatives confirmed this. Staffing levels had been increased so there was enough staff on duty to meet people’s needs safely. Staff recruitment was safe and staff training was up to date. Competency checks were carried out with staff to make sure they remained suitable for their role.

There were risk reduction measures in place to protect people’s health, safety and well-being. People’s medicines were well managed.

People’s care needs were thoroughly assessed. Staff provided care which met with people’s current needs. 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.

The premises were safe, and the home was clean and comfortable. Any accidents or incidents were fully investigated and reported as required. Lessons learned were shared with staff.

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

Rating at last inspection and update

The last rating for this service was good (published 6 April 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about Brunswick House until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We last inspected Brunswick House in September 2015. At that inspection we found the service was not meeting all its legal requirements with regard to staffing levels. At this inspection we found that action had been taken to meet the relevant legal requirements.

Brunswick House provides personal and nursing care to a maximum of 41 older people, including people who live with dementia or dementia related conditions. At the time of inspection 37 people were living at the home.

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 2008 and associated Regulations about how the service is run.

At our last inspection we found staffing levels on the middle floor were not sufficient to meet people's needs. At this inspection we found the breach had been actioned with regard to staffing levels on the middle floor of the home. However, we have made a recommendation that the service undertake a full review of the dependency levels of people to check how many staff are needed to effectively meet people’s needs, and adjust staffing levels accordingly to ensure the needs of people across the home are met in a timely way.

Risk assessments were in place and they accurately identified current risks to the person as well as ways for staff to minimise or appropriately manage those risks. People were protected as staff had received training about safeguarding and knew how to respond to any allegation of abuse.

Staff received opportunities for training to meet peoples' care needs and in a safe way. A system was in place for staff to receive supervision and appraisal and there were robust recruitment processes being used when staff were employed. Staff had a good understanding of the Mental Capacity Act 2005 and best interest decision making, when people were unable to make decisions themselves. People were able to make choices where they were able about aspects of their daily lives.

Staff were patient and kind as they supported people. People and their relatives spoke highly about the care they or their relatives received.

People had access to health care professionals to make sure they received appropriate care and treatment. Staff followed advice given by professionals to make sure people received the care they needed. People received their medicines in a safe and timely way.

A complaints procedure was available. People told us they felt confident to speak to staff about any concerns if they needed to. Staff and people who used the service said the registered manager was supportive and approachable. People had the opportunity to give their views about the service. Feedback was acted upon in order to ensure improvements were made to the service when required. The provider undertook a range of audits to check on the quality of care provided.

Records were regularly reviewed to reflect peoples' care and support requirements. Staff supported people who required help to eat and drink and special diets were catered for. Activities and entertainment were available for people and people were consulted to increase the variety of activities and outings.

The reason for this visit was to check if improvements had been made in areas of care and welfare and to see if staffing levels had increased.

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

-Is the service safe?

-Is the service caring?

-Is the service well-led?

-Is the service responsive?

-Is the service effective?

This is the summary of what we found.

Is the service safe?

We saw there were arrangements in place to ensure there were enough staff on duty to ensure people's needs were met in a safe and timely way. Records showed staff had enough information to provide individual care and support to people in a way that the person wanted.

Is the service caring?

This was a responsive inspection to previous non-compliance against the regulations and we did not look specifically at this area.

Is the service responsive?

We saw there was a variety of activities that were available and we were told they were being arranged according to individual interests. One person said; "A group of us sometimes play Monopoly." Some people told us they enjoyed the seasonal parties and entertainment that was available. People told us they were supported by staff to go out. One person told us they went out to church with staff. Another person said; "I'm looking forward to going out for the Christmas meal." Another said; "I sit in the garden even in the winter." We were told a person who was 100 had attended a meal at Alnwick Castle with other centenarians to mark the centenary of the First World War.

Is the service effective?

We saw staff with the appropriate skills and qualifications were available to ensure people's health and social care needs were met.

Is the service well-led?

We were told a new manager had been appointed since the last inspection. We were told the manager would be making an application for registration with the Commission as the manager of this location, in line with the requirements of the registration of the service. We saw the action that had been taken and the plans for improving quality outcomes for people who use the service. For example with regard to activities and outings, staffing and ensuring the environment was becoming more suitable to help maintain the independence of people who lived with dementia.

We were informed an existing member of staff had just been promoted to become the new manager.

This inspection began out of hours at 5:45 am in the morning.

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?

This is the summary of what we found.

Is the service safe?

An assessment of people's care and support needs was carried out before people started to use the service. This was to ensure staff had the skills and had received the training in order to safely meet the person's support requirements.

Risk assessments were in place. People were supported and encouraged to maintain their independence and this was balanced with the risk to the person. Audits were carried out to look at accidents and incidents and the necessary action was taken to keep people safe.

Information was available to show that the service worked with other agencies to help ensure people's health needs were met and to prevent admissions to hospital wherever possible.

We saw there were not enough staff on duty at the time of inspection to ensure the care and supports needs of people were met in a safe and timely way.

Is the service effective?

We saw the environment was not suitably designed to meet these needs and there was little evidence of the involvement of people with dementia in daily decision making about their care needs.

People commented how helpful and friendly the workers were. Relatives told us the service kept them up to date with what was happening with their relative's care and they felt able to ask any questions. Two people who lived at the home commented; "I like living here." And "Staff are kind."

We saw record keeping was not effective as written information was not available in all areas of care to reflect the care and support provided by staff.

Staff were observed to be patient and supportive as they worked with people.

Is the service caring?

Most people and relatives spoken with talked well of the level of care provided by staff. We found people with dementia or cognitive impairment were not sufficiently involved in daily decision making. Staff were helpful and offered people information and support about their care. We saw most staff interacted well with people and it was evident that staff had developed a good understanding of people's communication needs and how best to communicate with them. However due to the low staffing level, on the top floor, staff had little, or no time to spend interacting and engaging with people.

Is the service responsive?

Information was collected by the service with regard to the person's ability and level of independence before they moved into the service. Various assessments were completed by the manager of the service with the person and/or their family to help make sure staff could meet their needs. Regular reviews were carried out with the person who used the service and their representative to make sure plan's of care were kept up to date. This helped ensure staff provided the appropriate amount of care and support.

Referrals for specialist advice were made when staff needed guidance to ensure the health needs of people were met.

People's individual needs were taken into account and they, or their representative if they were not able, were involved in decision making with regard to their care. They were kept informed and given some information to help them understand the care and choices available to them, however this was not developed sufficiently to involve people with dementia.

Information collected by the service gave staff some insight into the interests and areas of importance to the person. Activity provision was not sufficiently developed to help ensure activities reflected people's interests and provided stimulation to people with dementia. Activity provision and opportunities for socialisation were not offered by support workers when activities personnel were not on duty. Staff we spoke with and people who used the service said there was little time for any socialisation and engagement as staff were kept so busy with other tasks.

Regular meetings took place with staff and people who used the service and their relatives to discuss the running of the service and to ensure the service was responsive in meeting the changing needs of people.

Is the service well-led?

There was a focus from management on the provision of individual care and support to people who used the service. However there was less emphasis about individualised care and support to people with dementia and cognitive impairment. Staff were knowledgeable about the support needs of people.

We saw people had the opportunity to comment on the quality of the service and that they felt able to speak to the manager and staff about any issues.

We saw people were cared for effectively and care was planned for the individual.

We saw people were safe and protected from abuse.

We saw there was sufficient staff to provide care and support.

The provider had an effective system in place to monitor their quality assurance and record and monitor complaints. Complaints were taken seriously and responded to appropriately.

The representatives or advocates of people who used the service were positive about the care and support provided. Comments included 'The care is very good here' and 'I am involved in decisions about my care and the staff are very good'.