Brenalwood Care Home

Brenalwood Care Home is a residential care home registered to provide personal care to up to 38 people across 2 floors. The service provides support to people aged 65 and over including people living with dementia. At the time of our inspection there were 15 people living at the service.

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

People’s medicines were not always being given safely and as prescribed by the pharmacy or following the manufacturer’s instructions. Risks to people’s health were managed well, however safety checks and fire drills needed to be more robust to ensure staff could safely evacuate people in the event of a fire or similar emergency. The standard of cleanliness, including the kitchen and laundry had continued to improve since our previous inspections. However, we found staff were not always following the providers hand hygiene policy, which stated staff were to be bare below the elbow to affect good hand hygiene.

Since our last inspections in June and November 2022 the provider had successfully recruited enough staff and was no longer using temporary agency staff. The service had 1 cleaner, which was insufficient to manage both cleaning and the laundry. There was enough staff to support the 15 people currently using the service. Any new admissions to the service are to be managed slowly and safely, considering the needs of the person and compatibility with the existing people. Improvements were needed to ensure staff recruited were of good character and suitable for the role. We have made a recommendation about staff recruitment.

Staff were seen to be caring and kind in their interactions with people. However, this appeared to intuitive, rather than based on learning from training and best practice guidance. On occasions this resulted in people’s privacy and dignity being compromised. We have made a recommendation about staff training on the subject of dignity and respect.

Staff told us, training had improved, however, staff struggled to demonstrate how they put learning into practice. Training for specialist roles, such as ‘champions’ and activities needed to improve to achieve good outcomes for people and promote a good quality of life. Systems for the induction of new staff, supervision and appraisal needed to improve to explore staff’s understanding of the training provided, and test their skills, competence and knowledge which was integral to their roles.

Overall people and their relatives were complimentary about the meals provided. However, improvements were needed to ensure attention was paid to people who were reluctant to eat, and to support people to make genuine choices about what they wanted to eat. People had access to plenty of snacks between meals. There was a creative approach to celebrate food encouraging people to eat and try different types of food. For example, recent events had included a world food day, chocolate cupcake day, British pudding day, and eat with a friend day.

Significant improvements had been made to the environment. The premises had been decorated throughout to a consistent standard. However, the lounge was not used to its full potential to provide different communal areas for people to use for their preferred activities, private space to spend time with their families or visitors, or to have time alone. People had been provided with specialist or adaptive equipment as and when needed.

People experienced positive outcomes regarding their health and wellbeing. Staff worked collaboratively with other professionals to understand and meet people's needs. Prompt referrals were made to health care professionals where needed. Staff worked with other services, and the district nursing team to provide end of life care. However, improvements were needed to ensure people’s wishes at the end of their life were assessed and documented to ensure their views would be respected and acted on.

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. People who had no family to act on their behalf, had regular visits by an appointed Responsible Person Representative (RPR) as a condition of their DoLS to ensure their rights as a person being deprived of their liberty were protected.

Engagement with people, staff and families had improved. People’s feedback had been gathered and used to make changes. The provider had a clear system for recording complaints, responses and outcomes. Improvements had been made to ensure information was provided to people in a format they could read and understand. However, further improvements were needed to ensure the communication needs of people with a disability or sensory loss were met.

Relatives told us, and photographs of events around the service reflected there had been improvements in provision of social activities, including special tea parties, an Hawaiian day, and a western party. However more needed to be done to ensure people are meaningfully engaged on a day-to-day basis.

Relatives, and staff told us, there had been significant improvements in the service since the changes in management. Relatives told us the acting manager was doing a really good job and there was now a nicer atmosphere in the home. Staff said morale had improved, and with better management the service was calmer and more organised. Whilst improvements had been made, we found systems to identify and manage risks to the quality and safety of the service, needed to be further embedded and sustained to drive improvements. Although audits had been completed, these had not identified the issues we found with the management of people’s medicines, and infection prevention and control.

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 inadequate (published 13 January 2023). This was the second inadequate rating and the service continued to be in special measures. The provider completed an action plan after this inspection to show what they would do and by when they would make the required improvements.

This service has been in Special Measures since 22 November 2022. During this inspection the provider demonstrated enough improvements have been made. The overall rating for the service has changed from inadequate to requires improvement. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection and to review information we held about this service. 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.

Enforcement and recommendations

We have found evidence the provider needs to make improvements. Please see the safe, effective, caring, responsive and well led sections of this full report. We have identified a continued breach of regulation 18 (Staffing) in relation to staff training, and further breaches of regulation 12 (Safe care and treatment) in relation to medicines management, and regulation 17 (good governance).

Please see the action we have told the provider to take at the end of this report.

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

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Brenalwood Care Home is a residential care home registered to provide personal care to up to 38 people across 2 floors. The service provides support to people aged 65 and over including people living with dementia. At the time of our inspection there were 22 people living at the service.

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

Our previous inspection in June 2022 identified a lack of leadership, management and oversight. This combined with high use of temporary agency staff had impacted on the quality and safety of the service provided. At this inspection we found significant improvements had been made.

There had been a cultural change in the service. The previous registered manager resigned, and a new manager had been appointed in September 2022. Staff told us they felt supported and had better direction which had helped to bring staff together as a team and improved morale.

Systems to assess, monitor and improve the quality and safety of the service had improved. This included better oversight to ensure each safeguarding concern, complaint or incident was reviewed and responded to. However, further work was needed to ensure audits explored root causes of themes and trends where these had been identified.

Arrangements for assessing risk, safety monitoring and management had improved. More robust systems were in place for checking the safety of premises, furniture and equipment to ensure risks to people's safety were identified and acted upon.

People’s risk assessments and care plans had been reviewed and amended to guide staff on how to keep people safe. However, some information was inconsistent or missing. Additional work was needed to keep care plans under review to ensure information was current and consistent throughout.

Significant improvements had been made to the environment ensuring the safety of people, staff and visitors to the service. The premises had been refurbished, including all people’s rooms and en-suite facilities. Refurbishment of the kitchen and better application of food safety management had led to improved catering facilities. The service had been reaccredited a 5-star food hygiene by Environmental Health in recognition of the improvements made.

Recruitment of housekeepers and enhanced cleaning schedules had improved the cleanliness of the service, minimising the risk of spreading infection. Equipment and facilities were cleaner, including sensor mats in people’s rooms, en-suite facilities, communal toilets and shower rooms. Staff were observed using personal protective equipment (PPE) safely in line with national guidance. Installation of a new sluice facility had led to better control of cleaning, and disinfection of commode pans and disposal of clinical waste.

Recruitment of staff, better management of sickness and reduction in the use of temporary agency staff ensured there were enough staff deployed to meet people’s needs and keep the home clean.

Staff had been provided with a range of training providing them with the knowledge and skills to ensure people were safe and well cared for. The manager worked alongside staff in a mentoring role and had introduced competency-based supervisions to ensure they had the right skills to meet people’s needs.

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 inadequate (published 22 November 2022) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of Regulation 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014

Why we inspected

We undertook this targeted inspection to check whether the Warning Notices we previously served in relation to Regulation 12 (Safe care and treatment) and 17 (Good governance) had been met. We use targeted inspections to follow up on Warning Notices or to check concerns.

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.

Based on our inspection of safe and well led the provider had made enough improvement and was no longer in breach of Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. 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 not changed following this inspection and remains inadequate.

Follow up

We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Brenalwood Care Home is a residential care home registered to provide personal care to up to 38 people across two floors. The service provides support to people aged 65 and over including people living with dementia. At the time of our inspection there were 24 people living at the service.

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

The environment was unhygienic, poorly maintained, and in need of extensive renovation to make it safe and comfortable for people living in the service. Infection control measures were poor and placed people at risk. Risks to people's health and welfare had not been considered or addressed by the service, and staffing levels were not adequate to provide safe, person-centred care.

Staff did not have the training, knowledge, or support in all areas to ensure people were well cared for. The training staff had received and the systems in place to ensure staff were competent or had understood the training were not always effective.

People were not supported to eat and drink properly, their personal care needs were not always met, and their dignity and independence were not considered. There was insufficient information in peoples care plans to support them appropriately with the varying degrees of dementia within the service. Staff did not have the time to engage with people in a meaningful and positive way.

The registered manager did not have the appropriate skills or training to safely and effectively manage the service. There was a lack of understanding of how to make decisions for people with their best interests, or knowledge of the Mental Capacity Act 2005.

End of life care planning was poor, with no advanced planning for how people may wish to have a respectful and dignified death. People did not have access to information in ways that would be accessible for them, the provider had not considered people who may have different communication needs or how to support them.

Systems and processes to monitor the safety and quality of the service, and the safety and welfare of the people who lived there were ineffective and poorly monitored. The provider and the registered manager had not identified the shortfalls and issues that had been identified by us on inspection, and had failed to act on issues which had been identified by external professionals, such as the local authority, and the clinical commissioning group.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

People received their prescribed medicines safely, and new staff were recruited in line with best practice guidance.

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 27 March 2019).

Why we inspected

The inspection was prompted in part due to concerns received about the environment, staffing, infection control and the management of the service. A decision was made for us to inspect and examine those risks.

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.

We have found evidence the provider needs to make improvements. Please see the safe, effective, caring, responsive, and well-led sections of this full report.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to the inadequate leadership and management of the service at this inspection. Governance systems were ineffective and failed to ensure the safety of the premises and equipment or identify people were not being treated with dignity and respect. There were insufficient staff to care for people, risks had not been identified or addressed and infection control was poorly managed all of which placed people at risk of harm.

Please see the action we have told the provider to take at the end of this report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Brenalwood Care Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. This service does not provide nursing care. Brenalwood Care Home accommodates up to 38 older people in one adapted building. During our comprehensive unannounced inspection, there were 30 people using the service, some living with dementia.

People’s experience of using this service:

¿ At our last inspection of 17 February 2016, the service was rated requires good. At this inspection of 6 March 2019, we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. The rating has not changed.

¿ People told us that they were happy with the service they received. One person commented, “I like being here.” One person’s relative said, “I would not want [family member] anywhere else, this is home.”

¿ There were systems designed to keep people safe, including from abuse. Risks to people in their daily lives were assessed and plans in place to reduce these. People’s medicines were managed safely.

¿ There were enough trained and skilled staff to meet people’s needs. Recruitment processes were safe.

¿ There was an ongoing programme of improvement in the environment. Infection control procedures to help protect people from the risks of cross infection.

¿ People had access to health care professionals when needed. People were supported to maintain a healthy diet.

¿ People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

¿ People shared positive relationships with staff. People’s privacy, independence and dignity was respected. People were listened to in relation to their choices about how they wanted to be cared for.

¿ There was a complaints procedure in place and people’s complaints were addressed. People were asked for their views about the service and these were valued and listened to.

¿ The service had systems in place to monitor and assess the service provided.

Rating at last inspection:

At our last inspection of 17 February 2016, which was published 16 September 2016, the service was rated good.

Why we inspected:

This inspection took place as part of our planned programme of inspections, based on the rating of good made at our last inspection.

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

Follow up: We will continue to monitor this service according to our inspection schedule.

Brenalwood provides accommodation and personal care for up to 38 older people and people who may be living with dementia. The service does not provide nursing care. At the time of our inspection there were 28 people using the service, four of whom were receiving respite care.

There was a registered manager in post at the service. 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.

People were safe because the manager and staff understood their responsibilities in managing risk and identifying abuse. People received safe care that met their assessed needs.

There were sufficient staff who had been recruited safely and who had the skills and knowledge to provide care and support in ways that people preferred.

The provider had systems in place to manage medicines and people were supported to take their prescribed medicines safely.

People’s health and social needs were managed effectively with input from relevant health care professionals and people had sufficient food and drink that met their individual needs.

The Care Quality Commission (CQC) monitors the operation of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) which apply to care homes. We found the provider was following the MCA code of practice.

People were treated with kindness and respect by staff who understood their needs.

Staff respected people’s choices and took their preferences into account when providing support. People were encouraged to enjoy pastimes and interests of their choice and were supported to maintain relationships with friends and family so that they were not socially isolated.

There was an open culture and the registered manager encouraged staff to provide care that met people’s needs.

The provider had systems in place to check the quality of the service and take the views and concerns of people and their relatives into account to make improvements to the service.

During our inspection we spoke with five people living in the home. People were very complimentary about the staff and told us that the food was 'very good'. One told us: 'I'm very happy here. The staff are very good. They're always helpful. I'm satisfied with everything.' People looked well cared for and there was a happy and relaxed atmosphere in the home.

Some care plans were of a good standard but others did not reflect people’s current medical condition and needs. This could result in a lack of consistent care. Staff were not consistently attending to people’s basic care needs, for example nail care and shaving, when they could not do this for themselves.

The premises where people lived were in need of considerable redecoration and refurbishment. A number of potential hazards were also identified during our inspection. This was of particular concern as all the people in the home had some form of mental disorder and might not have been able to avoid the risks by themselves. Audits of care, services and the environment were being carried out but were not always identifying concerns within the home.

There was wide range of activities that provided stimulation for people, helped them to retain their abilities and improved their quality of life. People were happy with the standard of the food and the choices available. One person who told us that they were “very fussy” about their food said, “The cook is very good and if you don’t like anything they’ll give you an alternative. They know what I like.”