Brenalwood Care Home

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Brenalwood Care Home had been rated inadequate twice in 2022. At our last inspection in 2023 some improvements had been made and the rating was requires improvement, with 3 breaches of regulation relating to staffing, safe care and treatment and good governance. The service had failed to sustain the improvements made and the rating at this assessment was inadequate. There had been a change of management since our last inspection and a further change 2 weeks prior to this assessment. This had not supported the embedding and sustaining of improvements. There was no registered manager in post since March 2023.

The provider was in breach of regulation relating to good governance at inspections which were published in November 2022 and in November 2023. At this assessment we have found continuing breach of regulation. People were being placed at risk by the provider failing to identify and address breaches of regulatory requirements.

There was a lack of provider oversight and the quality assurance systems in place, including audits, were not effective in enabling the provider to continuously assess, monitor and improve the service. The provider had failed to identify shortfalls raised during this assessment or those identified by external professionals.

The provider's oversight and monitoring systems and processes were not robust and failed to appropriately manage risks to people. This was a breach of Regulation 17: Good governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014

This service scored 32 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider information return received November 2023 stated, “Residents and those that matter to them, are encouraged to make their views known about their care, treatment and support and these are respected this is evidenced by regular contact with families, family and relative meeting and family / relative surveys.” The manager told us surveys were sent out to relatives to check their satisfaction with the service, but responses had not been received and offers of relative meetings had not been taken up. The manager told us they were speaking with people’s relatives as they visited to gain any feedback. The manager told us discussions were documented in people’s care records, but the provider had missed the opportunity to formally record and analyse feedback received as part of their quality assurance systems to monitor feedback received about the care provided and improvements made as a result of the comments received over time. Some relatives told us they were not kept updated about their family member’s wellbeing or outcomes if they raised concerns.

A staff member told us that some staff were able to work without direction, but some needed to be told what to do as could not work in their own initiative. They felt this was lacking in the service, “It is not my job to tell them what to do.”

We saw meeting minutes for people using the service, where they were asked for their views of the service including activities and meals.

We saw very little to show people and their relatives had been involved in the planning of their care. Despite some mental capacity assessments and risk assessments stating people and/or their next of kin were spoken with, this did not always include the date and detail the discussions.

We saw minutes for staff meetings held in February, May, June, July and August 2024, staff were advised to ensure the provision of care was to be recorded in people’s daily notes. During our assessment, we found significant shortfalls in people’s daily records, including fluids, engagement, personal care, such as oral care, and how people presented. This demonstrated governance systems were not robust and guidance was not followed by staff.

We received mixed views about if the service was well-led. Some relatives knew who the manager was, and some referred to the previous manager. A staff member told us they did not feel the service was well-led, they said, “At first not good management, then not good management, still not good management.” They told us they preferred to get on with their job and not raise concerns. Another staff member told us they felt the manager was approachable and asked if they had any issues they wanted to raise.

We spoke with the operations director as to how they felt they had got to where they were in the service, considering the deterioration and lack of continuous improvement. We were concerned that the provider’s governance systems had not been robust enough to identify and address shortfalls in the service when it was deteriorating. The PIR received November 2023 stated, “The Nominated Individual visits home monthly and supports the team with all aspects of quality and compliance.” The management team told us the operations director who was also the nominated individual, visited the service weekly or twice weekly and was available to provide support when needed. However, we were concerned the operations director told us they were responsible for 26 services. They did tell us there was support provided by head office such as records, and a company was due to provide mock inspections. We were concerned there was limited support available for the service which had deteriorated and required significant support and input to improve.

A staff member told us, “It needs 2 to run the service, [prior to our assessment] the [previous] acting manager did not have a deputy.” Since the recent changes in management, there was a manager and deputy manager in place.

There had been a change of management since our last inspection and a further change 2 weeks prior to this assessment, when the previous manager had returned to the service. This had not supported the embedding and sustaining of improvements. There has been no registered manager in post since March 2023.

Brenalwood Care Home had been rated inadequate twice in 2022 and at our last inspection in 2023 some improvements had been made and the rating was requires improvement. The service had failed to sustain the improvements made and remained in breach of regulations.

Governance systems were not robust. This assessment identified 3 repeated breaches of regulation as systems and processes were either not in place, or not robust enough, to ensure people's care needs were identified and people received safe care and treatment.

The 5 care records we reviewed were not always current, held contradictions and did not always provide guidance for staff in how to meet people’s needs and reduce risks. This could lead to people receiving unsafe and inappropriate care. For example, a person’s records referred to a mental health condition, but this was not specified, the document referred to a previous placement and feedback from a hospital which was not dated, not detailed the support to be provided in their day to day living. Some records were very similar in content and referred to a different gender and a different person’s name. There was no documentation to show these shortfalls had been identified. However, the management team told us they were working on reviewing the documentation to input on a new electronic care planning system.

The manager told us they had an open door and staff were encouraged to speak openly about their concerns in the service. In addition, the operations director told us at a recent staff meeting in September 2024, staff had been reminded of the procedure and policy for speaking out, were provided with copies, reassured staff they would be listened to if they spoke out and they provided staff with their mobile telephone number should they wish to contact them. The operations director also told us the provider had a system where staff could contact them if they had concerns.

We received the survey results from a staff survey completed September 2024, 6 responses had been received. Not all indicated that they were aware they could submit their responses anonymously, despite the survey stating they could be submitted this way. Whilst the responses were mainly positive, the summary of the surveys gave no indication of actions being taken where some staff had stated requires improvement to some questions, such as communication from leaders.

The provider told us in the Provider Information Return in November 2023, “We also provided staff with mental health help line if they wish to talk to someone other than the management. We have an open door policy approach where residents, relatives and families and staff can see and talk to management at any time. Honesty and transparency is encouraged and advocate from all levels of staff and management and staff are encouraged to report when mistakes or error occur so we can learn from them.” However, we had received some feedback from relatives where they felt they were not kept updated about their family member's wellbeing and comments they had made about the service.

There was a Duty of Candour policy and procedure in place and staff had received training in the duty of candour. The PIR stated, “Duty of candour policy is followed and we always admit any mistakes and staff learn from them and apologise to the resident and family and explain what action we have taken.” We asked for evidence where the duty of candour had been followed, we were provided with an undated letter, however, the corresponding root cause analysis was from 2022. Therefore, we did not see any recent evidence relating to the duty of candour. In addition, some relatives told us they were not kept updated about their family member’s wellbeing, this included a relative who had not been told about the outcomes of their family member itching, which had led to distress as they told us they were told by external professionals there had been a scabies outbreak. Despite the manager telling us there had not been scabies in the service, distress could have been mitigated if relatives had been updated on the treatment being provided as a measure to eliminate the risk.

There were policies and procedures in place relating to freedom to speak up and whistleblowing, which explained staff and provider responsibilities. This was accessible to staff on the provider’s electronic system. Following a recent safeguarding concern, a staff meeting was held where staff were reminded of the policy and provided with paper copies. Staff had received training in freedom to speak up.

A staff member told us they did not feel staff were treated equally relating to work distribution, they said, “Some can use their mouth, they know what to say. I don’t get involved.”

Staff received training in equality and diversity and there were policies and procedures in place. The PIR received November 2023 stated, “We have different race and cultures of staff within the home which we embrace to give various approaches and ideas to enhance care. With such a diverse staff team we have to ensure we are following the human rights and be fair, respectful, equal and autonomous to everyone.”

The operations director told us how they had spoken with staff following a recent safeguarding concern and allegations of bullying, when concerns were not raised with the provider but external professionals. The operations director told us how they had advised staff about respect between them, following the allegations of bullying.

Staff had been trained in equality and diversity, gender and sexual diversity and a range of training course relating to diverse needs, including learning disability, mental health, autism, communication and dementia. However, we were concerned that people were not always receiving person centred care, and the service was task led rather than person centred, as identified in records.

The provider had failed to have robust systems in place to continuously improve and, when improvements had been made, to ensure they were embedded in practice and sustained.

The operations director told us there was an improvement plan in place, and this reflected the feedback of concern they had received from the local authority. This was provided to us to evidence what we had been told. We were concerned the provider's own governance systems had failed to independently identify and address shortfalls until they had been told about them by external professionals. At the time of our assessment, there were many visits from external professionals due to the concerns about the service provision and safety and swift actions required to improve.

The manager and operations director told us about the new care planning system in place. For which care records were being transferred to the new system. During this assessment, we found care plans and risk assessments were not detailed enough to provide staff with the necessary guidance to ensure people were supported safely. Particularly given the number of agency staff being used by the service. Records had not been kept up to date to reflect people's current needs and there were contradictions which may lead to confusion for staff and result in people receiving inappropriate and unsafe care.

The manager told us the current call bell system did not support call bell audits, however, when they and the deputy manager were on duty they monitored if call bells were answered promptly. This was not documented other than in the manager walk round audits which asked if call bells were answered quickly. The audits reviewed noted they were answered, there was no information as to how this was being measured.

The governance systems in place had not identified and addressed the shortfalls we noted during our assessment and those identified by external professionals. This included staffing levels, actions had not been taken by the provider to adjust staffing levels, until concerns were raised by external professionals.

Audits had failed to identify the continued shortfalls found during the assessment. Audits had not identified poor recording in people’s daily records, including people’s fluid intake and repositioning. They had not identified how recordings were task based, lacked detail of engagement and how the person presented each day. Staff had recorded ‘little assistance required’ and ‘lot of assistance required’ in daily notes, it was not clear why this was and if there were any concerns arising when people required a lot of assistance.

Medicines audits identified no action required, until the local authority had visited and raised concerns. We were concerned where audits stated no action was required, this was not reflective of a service with a requires improvement rating and breaches of regulation.

Manager audits had not been used effectively to drive improvement, with all those reviewed stating no action, or new chairs and redecoration required for the shared areas.

The manager walk around audit template asked if people using the service were happy and to offer the opportunity for feedback, the response noted in an audit in July 2024, stated ‘service users happy’. There was no information on how this had been measured and who had been spoken with. In the same audit it stated ‘spot check of care plan completed’. There was no information to show which care plan was checked. This was also the case where there was no detail provided on which records were reviewed when it was recorded ‘fluid charts were accurate.’ We found significant shortfalls in care records and fluid charts, which showed the governance systems were not robust enough.

We received feedback from people's relatives which identified they were not always kept up to date with their family member’s wellbeing. This included when there had been changes in medicines, and when they had seen health care professionals. Some relatives told us it caused them distress when they had found out information from other means, for example a friend of their family member. A relative told us they could raise concerns with the management team, but were not always updated to the outcomes.

There was a duty of candour policy in place, however, the documents to support this was followed was from 2022.

There was little information to show people and their representatives had been consulted in their care plans and risk assessments. People's records had not been kept up to date with their current care needs.

Whilst we were told by the management team about the good working relationship the service had with health care professionals and external services. We were concerned that despite this, the provider had not sustained improvements, and had failed to ensure people were receiving good quality and safe care. The quality of the service had deteriorated and this had not been independently identified and addressed before external professionals noted their concerns.

We received feedback from the local authority who were concerned about the safety of people and the quality of service provided. They were so concerned they were visiting the service twice weekly and had suspended any new placements to the service which were commissioned by the local authority. We also received feedback relating to the provider’s lack of engagement to make the necessary improvements.

People’s care records did not always include up to date information about their needs, this included guidance and treatment provided by external professionals. For example a person’s records did not include the outcomes from hospital investigations into the cause of a person’s fall in January 2024. Another person’s records had not been updated to show health professional input for over 12 months.

There was a training programme in place for staff to undertake. A staff member told us the training was mainly eLearning, but there was training delivered face to face, such as moving and handling. A staff member told us they did the eLearning training at home in their own time, and they had reminders when training was due. However, they told us this could be overwhelming to do in their own time, “I did 13 courses in the last 2 months, yesterday I got 8 more to do. I am keeping up though.” We did see that competencies were undertaken in some areas such as medicines and moving and handling, however, we were concerned that this system did not support good life work balance, and when staff are working long day shifts, they may have to do the training on their days off. Medicines competencies were not always affective due to the shortfalls we identified at this assessment.

The operations director confirmed staff did eLearning in their own time, but arrangements could be made if staff were finding difficulties, such as caring responsibilities.

The management team were responsive to our feedback and gave assurances improvements would be made.

The provider had failed to learn lessons from previous inspections where shortfalls had been identified. Improvements made had not been sustained over time.

The service had previously been rated inadequate twice in 2022, with the first inspection of 2022 finding breaches of regulation relating to good governance, safe care and treatment, staffing, premises and equipment, person centred care, consent and dignity and respect. We had served warning notices relating to good governance and safe care and treatment at our first inspection in 2022, we followed this up with an additional inspection and found compliance with the warning notices and the service was no longer in breach of regulations relating to safe care and treatment and governance. At our inspection in 2023, the service was rated requires improvement with breaches relating to staffing, safe care and treatment and good governance. During this assessment we have identified repeated breaches in these areas. We were not assured the provider’s governance systems in place were robust enough to ensure improvements made were fully implemented, embedded and sustained over time to ensure people were always provided with high quality and safe care.