Brushwood

Updated 27 July 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The first day of the inspection was carried out by 3 inspectors, 2 of these inspectors returned on the second day.

Service and service type

Brushwood is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Brushwood is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was not a registered manager in post. A new manager was in post who stated that they intended to submit an application form to register as the manager of Brushwood.

Notice of inspection

This inspection was unannounced on both days.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority who work with the service. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 9 people who used the service and 14 family members about their experience of the care provided. We also observed interactions between staff and people who used the service. We spoke with 11 members of staff including the manager, members of the management team, catering and ancillary staff, nurses and carers. We reviewed a range of records. This included people's care records and medication records. We looked at a selection of staff files in relation to recruitment. A variety of records relating to the management of the service, including policies and procedures were reviewed.

Updated 27 July 2023

About the service

Brushwood is a purpose-built care home which can support up to 60 people over three floors. One of the units specialises in caring for people who are living with dementia. At the time of the inspection 56 people were living at the home.

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

Management and oversight of the service had failed to identify improvements needed to the management of people’s medicines; minimising known risks to people and the cleanliness of some areas of the environment. Concerns were not always managed in a timely manner.

Care records did not always contain the most relevant information or guidance that staff needed to follow in relation to minimising risk to people and keeping them safe. Quality performance measures were not effectively in place, areas of risk were not always safely managed.

People’s food choices and mealtime experiences varied around the service.

We were unable to confirm that people were always 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; policies and systems in the service were in place to support this practice. A review of Deprivation of Liberty safeguarding was in progress at the time of this inspection.

Family members had mixed views on the service their relatives received. Some were happy and other felt that improvements were needed.

Suitably qualified, competent, skilled or experienced staff were not always effectively deployed in some areas of the service. In other areas, people were seen to receive care and support from staff that knew them well and were caring.

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 requires improvement (published 26 July 2022) and there were breaches of regulation. At this inspection not enough improvement had been made and the service is rated inadequate.

At this inspection we found the provider remained in breach of regulations.

Why we inspected

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.

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

Enforcement and Recommendations

We have identified breaches in relation to medicines management; risk management; infection prevention and control and management and governance at this inspection.

We have made three recommendations in this report in relation to managing safeguarding concerns, numbers and deployment of staff and people’s mealtime experience.

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

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.