Brunswick Court Care Home

Brunswick Court Care Home is a residential care home providing personal and nursing care to up to 90 people. The service provides support to older people and people with dementia. At the time of our inspection there were 62 people using the service.

The building consisted of three floors and a basement. Each floor had living facilities which included people's individual bedrooms with en-suite, dining rooms and lounges.

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

People felt the support received by staff was inconsistent and at times felt isolated which affected their wellbeing. Peoples care plans did not always allow the opportunity to detail what was important to the person. The provider had acknowledged this and put new software in place to rectify this.

The provider and registered manager had a governance system in place, which included various audits and monitoring, improvement and actions were identified, however actions were not always completed.

The registered manager had implemented a lot of changes since the last inspection. Systems had started to be used and there were clear outcomes from the quality assurance systems in place. However, at the time of the inspection these changes had only recently been implemented. The registered manager understood the need to ensure the quality of care continued, and to ensure the systems and culture of the service is sustained.

People and their relatives felt staff provided care that was safe, and systems were in place to report concerns. The staff team had been safely recruited. Systems were in place to report and respond to accidents and incidents.

People felt safe with the care they received, and staff were knowledgeable about when to report concerns to safeguard people. Risk assessments highlighted people's individual needs, and professionals were referred to when staff needed input for people for example, a dietician. Where things went wrong, this was shared with staff and lessons were learnt and changes implemented.

Medicines were given to people when they needed them, where discrepancies were identified these were actioned appropriately. Infection prevention control measures were in place and staff were wearing appropriate personal protective equipment (PPE).

The registered manager had built positive relationships with professionals and was dedicated in making sure people got input from health professionals when needed. Professionals commented on the management teams support.

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 17 October 2020). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection whilst we found improvements had been made and the provider was no longer in breach of regulations, further improvements were required.

Why we inspected

The inspection was prompted in part due to concerns received about medicine management. 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.

Follow up

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

Brunswick is a residential care home providing personal and nursing care to 90 older people. At the time of the inspection the service supported 55 people.

The building consisted of three floors and a basement. The three floors had living facilities which included people's individual bedrooms with en-suite, dining rooms and lounges.

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

The management and staff team had worked hard to ensure people’s care and support needs were fully met during the ongoing Covid-19 pandemic and lockdown period. However, we observed some examples of poor practice where staff were not wearing the personal protective equipment (PPE) correctly whilst moving around the home.

People had care plans that detailed their support needs. In some circumstances the care plans had not detailed the change in peoples support, although when speaking to the staff they were able to confirm people’s current support needs.

People felt they had control of their lives and staff supported them in the least restrictive way possible.

Staff knew how to protect people and keep them safe. They had the right skills and knowledge to meet people’s needs, and people were generally happy with how staff supported them.

The management team felt passionate about ensuring they met all of people’s nutritional needs, however care plans needed to detail more information on people’s fluid intake.

We recommend that the care plans for nutrition and fluid have specific targets for the individual’s needs.

The management team and the provider demonstrated their willingness and commitment to learn lessons and improve the service where required. People and staff confirmed they were given opportunities to make suggestions and provide feedback about the service. There was evidence that people were listened to and their suggestions implemented.

Quality monitoring process were in place and the management team were able to demonstrate they were gathering the information, auditing, analysing and implementing improvements. However, we found some instances where the initial data that was collected was not always accurate, which then affected the overall analysis. This was addressed at the inspection and measure were implemented to ensure the data collected was checked for its accuracy.

The service demonstrated they understood the importance of close links with external stakeholders and agencies. Working in partnership in such an open way. Working in partnership in such an open and positive way meant that people received the overall care they needed.

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 14 August 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

Why we inspected

We undertook a targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about the management of nutrition and fluids. A decision was made for us to inspect and examine those risks.

We inspected and found there was a concern with the information detailed in care plans and the feedback from relatives, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led.

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 coronavirus and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this full report.

The overall rating for the service has not changed.

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

Enforcement

We have identified a breach in relation to the mitigating the risks of the spread of infection within the home.

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

Follow up

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

Brunswick is a residential care home providing personal and nursing care to 90 older people. At the time of the inspection the service supported 85 people.

The building consisted of three floors and a basement. The three floors had living facilities which included people’s individual bedrooms with en-suite, dining rooms and lounges.

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

People were not consistently being supported in a safe way. People’s risk assessments gave conflicting information which placed some people at risk.

We recommend the registered provider uses best practice guidance and staff training to ensure the environment meets the needs of the people living at the service.

People felt staff were kind and caring, however there was evidence that due to staffing levels, staff were not always prompt to respond to people when they needed support. Staff said that they did not always get the support they needed with in the home when it came to the induction or the procedures around the home such as fire procedure.

We recommend that people’s preference, cultural and religious needs are explored in more detail when completing their care plans.

Staff had not identified trends and completed analysis on what was happening in the home. For example, people had acquired a e a number of infections in a short space of time and this had not been managed effectively by the staff.

On the whole, the staff felt supported However, some staff felt they did not receive all the relevant training to meet the needs of the people living at the service for example, dementia training.

People were complimentary about the food, however there were gaps in recordings in how the staff were managing people’s nutritional needs.

People felt they were able to speak to the staff and management if they were unhappy about something and that they would be listened to.

On the ground floor, it was clear that a lack of leadership had an effect on the running of the service which affected outcomes for people. Following the inspection, the manager put measures in place to rectify this.

Quality monitoring was in place. However, audits were not completed effectively and did not show outcomes, trends and what improvements were made. The management did not always notify CQC when reportable incidents occurred.

People were not supported to have maximum choice and control of their lives and in some cases 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.

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 29 December 2017).

Why we inspected

The inspection was prompted in part due to concerns received about staffing and infection management. A decision was made for us to inspect and examine those risks and we completed a comprehensive inspection.

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

You can see what action we have asked the provider to take at the end of this full report.

The manager has offered information that confirms they are putting in steps to mitigate the risks found at the time of the inspection.

Enforcement

We have identified breaches in relation to people’s safety of their care, safeguarding people from abuse, not meeting nutritional needs, management of infections and the management of the quality of the service.

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

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At this inspection we found that there had been improvements in the service and was no longer in breach of regulation; however there were still areas in need of improvement.

Brunswick Court Care Centre is registered to provide accommodation and nursing care for up to 91 people. Some people may be living with dementia. At the time of our inspection there were 80 people living at the service with one person having recently been admitted to hospital.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 the time of our inspection the registered manager was unavailable to participate in the inspection process because they were on annual leave. A deputy manager was however overseeing the service in their absence. Another registered manager from the provider organisation came to the service to provide support to the deputy manager and to assist the inspection process on both days.

We received mixed views regarding the attitudes of staff. Most people we spoke with felt that staff were kind and respectful however we received reports of two incidents where people had experienced being spoken to in an abrupt or rude manner. People felt that privacy and dignity was maintained and promoted throughout their care.

People's needs had been assessed prior to admission at the service and individualised care plans took account of their needs, preferences and choices however we found that two care plans with regards to specific clinical needs were not in place. Care plans and risk assessments had been regularly reviewed and updated to ensure that they were reflective of people's current needs. People felt involved in deciding the care they were to receive and how this was to be given.

People felt safe. Staff were knowledgeable with regards to safeguarding people and understood their responsibilities to report concerns. There were effective safeguarding procedures in place and staff had received safeguarding training.

Potential risks to people’s health, safety and wellbeing had been identified and personalised risk assessments were in place. Incident and accidents were recorded and analysed by management to help ensure that action was taken to reduce the risk of reoccurrence.

People received their medicines as prescribed. There were effective systems in place for the safe storage and management of medicine and regular audits were completed.

There were sufficient numbers of staff on duty to meet people's needs. Staff recruitment was managed safely and robust procedures were followed to help ensure that staff were suitable for the role they had been appointed to, prior to commencing work.

Staff received regular supervisions and appraisals and felt supported in their roles. A full induction was completed by staff when they commenced work at the service followed by an ongoing programme of training and development.

People were supported to make decisions about their care and support. Decisions made on behalf of people were in line with the principles of the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). Consent was gained from people before any care or support was provided.

A varied menu was offered at the service and people were satisfied with the meals provided to them. People were supported to access the services of health and care professionals to maintain their health and wellbeing.

People were encouraged and supported to participate in a range of activities and received relevant information regarding the services available to them.

People we spoke with were aware of the complaints procedure and knew who they could raise concerns with. People felt listened to by the management team and that they were responsive to any concerns or complaints that they may have.

The service had a registered manager who was supported by a deputy manager and a clinical services manager. People, relatives and staff spoke highly of the management team and their ability to manage the service.

The service had an open culture. People and their relatives were asked for their feedback on the service and comments were encouraged. Robust quality monitoring systems and processes were used effectively to drive improvements in the service and identify where action needed to be taken.

Brunswick Court Care Centre is registered to provide accommodation and nursing care for up to 91 people.

The service had recently employed a manager who was in the process of registering with the Care Quality Commission. 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.

The provider had effective recruitment processes in place, but people did not always feel that there was sufficient staff to effectively support them. Staff understood their roles and responsibilities and would seek people’s consent before they provided any care or support. Staff received supervision and support, and had been trained to meet people’s individual needs.

People were supported by staff who were not always caring and respectful towards them. They also felt that some staff did not know them well. Staff felt that they knew the people they supported well. Relatives we spoke with described the staff as caring.

People’s needs had been assessed, and care plans took account of their individual needs, preferences, and choices but these were not always carried out in practice. Staff were unable to support people with their choices on how they wanted their care to be delivered.

This is a breach of Regulation 9: Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Person-centred care.

There were risk assessments in place that gave guidance to staff on how risks to people could be minimised and how to safeguard people from the risk of possible harm. People’s medicines had been managed safely.

The service supported people with health care visits such as GP appointments, optician appointments, chiropodists and hospital visits.

The provider had a formal process for handling complaints and concerns. The provider also had quality monitoring processes in place.

During this inspection we set out to find if the home was now meeting the needs of people's and to answer our five key questions; Is the service caring, responsive, safe, effective and well led?

The inspection was carried out by two inspectors over one day.

Below is a summary of our findings.

Is the service safe?

By safe, we mean that people were protected from abuse and avoidable harm. We considered our finding at our previous inspections and paid particular attention to staffing levels to ensure people were kept safe.

We found that people who used the service were protected from the risk of harm. Staff who worked at the service were aware of people's individual needs and how to keep people safe. Staff members demonstrated that they knew how to support people safely and minimise risk. We saw records which evidenced that staff members had received training in the protection of vulnerable adults. The staff we spoke with were able to describe what constituted abuse and the process they followed if they needed to raise any concerns.

Is the service effective?

By effective, we mean that people's care, treatment and support achieved good outcomes

and promoted a good quality of life which was evidence-based where possible. We reviewed the care and support plans for ten people who lived at Brunswick Court. We found that the care plans contained appropriate person centred information to inform care staff how to support people in an individualised way. We saw that the home had included the person or their representative in care planning. People told us that the staff always get the consent before care was delivered.

Is the service caring?

By caring, we mean that staff (involved and) treated people with compassion and kindness.

We observed the staff to be caring, compassionate and spent quality time with people who used the service. We noted that staff knew the people they were supporting and were aware of people's abilities and needs. We observed the staff to be patient with people who used the service.

Is the service responsive?

By responsive, we mean that services were organised so that they met people's needs. We found the staff responded appropriately when required. We saw evidence that the staff were aware of how to respond to people both in a planned way and also in response to their needs when required. People told us that their call bells were answered promptly both during the day and at night.

Is the service well-led?

By well-led we mean that the leadership, management and governance of the organisation

assured the delivery of high-quality person-centred care. We found that the home was managed in the best interests of the people who lived there. We saw that there were audits in place that ensured all aspects of care delivery was audited and where necessary action were put in place to address any areas of concern.

We found that the activities in the home were not tailored to meet the personal needs of the people. Activities were held in an activities room on the middle floor of the home, the timing of the activities was not always convenient or appropriate; some of the people were not up and dressed in time to join in the activities.

People told us that while some of the staff were kind and lovely they said that they were always busy and that they sometimes didn't call for assistance because their call bell didn't always get answered.

some people told us that they liked to sit in the garden but that staff did not always offer them the opportunity to sit outside. People told us that they had to wait until their relative visited so they could take them into the garden. We did note that some people had been assisted by staff to spend time in the garden but most of the people had been assisted by their visitor/s.

People told us that they were not always offered a bath or shower and that their personal care needs were usually met by having a 'bed bath'.

People gave a variety of views about their experiences. Individuals told us that the staff were, 'caring' and 'looked after them well'. Other people told us they had to wait if they called staff and did not have regular showers. We were told that the staff, 'seem to be very busy' and there 'were not enough of them around'.

We assessed that people's nursing needs were being met and that they had access to a range of community health care professionals, where specialist services were required.

The staffing levels and skill mix we observed meant that people had to wait to have their care needs met and choices about how they spent their time were limited. People described not being able to attend activity sessions because it was not their turn to get up early or staff were not available to take them.

People were not being protected against the risk of infection because a medical device had not been cleaned appropriately and attention was needed regarding the cleanliness of the environment and catering equipment.

We identified that people had experienced their medicines not being available as they had run out.

People's privacy had not been protected as patient records had not been stored securely.