Brushwood

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.

Brushwood is a nursing home providing accommodation, personal and nursing care to up to 60 people. The service provides support to people with physical disabilities and people living with dementia. At the time of our inspection there were 58 people using the service.

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

People did not always receive their medicines safely and as prescribed. Care plans had improved since the last inspection. Risks associated with people's care had been assessed and plans were in place to manage these risks. People felt safe living at the home. One person said, “I’m as safe as I can be.”

There was mixed feedback about staffing levels at the home from people living at the service, relatives and staff. Some had no concerns about the number of staff and others felt more staff were needed. Overall, there were enough staff at the home to meet people’s needs. Staffing levels were assessed and planned based on people’s needs.

Systems to assess, monitor and improve the quality and safety of service being provided were not always effective. General improvements had been made to governance and oversight at the service. However, further improvements were needed to make this more robust, effective and sustainable.

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's care and support needs and choices were regularly reviewed and documented in their care plans. This was a significant improvement since our last inspection. People and relatives told us the staff were well-trained and “very dedicated”. Staff were supported with regular training and supervision with senior staff to enable them to perform their roles effectively.

People and relatives’ feedback about the food at the service was positive. One relative commented, “The food is very good. My [Relative] has put on loads of weight, [Relative] was underweight when they arrived here.” Staff regularly reviewed people's health and wellbeing and referrals to other health and social care professionals were made when needed.

There was a positive, kind and caring culture amongst staff at the service. We observed positive and caring interactions between people living at the service and staff. People and relatives told us the registered manager, and staff in general, were approachable and communicated well. Comments included, “I’d go to the manager [if there was a problem] because she’s lovely” and “Their [the staff’s] communication is spot on, they always phone about [Relative’s] tests.” Staff worked in partnership with other health and social care professionals to support and improve people’s health and wellbeing.

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 18 January 2022). 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. However, the provider remained in breach of regulations.

The service remains rated requires improvement. This service has been rated requires improvement for two consecutive inspections. However, there had been considerable improvements since the last inspection. We will continue to engage with the provider and other stakeholders to monitor the ongoing progress of the service until we return to inspect.

Why we inspected

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

We undertook this focused inspection to check whether the Warning Notices we previously served in relation to Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

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 requires improvement. This is based on the findings at this inspection.

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

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

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 found the provider had met the Warning Notices we previously served in relation to Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. However, we have identified breaches in relation to medicines management and good governance.

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 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.

Brushwood is a purpose-built care home which can support up to 60 people over three floors in separate units. One of the units specialises in caring for people who are living with dementia. At the time of the inspection 59 people were living at the home.

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

Care records did not always contain the most relevant information or guidance that staff needed to follow, and people were exposed to unnecessary risk. Areas of risk were not robustly monitored, incidents and accidents were not analysed or reviewed.

Medication practices were not always safe. People were not always supported to receive their medications safely. PRN (as and when required medicines) protocols were not in place for all people living at the home.

People were not always 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.

Sufficient numbers of suitably qualified, competent, skilled or experienced staff were not always deployed across the home. People’s risk assessments and needs did not always reflect in staffing numbers. We have made a recommendation regarding this.

Quality performance measures were not effectively in place, areas of risk were not always safely managed. Gaps in quality assurance and governance measures meant that the provision of care people received was sometimes compromised.

The environment was clean, tidy, well maintained and stocked with personal protective equipment (PPE). People told us they liked living at the home.

Following the first day of our inspection the registered manager ensured risks we escalated were mitigated and there was process in place to avoid them being repeated.

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

Rating at last inspection

This service was registered with us on 01/04/2021 and this is the first inspection.

Why we inspected

The inspection was prompted in part due to concerns received about medication, infection control, and staffing. 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 that the provider needs to make improvements. You can see what action we have asked the provider to take at the end of this full report.

Enforcement

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to medications, consent and MCA, risk assessments, records and governance.

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.

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.