Brenan House Residential Home

Brenan House is a residential care home providing personal care to up to 16 older people in one large adapted building. At the time of our inspection there were 13 people using the service.

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

People told us they felt safe living at the service. However, the improvements found at the last inspection had not been maintained and the quality of the service has deteriorated.

When people had been admitted to the service, potential risks to their health and welfare had not been assessed. Risk assessments had not been robust and there was no guidance for staff to mitigate the risks.

Accidents and incidents had been recorded but these had not been analysed for patterns and trends. Checks had been completed on the environment and equipment, however, not all fire checks had been recorded and staff had not completed fire drills.

Medicines had not always been managed safely, some people had not received their medicines as prescribed. Checks and audits had not been completed consistently, when shortfalls had been identified action had not always been taken. Staff had not received regular supervision and staff did not have up to date training.

The service was clean and odour free, however, the service was cluttered with equipment and furniture restricting people’s use of communal space. There were enough staff to meet people’s care needs but there was no opportunity provided for meaningful activities.

Quality assurance surveys had been sent to people and staff, but these had not been analysed and the results had not been acted on. People and staff had not been given the opportunity to attend meetings t make suggestions about the service.

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.

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 requires improvement (published 12 November 2021). The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

This inspection was prompted by a review of the 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.

We carried out an unannounced comprehensive inspection of this service on 5 October 2021. Though no breaches of regulation were found further improvements were still required.

We undertook this focused inspection to check they had continued to make improvements and to confirm they had improved. This report only covers our findings in relation to the Key Questions Safe 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 not changed and remains Requires Improvements. 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 Brenan House on our website at www.cqc.org.uk.

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

Enforcement and Recommendations

We have identified breaches in relation to management of risk and good governance at this inspection.

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

Brenan House is a residential care home providing personal care to 14 older people who may be living with dementia at the time of the inspection. The service can support up to 16 people in one large adapted building.

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

People told us they felt safe and were happy living at the service. Improvements had been made to the quality of the service since the last inspection.

Medicines were now managed safely; people received their medicines as prescribed. Accidents and incidents had been recorded, analysed and action taken. However, there had been no overall service analysis to identify patterns and trends. This is an area for improvement.

Checks had been completed but these had not been consistently recorded. Though the service had improved there were no action plans in place to show how further improvement would be achieved. This is an area for improvement.

People and staff were asked their opinions; however, these had not been consistently recorded. There were no action plans in place to show how their views had been used to improve the service. This is an area for improvement.

Potential risks to people’s health and welfare had been assessed and there was guidance in place for staff to mitigate the risk and keep people safe. People were supported by staff who had been recruited safely. There were enough staff to support people. The addition of cleaning staff had improved the cleanliness of the service and enabled care staff to spend more time with people.

Care plans were now accurate, reflecting people’s needs. People told us they were supported in the way they preferred. Staff understood their responsibilities to keep people safe from abuse and discrimination. People were supported to be as independent as possible. Staff worked with health professionals to make sure people’s needs were met.

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 and relatives told us the registered manager was supportive and approachable.

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 6 September 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. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This inspection was prompted by our data insight that assesses potential risks at services, concerns raised and based on the previous rating.

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 undertook this focused inspection to check the provider had followed their action plan and to confirm they now met legal requirements. This report covers our findings in relation to the breaches of regulation in Key Questions Safe, Effective, Caring, Responsive and Well-led which contain those requirements. The Key Questions Effective, Caring and Responsive were inspected but not rated as not all the domain was covered.

The ratings from the previous comprehensive inspection for those key questions not rated on this occasion were used in calculating the overall rating at this inspection. 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 Brenan House on our website at www.cqc.org.uk.

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.

Brenan House is a residential care home providing personal and nursing care to 15 older people at the time of the inspection. The service can support up to 16 people in one adapted building.

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

People and relatives told us they were safe living at the service. However, potential risks to people’s health, welfare and safety had not been consistently assessed. Staff did not have guidance to mitigate risk and keep people safe. Some areas of the service put people’s safety at risk.

Staff were not always recruited safely; pre-employment checks had not been completed consistently. There were not enough staff to provide person centred care. Care staff were expected to clean the service and do people’s laundry. Staff did not have time to provide activities, spend time with people and always maintain their dignity. Staff had received training but not in topics related to people’s specific health needs such as diabetes or catheter care.

The service was odour free; however, some areas of the service were not clean. There were no cleaning schedules to record when areas and equipment had been cleaned to help prevent infection.

Medicines were not always managed safely. Staff did not have guidance for ‘when required’ medicines to make sure people received their medicines when they needed them. Accidents and incidents were recorded, and action had been taken. However, analysis had not been completed to identify patterns and trends.

Care plans were not always completed to reflect the care being given to people. However, staff knew people well and supported them in the way they preferred. Some audits were completed but these did not cover all aspects of the service. The audits completed had not identified the shortfalls found at this inspection.

People, relatives and staff had not been asked their opinion on the quality of the service and how to improve it. Relatives told us they would speak to the registered manager if they had any issues and these have been dealt with immediately.

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 met with the registered manager before they moved into the service to check staff could meet their needs. People were supported to eat a balanced diet, people had a choice of meals, people’s preferences and dietary needs were catered for.

People were supported to be as independent as possible. People’s health was monitored, and they were referred to health professionals when required. People’s end of life wishes were discussed and recorded. Staff worked with the GP and district nurses to support people at the end of their lives.

Relatives told us that the registered manager was supportive and kept them informed of any changes in their relatives’ care. Staff and the registered manager understood their responsibilities to protect people from abuse.

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

Rating at last inspection Good (published 31 January 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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.

Enforcement

We have identified breaches in relation to the assessment and management of risks, staffing and recruitment, medicine management, maintaining people’s dignity and the general management of the service at this inspection.

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.

Brenan House is a large Victorian building situated in front of a tree lined square, and provides care and accommodation to up to 16 older people.

Accommodation is set over three floors with two lounges, one upstairs on the first floor and one on the ground floor with an adjoining conservatory that leads out to a rear courtyard. There is a shaft lift for people to access all floors.

One of the owners is the registered manager and was present on the day of the inspection. 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.

At our last inspection in October 2015, the service was in breach of some of the regulations and was rated ‘Requires Improvement’. The provider sent us an action plan outlining how they would rectify those breaches. At this inspection all the regulations were met.

There were enough staff to keep people safe. Staff were checked before they started working with people to make sure they were of good character and had the necessary skills and experience to support people effectively. Staff had received sufficient training and guidance to make sure they knew how to support people safely and in the way they preferred. Staff received regular supervision and support from the registered manager who worked alongside them some of the time.

Staff knew how to recognise and respond to abuse. The registered manager was aware of their responsibilities regarding safeguarding and staff were confident the registered manager would act if any concerns were reported to them. Consideration had been given to people’s safety and potential risks had been assessed. People had the equipment and support needed to prevent unnecessary accidents and incidents.

The registered manager and team had worked hard to update and review the care planning system. Each person had a care plan that included their preferences and all the information necessary to meet their individual needs. People were involved in the assessments and planning and staff had a good understanding of making sure people had the right support to make decisions and give consent to care. This included support needed in regard to the Mental Capacity Act.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. These safeguards protect the rights of people using services by ensuring that if there are any restrictions to their freedom and liberty, these have been agreed by the local authority as being required to protect the person from harm. DoLS applications had been made to the relevant supervisory body in line with guidance.

People were treated with kindness, patience and respect. Staff said they had built up good relationships with people and people were complimentary of the kind and caring nature of the staff. A person said, “The owners and staff are kind and good, and all the people are alright in here. I would recommend this home.”

People were supported to eat and drink healthily. There was a good variety of homemade cooked food and people were complimentary of the meals provided. Relatives told us that people were well fed and the food always smelled good.

People were supported to keep well and healthy and if they became unwell the staff responded promptly and made sure that people accessed the appropriate services. Visiting health professionals including district nurses and doctors were involved in supporting people’s health and wellbeing as needed. People received their medicines safely and when they needed them, by staff who were trained and competent.

People, staff and relatives told us that the service was well led and that the registered manager and staff team were supportive and approachable and that there was a culture of openness within the service. A person’s friend said, “I visit other homes and this is definitely the best.”

People and their visitors told us that if they had a concern they would speak to the registered manager or any of the staff. There was a clear complaints procedure and opportunities for people to share their views and experiences of the service.

Checks on the equipment and the environment were carried out and emergency plans were in place so if an emergency happened, like a fire, the staff knew what to do.

Services that provide health and social care to people are required to inform the Care Quality Commission, (the CQC), of important events that happen in the service. This is so we could check that appropriate action had been taken. The registered manager was aware that they had to inform CQC of significant events in a timely way. Notifiable events that had occurred at the service had been reported. Records were stored safely and securely.

We found the home to be clean and tidy and free from unpleasant odours. There was a system in place for infection control to protect people from the risk of infection.

Staff recruitment records showed that new staff had been thoroughly checked to make sure they were suitable to work with vulnerable people. Systems were in place to monitor the service that people received to ensure that the service was satisfactory and safe. People told us they did not have any complaints but would not hesitate to speak to the manger or staff if they had any concerns.

People and relatives told us that they would not hesitate to raise any concerns with the manager or staff. They told us they were satisfied with the service.

People said: "I have no complaints, the staff are very good". "I feel comfortable living here".

We saw that staff were responsive in the company of people using the service. Staff listened to people and supported them to be where they wanted to be. They gave the people time to respond and answered their questions in a way they could understand.

The staff we spoke with understood people's needs and knew their routines and how they liked to be supported.