Brunswick House Nursing Home

Brunswick House is a residential care home providing personal and nursing care to a maximum of 46 people. The service provides support to older people, some of whom live with dementia. At the time of our inspection there were 41 people using the service. People are accommodated in one adapted building which has been extended.

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

We found the improvements required following our last inspection had been made. The provider had effective quality monitoring processes in place and the management of people’s care records had improved.

Prior to our inspection the registered manager had left and the deputy manager was now the new manager. They had been in this role for 6 weeks. They had been involved in the improvement program so were well informed about what now needed to be sustained.

People were aware of the change in management but were not concerned by it. They told us they already knew the new home manager, who they described as “friendly” and “approachable”. Staff felt supported and valued by the senior staff and were working with them, as one team, to provide people with the services they required. The new home manager had a clear vision for the service and had the support of the provider’s representative to achieve this.

People told us they felt safe because the staff were caring, friendly and always available to help them when needed. We found, there were enough staff to meet people’s care needs and to respond to them when needed to ensure their safety. People’s medicines were managed safely. People told us the home was kept clean and we found effective cleaning and infection, prevention and control arrangements in place. Safety checks and servicing arrangements ensured the ongoing safety and effectiveness of the building, equipment, all utilities and emergency systems.

People told us their health needs were met and they had access to the health professionals when needed. We spoke with two health care professionals who confirmed staff worked well with them to support and maintain people’s health. People’s care records provided clear information about their needs and how these should be supported. Staff were provided with training and support to meet these needs effectively. People told us their consent was sought and they were able to make independent decisions about their care and treatment. People’s nutritional needs were assessed and met. People told us staff were aware of and met their personal choices and cultural preferences regarding food and drink. Changes were made to people’s environment, their equipment and the care delivered to them as their needs altered.

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.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

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 3 November 2021).

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.

Why we inspected

This inspection was planned to see if the provider had met their action plan regarding the actions, they told us they would take to improve. We had also received concerns in relation to staff availability, staff culture and the management of the service. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

We found no evidence during this inspection that people were at risk of harm from these concerns.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection these were inspected, to calculate the overall rating. The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

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

Follow up

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

Brunswick House is a residential care home. It was providing personal and nursing care to 38 people, aged 65 and over at the time of the inspection, some of whom lived with dementia. The service can support up to 46 people.

People are accommodated in one adapted building across three floors. They are provided with single bedrooms, adapted communal bathrooms and toilets and communal areas to sit and eat in. An enclosed court-yard garden provides an easily accessible outside space for people who can walk or who require a wheelchair.

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

The new manager and Area Manager knew where improvements to the service were required and they were taking action to address these and improve outcomes for people. However, at the time of the inspection all the actions taken had not always been effective in addressing recording shortfalls or mitigating the risk to people till the improvements had been completed. We found more time was needed for the new manager to develop and further establish the improvements they were making and had planned to make to the service in order for the service to run smoothly and this result in consistent and effective high quality and person centred care.

Action had been taken to develop staff skills and knowledge to ensure, people’s nursing needs continued to be met.

People told us they felt safe and looked after. They told us staff were friendly and kind but always busy and this meant they sometimes had to wait for staff to be available to support their wellbeing.

People’s dietary needs were met. Support staff had been employed to help people access enough drinks and to support them with their meals and snacks.

People had access to medical support as required as well as other health associated services. Most people were registered with one GP surgery. A GP from that surgery maintained weekly visits to review people’s health needs.

People’s oral health had been assessed and when required, the care home staff organised dental support (when this had been possible during the pandemic).

People were supported to have 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.

Infection, prevention and control (IPC) arrangements were in place but inspectors signposted managers to specialist IPC support so they could be sure that their processes were robust and effective enough to respond to the risks posed by COVID-19.

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 30 December 2020).

Why we inspected

The inspection was prompted in part due to concerns received about the quality of care provided to people. As a result, we undertook a focused inspection to review the key questions of effective and well-led only.

We looked at the home’s infection prevention and control measures under the safe 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. Please see the effective 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 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 reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Good to 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 on our website at www.cqc.org.uk.

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 review our regulatory action in response to information we receive about the service.

Brunswick House is a residential care home providing personal and nursing care to 45 people aged 65 and over at the time of the inspection. The service can support up to 46 people. People live in one adapted building across three floors. There is an external court-yard which people and relatives can use for visiting when the weather is good.

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

People told us they felt safe. There were arrangements in place to protect people from abuse and avoidable harm. One person said, “Not one member of staff has been horrible to me.” There were processes in place to support staff and people to report any concerns they may have. Staff recruitment checks helped managers make safe decisions when employing staff. Managers ensured there were enough staff, with the appropriate skills, to meet people’s needs. Risks to people such as the spread of infection, falls and loss of weight were assessed, managed and reduced. People received their medicines as prescribed and safely. One person said, “I get pain relief when I need it, I’m not left waiting”.

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 was planned and delivered in a way which met their needs, and which met their preferences. One person told us they were “In control of decision making” and they said, “Staff know the way I like things done.” Care plans provided staff with guidance on how people’s care must be delivered, and they included people’s preferences and wishes.

People receiving palliative care were involved in making decisions about their care and treatment, and about their end of life care. Staff ensured people at the end of their life had a dignified and comfortable death.

Since the last inspection improvements had been made to how information was made available to people. To support people who found the written word challenging, pictures for example, had been added to the meal menus. Other information such as newsletters and the complaints procedure could be provided in large print. People’s care plans included how they should be communicated with and how they required information to be provided to them.

Arrangements were in place to manage complaints and to learn from these. Feedback was gathered both informally and formally from people and their relatives and used to help improve the service.

There had been changes to the leadership arrangements in the service as well as some organisational improvements. Staff told us they felt well supported and managers were both approachable and available to help. The provider’s quality monitoring processes had continued to evolve and had resulted in ongoing and significant improvement being made to the service.

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 4 April 2019).

Why we inspected

This inspection took place as there had been changes to the leadership and management arrangements in the service. We wanted to check if people were safe, their needs were being met and that good governance was in place.

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 reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has remained Good.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Brunswick 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.

Brunswick House is a 'care home' and provides accommodation and personal care for up to 46 older people, including those living with dementia. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. At the time of our visit 40 people were using the service.

We last inspected the home on 20 and 22 February 2018 and found five breaches of the legal requirements. People did not always receive safe care and good medicine practices were not always followed. When people had been deprived of their liberty for the purpose of receiving care or treatment lawful authority had not been sought. Staff were not appropriately trained and supported and people did not always receive personalised care. The provider’s quality monitoring systems had not been effective in identifying these concerns prior to our inspection and action had not been taken promptly to improve the service people received.

During this inspection we found that improvements had been made and the provider met legal requirements. We found people’s plans of care had improved and contained detailed information about their individual needs and preferences. Medicine practices had improved. There were systems for ensuring people were not being deprived of their liberty without lawful authority and a new co-ordinator for training had been employed. Staff induction training and mandatory training had been completed as required by the provider's policy. Plans were in place to ensure staff one on one supervision and refresher training were provided in line with the provider's policy.

The service had a registered manager who registered with CQC in January 2019. 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 registered manager had implemented the service action plan to address the shortfalls in the service and had implemented improvements as required. There was a clear vision for the delivery of good quality care to people and a positive culture within the staff team.

People and their families did not always know what was contained in care records, and people did not have the opportunity to review information held about them.

There was an activities coordinator in place however, more time was needed to imbed a full activities program to support people to maintain or improve their health and mental wellbeing within the home.

Information for people within the home was not always presented to them in a way they could understand.

People told us they felt safe living at the home and we saw there were effective safeguarding processes in place to protect people from the risk of harm. Staff were knowledgeable about the procedures relating to safeguarding and whistleblowing.

Safe recruitment checks were carried out and there were adequate numbers of staff to meet people's needs safely.

Risks to people had been assessed and managed appropriately. Staff followed safe moving and handling practices. Information in relation to risk was clearly identified. People at risk had clear assessments in place with guidance to enable staff to support people effectively. There were systems in place to check and maintain the safety and suitability of the premises.

Brunswick House Nursing Home is registered to provide nursing and residential care for up to 46 people. Accommodation is provided in one adapted building. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Brunswick House is for older people who may be living with dementia. Care is provided on a long-term or short-term basis, with some people admitted for respite or further assessment on discharge from hospital. At the time of this inspection 42 people were living at the home.

Accommodation at Brunswick House is provided over three floors with bedrooms located on the ground, first and second floors. All floors were wheelchair accessible, with upper floors being accessed via the lift or stairs. Most bedrooms had en-suite facilities and adapted communal bathrooms were available to all. Lounge / dining rooms were located on the ground and first floor. A small garden was accessible from the conservatory / dining area on the ground floor.

Brunswick House Nursing Home was last inspected in April 2016. At this inspection, the home was rated “Requires Improvement” in the Safe domain, as minor improvements were needed in records relating to medicines management. No breaches of regulations were identified. Brunswick House was rated Good overall at this inspection and an action plan was not required.

This inspection was brought forward in response to concerns raised to us in February 2018. This information suggested required standards may not be being met. We therefore wanted to review the care and treatment provided to people.

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. The registered manager had been in post as manager of the home since 2003. They were registered with CQC as manager of the home in 2011.

During this inspection we identified five breaches of the Health and Social Care Act 2005 (Regulated Activities) Regulations 2014. Regulation 12 Safe Care and Treatment was not met. Improvements were needed to ensure risks to people were managed safely. This included safe use of equipment, adherence to safe moving and handling practices, ensuring staff followed the guidelines in place and managing people’s medicines safely. There were enough suitable staff to meet people’s needs. The building and equipment were appropriately maintained and people were protected from risks associated with cross infection.

Regulation 13 Safeguarding service users from abuse and improper treatment was not met. People were not always protected from improper treatment as requirements to obtain authorisation to deprive people of their liberty were not always followed.

Regulation 18 Staffing was not met. People were not always supported by staff whose skills and competency to carry out their duties had been suitably checked.

Regulation 9 Person-centred care was not met. People’s needs were not always assessed promptly and detailed care plans were not always in place to ensure people’s needs and preferences would be met. Staff worked well with external health professionals to meet people’s health needs and supported people to eat a suitable diet.

Regulation 17 Good governance was not met. The systems and processes in place to monitor the safety and quality of the services provided to people were not always effective in identifying and addressing shortfalls. Complete records of the care and treatment provided to people had not always been kept. People’s views about the service they received were sought and these were used to improve the service people received.

People received support from caring staff. Their privacy was respected and they were treated with dignity and kindness. People were supported to maintain relationships with others who were important to them. When people’s preferences were known to staff, these were respected and people were offered choices in their day to day lives. People received suitable end of life care.

This is the first time the service has been rated Requires Improvement. You can see what action we told the provider to take at the back of the full version of the report.

We last inspected in April 2014 and found the provider was meeting all of the requirements of the regulations at that time.

There was registered manager in post on the day of our 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.

People and their relatives were positive about the home, the staff and management. People told us they were safe and looked after well in the home. Staff managed the risks of people’s care and understood their responsibilities to protect people from harm. Mostly people had the assistance they required to take their prescribed medicines. However, nurses did not always maintain an accurate record of people’s prescribed medicines and the medicines they had in stock.

People had access to plenty of food and drink and received a diet which met their needs. Staff ensured their on-going healthcare needs were met.

People told us they enjoyed living at Brunswick House and that it was a friendly, pleasant and lively atmosphere within the home. People also enjoyed the time they spent with each other and staff and carrying out activities. People were offered choices about their day. They told us they felt listened to and able to raise concerns or suggestions.

Staff were supported by a committed registered manager and had access to training, supervision and professional development. They could request further training and development as required. There were enough staff with appropriate skills deployed to meet the needs of people living at the service and support them with activities. Staff spoke positively about the home and the registered manager and told us they valued the continuity of staff.

People and their relatives spoke positively about the management and the service. The registered manager ensured people, their relatives and external healthcare professional’s views were listened to and acted upon. The registered manager involved staff were involved in decisions regarding the home, and respected their views. The registered manager and provider had systems to assess, monitor and improve the quality of service people received at Brunswick House.

A single inspector conducted the inspection and helped to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, from speaking with people who use the service and a relative, from speaking with the staff supporting them and from looking at records. We spoke with seven people who lived in the home although they did not all comment on the service provided. One person told us 'it is really nice here, I like it.'

If you would like to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by the staff. There were safeguarding procedures and staff received training so that they understood how to safeguard the people they supported. When there had been concerns these were reported appropriately to the local safeguarding team for investigation.

Each person had a series of risk assessments which included the action that was needed to reduce risk and keep people safe. There were also general risk assessments and risk management plans so that the people who lived in the home, staff and visitors were kept safe.

There were systems to make sure that managers and staff learned from events such as accidents and incidents, complaints, concerns, and investigations. This reduced the risks to people and helped the service to improve continually.

The home had policies and procedures about the Mental Capacity Act and Deprivation of Liberty Safeguards and applications had been made when necessary. Relevant staff had been trained to understand when an application should be made, and about how to submit one. This meant that people would be safeguarded as required.

The home looked safe, clean and hygienic. We saw hand washing facilities and hand gel for staff and visitors. Staff wore plastic aprons and gloves when giving personal care and when serving food. These measures helped to control the spread of infection.

We saw that there were enough staff so that they were not rushed and could respond to people calmly. This helped to make sure that people's needs were always met. Before staff were employed they had thorough recruitment checks to make sure they were suitable to work with people. Staff received a range of training and most of them had relevant qualifications so that they had the right skills to support people and keep them safe.

A senior manager visited once a month to monitor the quality of service and make sure that practice was safe. There was an enclosed rear garden where people could walk about safely.

Is the service effective?

People's health and care needs were assessed with them and they had signed a record to show that they consented to them. Information about people's previous lives and their likes and dislikes were recorded in their plans. People told us that the service was flexible to meet the needs. For example, they could get up and go to bed when they wanted and stay in their rooms or go to the lounge. One person said that it was "free and easy here, there are no rules, you can do what you like." When we looked at the care plans we saw that they were regularly reviewed so that they reflected people's current needs.

There was a quiet lounge so that people could have visitors in private away from their bedrooms. We saw that visiting times were flexible and relatives were visiting at different times of the day.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. A relative told us that the care was very good. People told us that the staff always asked them what they would like before giving care or support. One person said. "They look after me really well." Another person said. "The staff are all very good."

People's relatives, staff and other professionals involved with the service completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in line with people's wishes.

Is the service responsive?

People completed a range of activities in and outside the service regularly. The home had an activity co-ordinator. Staff took care to find out what each person was interested in so that they could provide activities that suited their needs.

People's relatives knew how to make a complaint if they were unhappy. There had been only one recent complaint. We looked at how this had been dealt with, and found that the response had been open, thorough, and timely. People could therefore be assured that complaints were investigated and action was taken as necessary.

There were surveys to obtain people's views and action was taken in response to comments.

Is the service well-led?

The service worked with other agencies such as the social care commissioners, district nurse and GP to make sure people received their care in a joined up way. The service has notified CQC of incidents as required.

The service had a quality assurance system. We saw records, which showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving.

Staff we spoke with were clear about their roles and responsibilities. The manager told us that the senior managers in the organisation provided good support and direction.

We observed staff treating people with kindness and respect. There was sufficient staff available to meet people's needs. During staff handover report there was a time when one floor had no staff for a while but we observed people were safe. We also observed staff appropriately using personal protective equipment while completing personal care to promote infection control.

There was a linen cupboard on each upper floor and both had been left open when they should be locked shut to prevent a fire risk. We have informed Gloucestershire Fire and Rescue Service.

People had detailed plans of care and support from healthcare professionals to ensure their health and welfare needs were met. We found that many people felt safe in the home according to the survey results and that the staff were trained to identify any abuse and help prevent it. The staff were well trained and supported and had regular supervison and annual appraisals.

The manager ensured that systems in the home were audited frequently and that action was taken when required.