We carried out a review of the data available to us about Brownlands Nursing Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Brownlands Nursing Home, you can give feedback on this service.
We found the following examples of good practice.
People, staff and visitors were protected again the spread of COVID-19. The provider carried out regular testing and screening procedures ensure visitors could safely visit. The registered manager maintained contact with relatives and kept them updated on any changes.
The environment appeared clean and had no odours. Room cleaning schedules were in place and completed daily. The disposal of Personal Protective equipment (PPE) followed government guidance and best practice.
Staff wore appropriate PPE and PPE stations including hand sanitiser were placed throughout the home. Staff changed their uniform before and after their shift. There were designated areas available for staff to store their clothes. All staff received IPC and donning and doffing training.
Risk assessments were in place for people and staff regarding individual risk factors of COVID-19. Staff and people were regularly tested and had received COVID-19 vaccinations.
The registered manager completed regular audits to ensure oversight of IPC practices.
This was the second comprehensive inspection at Brownlands Nursing Home.
Brownlands Nursing Home is a care home with nursing. 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. The care home accommodates up to 31 people in one adapted building. On the day of our visit, 27 people were using the service.
At the first comprehensive inspection on 10 November 2016, we rated the service ‘Requires Improvement’. We served a fixed penalty notice under Section 33 of the Health and Social Care Act 2008. This was because the provider had not complied with the conditions of their registration to have a registered manager in post. The provider was also in breach of regulation 17 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Good Governance. This was because sufficient arrangements were not in place to monitor and manage the quality and safety of the care and support provided for people at the service.
Since the inspection a registered manager had took up post on 8 March 2017. 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.
During this inspection, we found that the registered manager had taken sufficient action to meet the breach of regulation and drive improvement in all areas at the service. The registered manager and staff strived to continue to make improvements to the service by using lessons learnt from feedback received from people using the service, relatives, staff and health and social care professionals.
The registered manager promoted an open transparent culture, which involved people using the service, relatives and staff. They invited people to provide feedback about the service, which they used to analyse the quality of their care, to make positive changes to drive improvement.
Risk assessments supported people to stay safe and took into account people’s rights to take risks and have their freedom respected. People received care that continuously met their assessed needs. The assessments were reviewed and updated. The registered manager took prompt action to address any concerns about people’s safety.
There were enough staff deployed to meet people's assessed needs. Staff understood their roles and responsibilities to safeguard people from the risks of harm or abuse. Safe recruitment and selection processes were followed to ensure staff were suitable to work at the service.
Staff received appropriate training and support to carry out their roles. People were provided with meals that were varied and nutritious and they were supported to eat and drink sufficient amounts to maintain their health and well-being. People were supported to access appropriate health and social care professionals as and when needed. Staff followed best practice infection control guidelines to control the risks of the spread of infection. Systems were in place to manage medicines in a safe way.
Staff understood the principles of the Mental Capacity Act, 2005 (MCA). They sought people's consent and involved people in the planning of their care so to have maximum choice and control of their lives. Staff understood the principles of the Deprivation of Liberty Safeguards (DoLS) and supported people in the least restrictive way possible.
Staff protected people’s privacy and dignity. Staff, people using the service and relatives had developed positive relationships. Staff had a good understanding of people's backgrounds, needs and preferences. People’s views were valued and acted on.
Information was available to people on how to make a complaint. People using the service and their relatives knew how to raise a concern or make a complaint. They were confident the registered manager would respond to any complaints appropriately.
Brownlands Nursing Home is registered to provide residential care for up to 31 older people, including people with dementia care needs. At the time of this inspection there were 27 people living in the home.
A registered manager was not in post at the time 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. Although CQC has taken enforcement action in relation to the lack of a registered manager it is a significant concern that an application for a registered manager has yet to be submitted.
There were insufficient systems in place to monitor the quality and safety of the service. Audits failed to identify risks associated with the management of medicines, record keeping and accidents and incidents. People were not always protected as environmental risks were not identified.
People did not always have care plans that reflected identified risks. This had been identified by the lead nurse and new care plans were being implemented. People had prompt access to healthcare services when needed and we found that their nutritional needs were being appropriately met and monitored.
People could be assured that sufficient numbers of staff would be working within the home to provide their care and support in the way in which they wished to receive it. Staffing levels had been calculated to reflect the dependency levels of people living in the home and the number of staff deployed reflected this. People participated in a range of activities and received the support they needed to help them do this. People were able to choose where they spent their time and what they did.
People felt safe in the home and relatives said they had no concerns about people’s safety. Staff had been safely recruited and understood the need to protect people from harm and abuse and knew what action they should take if they had any concerns. Staff received training in areas that enabled them to understand and meet the care needs of each person.
Staff had good relationships with the people that lived in the home and knew people well. Staff supported people to be as independent as possible, provided appropriate support to people to enable them to make choices and treated people with respect and dignity. Staff listened to people and their relatives and responded to complaints promptly and in line with the provider’s policy.
Where possible people were involved in making decisions about their care and support needs. There were formal systems in place to assess people’s capacity for decision making under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).
At this inspection we found the service to be in breach of two regulations of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014. The actions we have taken are detailed at the end of this report.
This unannounced inspection took place on the 13 and 15 January 2016.
Brownlands Nursing Home is a care home providing care for up to 31 older people, including people with dementia care needs. There were 29 people in residence when we inspected.
A registered manager was not in post. 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.
People were safe. People were protected by robust recruitment procedures from receiving unsafe care from staff that were unsuited to the job. They were cared for by sufficient numbers of appropriately experienced and trained staff. People were safeguarded from abuse and poor practice by staff that knew what action they needed to take if they suspected this was happening.
People’s care needs had been assessed prior to admission and they each had an agreed care plan. Their care plans were regularly reviewed, reflected their individual needs and provided the information and guidance staff needed to provide person centred care. Staff knew what was expected of them when caring for older people, including those with dementia and nursing care needs, and they carried out their duties effectively and with compassion.
People’s individual preferences for the way they liked to receive their care and support were respected. People were enabled to do things for themselves by friendly staff that were responsive and attentive to each person’s individual needs.
People’s healthcare needs were met and they received timely treatment from other community based healthcare professionals when this was necessary. People’s medicines were appropriately and safely managed. Medicines were securely stored and there were suitable arrangements in place for their timely administration.
People’s individual nutritional needs were assessed, monitored and met with appropriate guidance from healthcare professionals that was acted upon. People had enough to eat and drink. People that needed support with eating and drinking received the help they required.
People, and where appropriate, their representatives or significant others were assured that if they were dissatisfied with the quality of the service they would be listened to and that timely remedial action would be taken to try to resolve matters to their satisfaction.
Below is a summary of what we found. The detailed evidence supporting our summary can be read in our full report.
Is the service safe?
There were sufficient numbers of experienced and competent staff on duty to safely meet people's personal and healthcare needs. We saw that staff had been appropriately trained to provide safe care. One person said, "All the staff are very caring. It makes me feel content because I know I am safe here."
Staff said they had received training in the safeguarding of vulnerable adults (SoVA) and the staff that we spoke with knew how to report concerns. This meant that people were protected from the risk of neglect or unsafe care.
Suitable arrangements were in place for staff to respond to emergencies, deal with incidents, or seek guidance from their manager. This meant that staff received the advice and support they needed to manage problematic situations safely, effectively, and in a timely way.
We found that people's needs had been appropriately assessed before they were admitted to Brownlands Nursing Home. After admission to the home we saw that their needs were regularly reassessed to ensure they continued to receive safe care when their needs changed. This meant that staff had the up-to-date information they needed to minimise identified risks to people's safety and welfare.
We saw that people were cared for in an environment that was clean and hygienic. We found that the equipment in place for staff to use was appropriately serviced. This meant that people were cared for in a safe, well maintained environment.
Is the service effective?
We observed staff going about their duties without hurrying. One person said, 'I get the help I need, when I need it. They never keep me waiting or leave me feeling uncomfortable.'
We spoke with four staff and they were knowledgeable about people's needs. They said they always received a briefing before they started their shift so that they knew what needed to be done. They were able to tell us about people's individual needs and how they delivered their care. This meant that because staff had a good knowledge of each person's care needs and preferences they were able to provide effective care.
Is the service caring?
When we saw staff interact with people their manner of approach was patient, kind, and good humoured. They encouraged people who struggled to do things for themselves but made sure people were safe. We saw they provided people with timely assistance whenever that was appropriate but never 'rushed' anyone.
Is the service responsive to people's needs?
People said they received the support they needed to enable them to do what they could for themselves. On person said, "I am not able to do much for myself now, but I like to have a go and they always let me try. That is important to me."
We saw that there was enough staff on duty to meet people's needs. We heard, for example, that whenever a call bell was activated staff responded in a timely way. The four staff we spoke with said they were able to meet people's needs without feeling under pressure. One person said, "The carers are busy, but they always have time for me." A visitor we spoke with said, "I think the staff here are very attentive. They do a good job."
Is the service well led?
When we inspected we found that the manager in post had not yet applied to register with the Care Quality Commission (CQC). We advised the provider and manager that an application to register the manager with CQC was required to be submitted by the post holder and they confirmed that appropriate action would be taken to remedy this.
The staff we spoke with all confirmed that they had received the support and guidance they needed from the manager and other senior staff, such as the nurse-in-charge. They said they were encouraged to raise issues for discussion or make suggestions for improvements. They all said the manager was very approachable. They also said they received a good level of managerial support and guidance that enabled them to carry out their duties.
We spoke with two relatives of people that used the service who visited on a regular basis. Both of them spoke positively about the service. One relative told us 'The care is absolutely 100 per cent'.
We found that the provider carried out regular checks and appropriate servicing of equipment within the service and that where any concerns with equipment were identified they were dealt with efficiently. We also found that records that were kept within the service were being regularly updated to ensure that they contained current information.
However we found that where people's nutritional needs had been identified, plans to meet their needs were not being followed. We also had concerns about the management of the ordering of medicines and how stock levels of medicines were being recorded.
We spoke with a relative of a person who used the service who told us "the food is excellent".
We spoke with three staff members who all told us that they enjoyed their work and that the people who used the service received good care. The staff told us that they felt well supported and one staff member told us that they had completed a qualification which had improved their knowledge and skills while working for the provider.
We found that people who used the service were involved with decisions about their care and support. We saw that they had detailed care plans that were reviewed regularly. We found that people's complaints and comments were recorded and investigated. However we found concerns with the records kept by the home of peoples care and treatment and the staff records relating to training and supervision. They did not always provide accurate details.
People and their relatives we spoke with praised the service: ''It's better now. Staff are all friendly.' 'You can't fault the staff. They try to be helpful.' 'Staff always try to help you though they are very busy.'
There was a suggestion that we received :
Although staffing levels appear high, there needed to be another member of staff on duty for the early shift so that people did not have to wait to get up, or wait too long to go to the toilet.
There was a suggestion that we received :
Although staffing levels appear high, there needed to be another member of staff on duty for the early shift so that people did not have to wait to get up, or wait too long to go to the toilet.
The people we spoke with were largely satisfied with the home's care. Staff were mostly seen as friendly and caring. There were some complaints about the service. Some people told us that they were cold on the day of inspection. Staff then turned the heating on. Two people also said that staff had run out of the right size continence pads and this meant that they were using pads that did not fit. This made them feel uncomfortable. The provider acknowledged that these stocks of pads had run out. He said he had taken steps to make sure that this did not happen again. We saw boxes of pads being delivered in the afternoon of our visit to ensure people's needs were met. Two people also said that sometimes they had to wait for a long time for staff to take them to the toilet. One person said that she has had to wait for up to 45 minutes on one occasion.
People and their relatives largely praised the service: ''Staff are good. They are always friendly to me'. '' 'There are no rules. I can do what I like.'
In all we spoke with eight people and three relatives, who all highly praised the service: 'I cannot fault anything ', 'everything seems to be working well and staff are very friendly '. 'I am pleased with the care that I get here. I've never had any complaints '. ''Staff are friendly and polite and I can have my room the way I want it '.