Brenalwood Care Home

Updated 2 November 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection, we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by 2 inspectors, and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service. A CQC non-executive director board member joined the team to observe the inspection process.

Service and service type

Brenalwood Care Home is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Brenalwood Care home is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was not a registered manager in post.

Notice of inspection

This inspection was unannounced. Inspection activity started on 19 September 2023 and ended on 27 September 2023. We visited the location on both dates.

What we did before inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We observed people’s care to help us understand the experience of those who could not talk with us. We spoke with 10 people who used the service, and 9 relatives about their experience of the care provided. We spoke with 6 members of staff, including 2 seniors, 2 care staff, 1 activities person and the member of staff responsible for the maintenance of the service. We also spoke with the acting manager and deputy manager from Blenheim Care Home (also owned and managed by Regal Care Homes Ltd) supporting the manager, and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

We reviewed a range of records including 4 people's care plans and all people’s medicines records. We looked at 3 staff files in relation to recruitment and a variety of records relating to the management of the service.

Updated 2 November 2023

About the service

Brenalwood Care Home is a residential care home registered to provide personal care to up to 38 people across 2 floors. The service provides support to people aged 65 and over including people living with dementia. At the time of our inspection there were 15 people living at the service.

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

People’s medicines were not always being given safely and as prescribed by the pharmacy or following the manufacturer’s instructions. Risks to people’s health were managed well, however safety checks and fire drills needed to be more robust to ensure staff could safely evacuate people in the event of a fire or similar emergency. The standard of cleanliness, including the kitchen and laundry had continued to improve since our previous inspections. However, we found staff were not always following the providers hand hygiene policy, which stated staff were to be bare below the elbow to affect good hand hygiene.

Since our last inspections in June and November 2022 the provider had successfully recruited enough staff and was no longer using temporary agency staff. The service had 1 cleaner, which was insufficient to manage both cleaning and the laundry. There was enough staff to support the 15 people currently using the service. Any new admissions to the service are to be managed slowly and safely, considering the needs of the person and compatibility with the existing people. Improvements were needed to ensure staff recruited were of good character and suitable for the role. We have made a recommendation about staff recruitment.

Staff were seen to be caring and kind in their interactions with people. However, this appeared to intuitive, rather than based on learning from training and best practice guidance. On occasions this resulted in people’s privacy and dignity being compromised. We have made a recommendation about staff training on the subject of dignity and respect.

Staff told us, training had improved, however, staff struggled to demonstrate how they put learning into practice. Training for specialist roles, such as ‘champions’ and activities needed to improve to achieve good outcomes for people and promote a good quality of life. Systems for the induction of new staff, supervision and appraisal needed to improve to explore staff’s understanding of the training provided, and test their skills, competence and knowledge which was integral to their roles.

Overall people and their relatives were complimentary about the meals provided. However, improvements were needed to ensure attention was paid to people who were reluctant to eat, and to support people to make genuine choices about what they wanted to eat. People had access to plenty of snacks between meals. There was a creative approach to celebrate food encouraging people to eat and try different types of food. For example, recent events had included a world food day, chocolate cupcake day, British pudding day, and eat with a friend day.

Significant improvements had been made to the environment. The premises had been decorated throughout to a consistent standard. However, the lounge was not used to its full potential to provide different communal areas for people to use for their preferred activities, private space to spend time with their families or visitors, or to have time alone. People had been provided with specialist or adaptive equipment as and when needed.

People experienced positive outcomes regarding their health and wellbeing. Staff worked collaboratively with other professionals to understand and meet people's needs. Prompt referrals were made to health care professionals where needed. Staff worked with other services, and the district nursing team to provide end of life care. However, improvements were needed to ensure people’s wishes at the end of their life were assessed and documented to ensure their views would be respected and acted on.

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 who had no family to act on their behalf, had regular visits by an appointed Responsible Person Representative (RPR) as a condition of their DoLS to ensure their rights as a person being deprived of their liberty were protected.

Engagement with people, staff and families had improved. People’s feedback had been gathered and used to make changes. The provider had a clear system for recording complaints, responses and outcomes. Improvements had been made to ensure information was provided to people in a format they could read and understand. However, further improvements were needed to ensure the communication needs of people with a disability or sensory loss were met.

Relatives told us, and photographs of events around the service reflected there had been improvements in provision of social activities, including special tea parties, an Hawaiian day, and a western party. However more needed to be done to ensure people are meaningfully engaged on a day-to-day basis.

Relatives, and staff told us, there had been significant improvements in the service since the changes in management. Relatives told us the acting manager was doing a really good job and there was now a nicer atmosphere in the home. Staff said morale had improved, and with better management the service was calmer and more organised. Whilst improvements had been made, we found systems to identify and manage risks to the quality and safety of the service, needed to be further embedded and sustained to drive improvements. Although audits had been completed, these had not identified the issues we found with the management of people’s medicines, and infection prevention and control.

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 inadequate (published 13 January 2023). This was the second inadequate rating and the service continued to be in special measures. The provider completed an action plan after this inspection to show what they would do and by when they would make the required improvements.

This service has been in Special Measures since 22 November 2022. During this inspection the provider demonstrated enough improvements have been made. The overall rating for the service has changed from inadequate to requires improvement. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

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

Enforcement and recommendations

We have found evidence the provider needs to make improvements. Please see the safe, effective, caring, responsive and well led sections of this full report. We have identified a continued breach of regulation 18 (Staffing) in relation to staff training, and further breaches of regulation 12 (Safe care and treatment) in relation to medicines management, and regulation 17 (good governance).

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Brenalwood Care Home 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 monitor information we receive about the service, which will help inform when we next inspect.