Archived: The Brunswick

The Brunswick provides accommodation and personal care for a maximum of 58 residents. At the time of the inspection there were 26 people in residence.

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

At our last inspection we found breaches of regulations because the provider was failing to manage policy and practice related to medicine management, staffing and overall management and governance.

Enough improvement had been made at this inspection regarding staffing and governance and the provider was no longer in breach of these Regulations. There was continued concerns regarding medication management and the provider remains in breach of this regulation.

Although we saw some improvement in the management of medicines, these were not consistently implemented and embedded. This meant there was a risk some medicines for people were not monitored safely and there was a risk some people might not receive their medicines. This was an ongoing concern from the last inspection.

Arrangements were in place for checking the environment to ensure it was safe. We found good ongoing checks of the environment helped ensure people were safe. This was an improvement from the last inspection.

The home was staffed appropriately and consistently. This helped to maintain a consistency of care for people. People and their relatives told us they felt safe living at The Brunswick. This was an improvement.

There were a series of quality assurance processes and audits carried out internally and externally by senior managers. The new manager for the service had ensured the well-developed management systems had been applied in the home. There was a strong emphasis on communicating with relatives and getting people’s feedback to further improve the service. This was an improvement.

Some of the systems needed further embedding to ensure all aspects of care and safety were consistently monitored and improved.

The service was following good practice guidance regarding the management of COVID-19 and maintaining standards of hygiene and infection control.

People's experience of using the service was positive. Most people received the care and support they needed when required. Most of the feedback we received showed staff were helpful and kind and treated people with dignity and respect. Positive relationships had been developed between staff and people they supported.

A relative commented. “Communication was poor before the new manager but has now vastly improved. We have zoom calls and lots more updates and contact. I feel very reassured because of this. My relative seems very happy [living at the home].”

Risks associated with people’s care were identified and managed to minimise harm. Supporting care records mostly identified risks clearly and there were plans in place to help keep people safe.

Since the last inspection there had been changes of management. The current manager was providing effective leadership and was supported by a senior management team. The provider’s governance systems and organisational structure provided monitoring and support for the service.

Rating at last inspection and update

The last rating for this service was Requires improvement (published 8 October 2019). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been sustained to meet all of the breaches.

Why we inspected

We carried out an unannounced focussed inspection of this service on 27 August 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at 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.

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.

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

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 a breach in relation to medicines management 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 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The Brunswick provides accommodation and personal care for a maximum of 58 residents. At the time of the inspection there were 46 people in residence.

People’s experience of using this service

There were several shortfalls and inconsistencies in the completion of the paperwork used to record the administration of medicines. This meant there was a risk some medicines for people were not monitored safely and there was a risk some people might not receive their medicines.

Arrangements were in place for checking the environment to ensure it was safe. We found, however, that the monitoring of fire safety was a concern. Issues were rectified and made safe at the inspection.

The home was not staffed appropriately and consistently. This sometimes affected the way care could be carried out. There were measures in place to make staffing more consistent but further improvements were needed.

Most people we spoke with told us that, despite staffing issues at times, they felt safe in the home. This was not always the case however. One relative commented that the home provided a good overall environment but “Staffing was not consistent, and this is a worry.”

The registered manager could evidence a series of quality assurance processes and audits carried out internally and externally by staff and visiting professionals. These were effective in some areas of managing the home and were based on getting feedback from the people living there. These checks and audits had not highlighted some of the issues we found on the inspection.

People told us that the regular staff had the skills and approach needed to help ensure they were receiving the right care.

Some people told us they did not always feel supported with their needs. This related to the provision of staff at certain times. The formal assessment and planning of people’s care in care records had been reviewed, and updated records displayed good detail of peoples care needs and evidenced their involvement.

Overall there was a positive and relaxed atmosphere in the home. People living in the home interacted freely and staff interactions we observed were seen to be caring and supportive.

The staff we spoke with described how they would recognise abuse and the action they would take to ensure actual or potential harm was reported.

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.

We saw people’s dietary needs were managed with reference to individual needs and choice. Meal times provided a good social occasion.

Rating at last inspection:

The last rating for this service was Good (published 12 December 2018).

Why we inspected:

We received concerns in relation to the management of medicines, staffing levels and people’s care needs. As a result, we undertook a focused inspection to review the Key Questions of Safe and Well-led. Because we found concerns with these key questions we went on to complete a full inspection looking at all key questions.

The overall rating for the service has changed from Good to Requires improvement. This is based on the findings at this inspection.

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

Follow up:

We have asked the provider to send us an action plan telling us what steps they are to take to make the improvements needed. We will continue to monitor information and intelligence we receive about the service to ensure good quality is provided to people. We will return to re-inspect in line with our inspection timescales for Requires Improvement services.

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

The Brunswick is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The Brunswick provides accommodation and personal care for a maximum of 58 residents. Care needs for people using the service include older people, people with physical disability and people with sensory impairment. The service was registered 12 months ago and this was the first inspection. At the time of the inspection there were 36 people in residence.

A registered manager was in place. 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.

We found management and overall governance was stable. The provider had other locations registered with CQC and was experienced in the care sector. The registered manager was a consistent lead in the home and had been effective in building a positive staff team.

Staffing numbers helped ensure people’s care needs were being consistently met. Feedback from staff, people using the service and visitors was positive in that staffing levels were adequate to ensure safe standards of care. We looked at how staff were recruited and the processes to ensure staff were suitable to work in the home. We saw checks had been made so that staff employed were suitable to work with vulnerable people.

We found medicines were administered safely. People received their medicines consistently. Medication administration records (MARs) were not always clear and this was discussed with reference to future changes in some of the pharmacy arrangements.

People’s nutritional intake was supported appropriately. There had been some negative feedback prior to our inspection and the provider had responded by reviewing the meal arrangements for people. Most people’s comments on the inspection were that the meals had improved. Meal times were seen to be a relaxed and enjoyable experience for people. People’s nutritional intake was monitored.

Staff told us there were very good systems in place to support them in their work such as training and supervision.

Observations and feedback from people and their relatives evidenced people’s dignity was protected and maintained.

The activities programme continued to be developed. A newly employed activities coordinator had made positive improvements to help ensure a more consistent programme of social activities had been developed.

People’s risks regarding their health care were being adequately assessed and monitored. There was good referral and liaison with community health care professionals who worked with the home to help ensure people’s health care needs were met.

The staff we spoke with described how they would recognise abuse and the action they would take to ensure actual or potential harm was reported. All staff were clear about the need to report any concerns they had.

Arrangements were in place for checking the environment to ensure it was safe. Planned development / maintenance was assessed and we could see the home was furnished to a high standard.

Staff sought consent from people before providing support. When people were unable to consent, the principles of the Mental Capacity Act 2005 were followed and an assessment of the person’s mental capacity was completed and decisions made in the person’s best interest.

There were people being supported on a Deprivation of Liberty [DoLS] authorisation. DoLS is part of the Mental Capacity Act (2005) and aims to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom unless it is in their best interests. We found these were being monitored by the registered manager of the home.

We saw written care plans were formulated and reviewed regularly. We saw that people and their relatives were involved in the care planning and reviews were held.

We observed staff interacting with the people they supported. We saw how staff communicated and supported people. People we spoke with and their relatives told us that staff had the skills and approach needed to ensure people were receiving the right care.

A complaints procedure was in place and people, including relatives, we spoke with were aware of how they could complain. There were records of complaints made and the provider or registered manager had provided a response to these.

The management structure within the home was clear and supported the home with clear Iines of accountability and responsibility.

There were systems in place to gain feedback from people so that the service could be developed with respect to their needs and wishes.

The registered manager was aware of their responsibility to notify us [CQC] of any notifiable incidents in the home.