CQC report explained · a nursing home
What the CQC found at Brandon House
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
What inspectors found, August 2022
Brandon House is rated Requires Improvement; inspectors found people felt safe and medicines were given on time, but records and management oversight were not reliable.
This was an unannounced inspection. Inspectors visited on 21 July 2022, spoke with eight relatives and six staff, and checked care records, medicine records, recruitment files and quality monitoring records.
People told inspectors they felt safe. There were enough staff, risks were assessed, and medicines were given safely and on time. However, some medicine records were not signed or dated, some staff did not wear masks correctly, and the home did not look for patterns in accidents and incidents.
The home did not have a registered manager. Staff had not received regular supervision and meetings were not held regularly. The CQC found a breach of Regulation 17 for weak management oversight. The overall rating remains Requires Improvement, as it was at the previous inspection, although improvements meant the home was no longer in breach of the earlier recruitment regulation.
Enough staff
Staffing levels were above the minimum and inspectors saw staff responding to people's needs promptly.
“There were enough staff employed to ensure people's needs were being met.” from the report
Medicines given on time
People received their medicines safely and on time. Staff gave people time and support when they were reluctant to take them.
“People received medicines safely and on time.” from the report
Risks were assessed
Care plans included guidance about risks such as eating, drinking, mobility and skin integrity. Staff knew how to keep people safe.
“Risks were assessed appropriately.” from the report
Mental capacity practice
Inspectors found that the home was working within the principles of the Mental Capacity Act and that required legal authorisations were in place.
“We found the service was working within the principles of the MCA and if needed, appropriate legal authorisations were in place” from the report
Health professional links
The home had good working relationships with health professionals.
“The home had established good working relationships with health professionals and received compliments from visiting professionals.” from the report
Weak records and monitoring
seriousMedicine records were incomplete, safeguarding records lacked detail, and the home did not monitor patterns in accidents and incidents. These weaknesses reduced assurance that problems would be identified and acted on.
“We were not assured there was robust management of the service.” from the report
No registered manager
needs fixingThere was no registered manager at the inspection. Staff had not received regular supervision and meetings had not been held regularly since the previous manager left.
“Since the previous registered manager left staff had not received regular supervision.” from the report
Incomplete medicine records
needs fixingPeople received medicines on time, but some records were not signed or dated. The report linked this shortfall to poor governance.
“some documentation regarding medicines were not signed or dated.” from the report
Mask wearing
needs fixingSome staff were not wearing masks correctly during the visit. The provider agreed to take immediate action.
“We observed some staff not wearing masks correctly during our inspection.” from the report
Recruitment records
minorRecruitment checks were in place, but some records were out of date and the documentation was not clear.
“Recruitment documentation was not clear.” from the report
- 01When will a registered manager be appointed, and what additional support is in place until then?
- 02How will you make sure every medicine record is signed and dated correctly?
- 03How are you monitoring accidents, incidents and safeguarding referrals for patterns or repeated risks?
- 04How often will staff receive supervision and how regularly will staff and relatives be invited to meetings?
- 05What action was taken after inspectors found that some staff were not wearing masks correctly?
This was an unannounced focused inspection of Safe and Well-led; the other key question ratings were not inspected at this visit and the report says previous ratings were used for the overall rating. This explanation was written from the published report of 27 August 2022 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, November 2021
Requires Improvement; inspectors found people generally felt safe and supported, but recruitment checks and management systems were not reliable enough.
Inspectors visited on 9 September 2021. They observed care, spoke with five people, nine relatives and 10 staff, and reviewed care, medicines, training and quality records.
People and relatives said staff were kind, responsive and available. Inspectors found good safeguarding arrangements, enough staff for people's daily needs, clean and maintained premises, and activities based on people's needs and preferences.
There were important shortfalls. Some staff did not have the required enhanced criminal record checks. One person's pain-relief patch was not replaced as prescribed on two occasions. Records about behaviour incidents and some audits did not make it clear what action was needed.
The overall rating was Requires Improvement. Safe and Well-led were both rated Requires Improvement. The home had the same overall rating at its previous inspection, but this inspection found a breach relating to recruitment.
People felt safe
People said they felt safe, and inspectors found appropriate safeguarding procedures. Staff understood how to raise concerns about possible abuse.
“People told us they felt safe living at Brandon House.” from the report
Kind and available staff
People and relatives described staff as caring and available. Inspectors found enough staff to meet people's daily needs.
“People and their relatives said there was enough staff to meet their needs.” from the report
Risk management
Care plans included information about risks involving eating, drinking, mobility and skin integrity. Staff showed a good understanding of how to manage these risks.
“Staff had a good understanding of people's risks and how these should be managed.” from the report
Activities and relationships
The home organised activities around people's needs and preferences. It also had good working relationships with health professionals.
“There were various activities organised for people focused on their needs and preferences.” from the report
Incomplete recruitment checks
seriousThe home had employed people without completing the required enhanced criminal record checks. The application process had started and risk assessments were in place, but CQC found this was not safe enough.
“The recruitment procedures did not ensure all persons employed had enhanced criminal record certificates” from the report
Pain relief not replaced as prescribed
needs fixingOne person's pain-relief patch was not replaced as prescribed on two occasions. Inspectors found no evidence that the delay affected the person, but the medicines process was not fully reliable.
“On two occasions a pain-relieving patch had not been replaced as prescribed.” from the report
Behaviour records were hard to use
needs fixingInformation about incidents was mainly recorded in daily notes. This made it difficult to identify triggers and prevent further incidents.
“This made it difficult to identify triggers to prevent further incidents occurring.” from the report
Audits did not always lead to action
needs fixingThe home carried out audits, but some had no action plans. Inspectors were therefore not assured that identified improvements were always made.
“Audits were carried out, however we found audits without action plans therefore we were not assured improvements were always made.” from the report
Some infection control practice needed improvement
needs fixingAn agency nurse was not wearing a face mask and was wearing nail varnish. The dining-room servery also needed cleaning.
“We were somewhat assured that the provider was using PPE (personal protective equipment) effectively and safely.” from the report
- 01Have all staff now received the required enhanced criminal record checks, and how do you check this before employment?
- 02What checks are now in place to make sure pain-relief patches and other medicines are given exactly as prescribed?
- 03How are behaviour incidents recorded now, and how do you use the records to identify triggers?
- 04Which actions followed the audits that had no action plans at the inspection?
- 05What has been done to improve PPE use and cleaning in the dining-room servery?
This was a planned inspection focused on Safe and Well-led, including infection prevention and control; the other key questions were not inspected because CQC had identified no areas of concern. This explanation was written from the published report of 10 November 2021 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Brandon House
7 rated inspections over 7 years: the service has improved, from Inadequate to Requires improvement.
- August 2022Requires improvementcurrent ratingstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- November 2021Requires improvementstayed Requires improvementSafe: Requires improvementWell-led: Requires improvement
- August 2020Requires improvementup from InadequateSafe: Requires improvementWell-led: Requires improvement
- October 2019Inadequatedown from GoodSafe: InadequateWell-led: Inadequate
- February 2017Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Good
- October 2015Requires improvementup from InadequateSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- March 2015InadequateSafe: InadequateEffective: InadequateCaring: Requires improvementResponsive: InadequateWell-led: Inadequate
- October 2014
Report published without a new overall rating.
- October 2013
Report published without a new overall rating.
- March 2013
Report published without a new overall rating.
- April 2012
Report published without a new overall rating.
- July 2011
Report published without a new overall rating.
- March 2011
Report published without a new overall rating.
- February 2011
Registered with the Care Quality Commission on 8 February 2011.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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