CQC report explained · a nursing home
What the CQC found at Brandon House Nursing Home
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Inspectors found shortfalls in medicine management, infection control and records about risks, including diabetes and wound care. There were enough staff, safe recruitment checks, and systems for responding to emergencies.
- Effective?
- Good
- This question was not inspected during this focused inspection. Its rating carried over from the last inspection.
- Caring?
- Good
- This question was not inspected during this focused inspection. Its rating carried over from the last inspection.
- Responsive?
- Good
- This question was not inspected during this focused inspection. Its rating carried over from the last inspection.
- Well-led?
- Requires improvement
- Management audits and communication systems had not consistently identified or controlled risks. The provider had taken action, but inspectors found a breach relating to governance and oversight.
What inspectors found, May 2022
Brandon House Nursing Home was rated Requires Improvement; inspectors found staffing and care that people valued, but weaknesses in medicines, risk records and management checks.
This was an unannounced focused inspection on 7 March 2022. Inspectors looked only at Safe and Well-led because concerns had been raised about nutrition and care. They spoke with people, relatives and staff, observed care, and checked care, medicines, safety and management records.
The home had enough staff and recruitment checks were completed safely. People and relatives generally spoke positively about the care, and relatives said their family members were safe. Staff knew how to report safeguarding concerns and people received their medicines as prescribed.
However, inspectors found problems with medicine storage and records, infection control, and records showing how risks such as diabetes and wounds were managed. Quality checks had missed some of these issues. The provider took action during or shortly after the inspection, but the home breached Regulation 17 for ineffective oversight.
The overall rating changed from Good to Requires Improvement. The Safe and Well-led ratings were Requires Improvement. The other three question ratings were not inspected and carried over from the previous inspection.
Enough staff
Inspectors found staff had enough time to support people and were not rushed. Staff said staffing levels allowed them to maintain a presence in communal areas.
“We saw staff had enough time to support people, they were not rushed and there was always cover and support.” from the report
Safe recruitment
The provider checked references and completed Disclosure and Barring Service checks before new staff started.
“Staff were recruited safely, which minimised risks to people's safety and welfare.” from the report
Positive experiences
People and relatives spoke positively about the service. Relatives said they felt their family members were safe living at the home.
“People and their relatives spoke positively of their experiences of the service.” from the report
Staff support
Staff said managers were visible and supportive. Staff were also supported with supervision and health and social care training.
“Staff told us the registered manager was visible and supportive.” from the report
Learning from incidents
The manager investigated accidents, incidents and clinical concerns. Inspectors found evidence that changes had been made after things went wrong.
“Records demonstrated where things had gone wrong, investigations were carried out to identify where improvements could be made and changes in practice had occurred as a result.” from the report
Medicines management
seriousSome insulin was not dated when opened. Pharmaceutical waste was not stored securely, pain relief patch records were unclear, and one sharps container was overfilled.
“Some practices regarding medicine management did not follow safe practice and records were not consistently clear.” from the report
Risk records
seriousRecords did not always clearly show how diabetes, blood sugar monitoring, wounds and repositioning were being managed. Some wound records were incomplete.
“People's care records were not always sufficiently detailed to show risks associated with people's care were effectively managed and responded to in a timely way to keep people safe.” from the report
Infection control
seriousSome staff, including the infection control lead, did not know that a person had tested positive for COVID-19. Inspectors also found a ripped mattress and limited access to PPE and hand sanitisers.
“A staff member responsible for infection, prevention and control was not aware one person had tested positive for COVID-19.” from the report
Management checks
seriousAudits had not identified several problems found by inspectors. This meant there was not consistent oversight of quality and safety.
“There had been a failure to have consistent and effective oversight of the service.” from the report
- 01What checks have you put in place to make sure insulin is dated, pharmaceutical waste is secure, and sharps containers are managed safely?
- 02How do you now record and review diabetes monitoring, wound care, dressings and repositioning?
- 03How will staff, including the infection control lead, be told promptly about COVID-19 risks or other infection concerns?
- 04What daily and management audits are now used to identify dirty or damaged equipment and other infection risks?
- 05How do you decide which people need fortified food, and how do you check that this remains appropriate?
This was a focused inspection of Safe and Well-led only; the other three ratings carried over from the previous inspection. This explanation was written from the published report of 5 May 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, January 2019
Rated Good overall, but Safe Requires Improvement because medicines practice and some records were not consistently reliable.
Inspectors carried out an unannounced comprehensive inspection on 8 January 2019. They spoke with people living in the home, relatives and staff. They reviewed care plans, medicine records and quality checks.
Overall, the home was rated Good. Inspectors found kind care, suitable support with food and healthcare, personalised care plans, activities and improved management. People and relatives generally spoke positively about the service.
Safe was rated Requires Improvement. Medicines were mostly managed safely, but staff did not always follow the medicine policy. Some skin care and other records were also inaccurate or incomplete. The report says improvements had been made since the previous inspection, but they still needed to become consistent.
Kind and respectful care
Inspectors saw staff taking time with people and supporting them at their own pace. People's privacy and dignity were respected.
“Staff took their time with people, and supported them at the person's pace with, for example, support to eat or drink and move about the home.” from the report
Personalised care
Care plans reflected people's needs, likes and dislikes. Staff could explain how they supported people who were unsettled or unable to communicate verbally.
“People's needs were assessed and everyone had an individual plan of care which was reviewed regularly to reflect people's changing needs.” from the report
Clean home
The home was clean and tidy, with cleaning schedules and protective equipment available for staff.
“The home was clean and tidy, and housekeeping staff told us they cleaned the home and bedrooms according to cleaning schedules.” from the report
Improved management checks
Audits and daily checks had improved since the previous inspection. Managers identified areas needing further work and took action.
“Improvements had been made to ensure systems and processes to audit the quality of the service identified where improvements were required and actions were taken to implement those improvements.” from the report
Medicine administration
seriousA nurse signed a medicine record before the medicine had been safely taken, and another medicine patch record was not completed at the time. The home said this practice would be addressed.
“However, individual staff practices did not consistently follow the provider's expectations in relation to the safe management of medicines.” from the report
Inaccurate care records
needs fixingInspectors found conflicting information in skin care records. The manager said staff would be reminded to record information accurately.
“We discussed conflicting information in two people's skin care records with the deputy manager who assured us neither person had sore skin and the recording was inaccurate.” from the report
Unequal access to activities
minorMost organised activities took place on the ground floor. People on the first floor who did not want to go downstairs could miss some events.
“However, most organised activities took place on the ground floor and whilst people on the first-floor were welcome to join these, those who did not feel comfortable about going to the ground floor missed out on some of the numerous and varied events that took place.” from the report
Some meal presentation
minorSome people and staff said potatoes were sometimes undercooked and meals served on the first floor were not always presented as well. The manager said action would be taken.
“However, some people and staff told us on occasions the potatoes were not properly cooked, and sometimes the meals for people on the first-floor were not as well presented as those for people on the ground floor.” from the report
- 01What checks now make sure staff support people to take every medicine safely before signing the medicine record?
- 02How do you check that skin care records and other important records are accurate and completed at the right time?
- 03What progress has been made in providing activities and communal space for people living on the first floor?
- 04What changes were made after concerns about undercooked potatoes and the presentation of first-floor meals?
- 05How are staffing levels monitored on the first floor so staff have time to talk with people and support activities?
This was an unannounced comprehensive inspection covering all five key questions; the report says the previous overall rating was Requires Improvement in February 2018. This explanation was written from the published report of 29 January 2019 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 Nursing Home
5 rated inspections over 7 years: the service has slipped, from Good to Requires improvement.
- May 2022Requires improvementcurrent ratingdown from GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- January 2019Goodup from Requires improvementSafe: Requires improvementWell-led: Good
- March 2018Requires improvementstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- August 2017Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- January 2015GoodSafe: GoodEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Good
- July 2014
Report published without a new overall rating.
- July 2014
Report published without a new overall rating.
- July 2014
Report published without a new overall rating.
- September 2012
Report published without a new overall rating.
- October 2011
Registered with the Care Quality Commission on 31 October 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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