CQC report explained · a nursing home
What the CQC found at Brendoncare Froxfield
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- People were protected from abuse and medicines were managed safely. Some people reported waiting up to 15 or 30 minutes for help, and inspectors found the call-bell audit did not accurately show these waits.
- Effective?
- Good
- Care needs were assessed using recognised guidance. People had access to healthcare, suitable food and activities, and staff had training and supervision.
- Caring?
- Good
- People said staff were kind and respectful and were supported to be independent. However, some people said their preference about the gender of staff providing personal care was not always respected.
- Responsive?
- Outstanding
- Support was tailored to people's interests and needs. Inspectors highlighted personalised trips, activities, family support, accessible communication and strong community links.
- Well-led?
- Good
- The management team was described as accessible and supportive. Audits, feedback meetings and links with healthcare professionals and the local community supported oversight and improvement.
What inspectors found, August 2019
Brendoncare Froxfield was rated Good overall; inspectors found caring and highly responsive support, but some people waited too long for call-bell assistance.
This was an unannounced inspection on 26 and 27 June 2019. The inspection team spoke with people, a relative, staff, a volunteer and healthcare professionals. They observed care and reviewed care plans, medicine records, recruitment files and management documents.
The home was rated Good for Safe, Effective, Caring and Well-led. Inspectors found safe recruitment, medicine management, safeguarding systems and healthcare support. People were treated kindly and respectfully. Food, activities, links with families and community involvement were also viewed positively.
The home was rated Outstanding for Responsive. Inspectors highlighted personalised trips, activities to reduce isolation, support for family relationships and strong community links. However, some people reported long waits for help with call bells, and the call-bell audit did not show the true waiting times. The overall rating was lower than at the previous inspection, when the service was rated Outstanding.
Personalised activities
The home organised individual trips based on what each person enjoyed. Activities were also linked with physiotherapy to help people reach personal goals.
“This meant that each person living at the service had a personalised trip organised for them to do something they really enjoyed” from the report
Family and community links
People were supported to stay in touch with family and friends, including through video calls. Relatives, volunteers, nurseries and colleges were involved in activities and events.
“This meant that all people living at the service were able to video call with their family and friends if they wished.” from the report
Kind and respectful care
People said staff treated them well and helped protect their privacy. Care plans involved people and families in decisions about care.
“People were cared for by staff who treated them respectfully and kindly.” from the report
Safe medicines and recruitment
Inspectors found that staff recruitment checks were completed and medicines were stored, administered and disposed of safely.
“The service was following safe protocols for managing the receipt, storage and disposal of medications.” from the report
Long waits for call-bell help
needs fixingSome people said they waited a long time for assistance, particularly during the day. Staff sometimes turned off call bells and said they would return, so the audit did not show the actual waiting time.
“This had been unable to identify this as some staff turned off call bells and said they would come back, this meant the report did not accurately reflect how long people waited for assistance.” from the report
Personal care preferences
minorSome people said their preference for the gender of staff helping with personal care was not always respected.
“People told us that their preference regarding gender of care staff was not always respected.” from the report
- 01How quickly do people receive help after using their call bell now?
- 02How do you make sure call-bell records show the full time people wait for assistance?
- 03How do you record and respect each person's preference about the gender of staff providing personal care?
- 04How are personalised activities and individual trips planned for new residents?
- 05How will you maintain the activities and community links that inspectors found helped reduce isolation?
This was an unannounced inspection covering all five CQC questions, with the previous ratings also used for comparison. This explanation was written from the published report of 14 August 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.
What inspectors found, December 2016
Rated Outstanding; inspectors found exceptionally kind, effective care, with one medicines knowledge gap for staff to address.
The inspection took place without notice over 15 and 16 November 2016. Inspectors spoke with people living at the home, a relative, staff and health professionals. They observed care, looked around the building and checked care plans, medicines records, staffing, training and quality checks.
The overall rating was Outstanding. Effective care and caring were rated Outstanding. Safe, responsive and well-led were rated Good. Inspectors found people were treated with kindness and respect, received personalised support, had their health needs followed up and were supported with food, activities and daily choices.
The home had improved since the November 2015 inspection. Earlier problems with care records, medicines management, mental capacity assessments and quality monitoring had been addressed. Inspectors found the required improvements had been made.
Inspectors identified one remaining knowledge gap. Two nurses could not explain that pharmacy advice should also be sought when medicines are altered for covert administration. No one was receiving covert medicines during the inspection, and the manager said this would be discussed with nurses.
Kind and respectful care
Inspectors saw staff taking time with people, speaking kindly and supporting their dignity, privacy and independence.
“We observed staff developed extremely positive caring and compassionate relationships with people.” from the report
Personalised support
Staff knew people's preferences, interests and routines. Care plans explained how each person wanted to receive support.
“People received personalised care and staff knew each person well, such as what made a good day for them.” from the report
Strong health support
Health needs were monitored and staff worked closely with doctors and other health professionals. Inspectors received very positive feedback about this partnership.
“Links with healthcare professionals was excellent.” from the report
Food and drink support
The home monitored people's nutrition and hydration risks, offered choices and adapted food to individual preferences and needs.
“There was a strong emphasis on supporting people to eat and drink well.” from the report
Activities and independence
People could take part in varied activities, outings, hobbies and everyday tasks. Staff also supported people who preferred to spend time in their rooms.
“People were occupied and encouraged to socialise through a programme of engagement and activities.” from the report
Covert medicines knowledge
needs fixingTwo nurses could not say that pharmacy advice should be obtained if medicines needed to be crushed, added to food or otherwise changed for covert administration. No one was receiving covert medicines during the inspection.
“However, both were unable to tell us they would also contact a pharmacist for advice in the event medicines needed to be crushed, added to food or altered in any way in order to give them covertly.” from the report
- 01What action was taken after inspectors found that two nurses did not know when pharmacy advice was needed for covert medicines?
- 02How are care plans reviewed now to make sure they still reflect each person's preferences, risks and health needs?
- 03How are people's food and fluid intake monitored if they are at risk of malnutrition or dehydration?
- 04How are people living with dementia supported to remain independent and choose where they spend their time?
- 05How are families involved in care reviews, complaints and decisions about end of life care?
This was an unannounced inspection over two days that assessed the overall quality of the home and all five key questions, while also checking improvements required after the 2015 inspection. This explanation was written from the published report of 22 December 2016 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. The report was longer than we could read in one go; the later sections may not be reflected.
Every inspection of Brendoncare Froxfield
3 rated inspections over 4 years: the service has improved, from Requires improvement to Good.
- August 2019Goodcurrent ratingdown from OutstandingSafe: GoodEffective: GoodCaring: GoodResponsive: OutstandingWell-led: Good
- December 2016Outstandingup from Requires improvementSafe: GoodEffective: OutstandingCaring: OutstandingResponsive: GoodWell-led: Good
- January 2016Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- October 2013
Report published without a new overall rating.
- August 2012
Report published without a new overall rating.
- December 2011
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 24 January 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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