CQC report explained · a nursing home
What the CQC found at Brook View
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, January 2022
Targeted inspection was not rated; inspectors found safe staffing, risk checks and infection control, but the full service was not assessed.
This was an unannounced, targeted inspection on 02 December 2021. One inspector looked specifically at environmental risks, staffing, and infection prevention and control. The inspection followed concerns linked to an incident, but the circumstances of that incident were not examined because it was subject to a criminal investigation.
Inspectors found personalised risk assessments, a safe and well-maintained environment, enough staff, working call bells and prompt responses. They also found the home clean and hygienic, with infection control measures and COVID-19 testing and vaccination support in place.
The service was recorded as inspected but not rated. The report says the previous safe rating was requires improvement and that the full Safe question would be assessed at a later comprehensive inspection. It also says the overall rating remained requires improvement, although another part of the report says the last overall rating was good. This report did not provide a new full rating.
Personalised risk planning
People had individual risk assessments that gave staff information about how to manage their care safely.
“People had personalised risk assessments which gave staff the information needed to safely manage the risks associated with their care.” from the report
Safe environment
The building, equipment and utilities were regularly checked. Fire safety equipment and emergency plans were also in place.
“The environment was safe and well-maintained and regular safety checks were carried out on the environment, utilities and equipment.” from the report
Staff available
Inspectors found enough staff, including one-to-one support where needed. Call bells worked and staff responded promptly.
“There were enough staff at the home to meet people's needs. Staffing levels were monitored, reviewed and amended when needed by the manager.” from the report
Infection control
The home was clean and hygienic. Staff used protective equipment correctly and the home had COVID-19 testing and vaccination arrangements.
“The home was clean and hygienic. Enhanced cleaning schedules were in place and cleaning products had been reviewed and amended in response to COVID-19.” from the report
Limited information about the incident
minorThe inspection followed an incident in which a person died, but inspectors did not examine what happened because of the criminal investigation. This report therefore cannot provide findings about that incident.
“This incident is subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident.” from the report
- 01What issues led to the previous requires improvement rating for Safe, and what evidence shows they have been fixed?
- 02How do you check that staffing levels remain enough when people's needs change?
- 03How is one-to-one support arranged and checked for people who need it?
- 04How often are environmental, fire safety and equipment checks completed, and what happens when a problem is found?
- 05When will the next comprehensive inspection assess the other parts of the service?
This was an unannounced targeted inspection of environmental risk management, staffing and infection prevention and control; it did not assess the whole service or change the previous ratings. This explanation was written from the published report of 13 January 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, June 2021
Brook View rated Requires Improvement; inspectors found kind, personalised care, but medicines were not always managed safely.
Inspectors visited on 10 and 25 March 2021. The first visit was unannounced and focused on medicines and personalised care. Because they found concerns about medicines, they widened the inspection to cover all five areas.
The main problem was medicine safety. Records did not always match medicine stocks, some time-specific medicines were not given at the correct time, and guidance was not always available when medicines were given in a different way. Inspectors said this placed people at risk of harm, although they found no evidence of significant harm.
People told inspectors they felt safe and well cared for. Staff were kind, respected privacy and supported choice. The home was rated Good for Effective, Caring, Responsive and Well-led, but Safe and the overall service were rated Requires Improvement.
Kind and respectful staff
People said staff were kind, caring and respectful. Inspectors observed that privacy and dignity were respected.
“People were treated well by staff. People spoke positively about how they were supported.” from the report
Personalised support
Care plans included people's goals, likes and dislikes. Staff encouraged people to make choices and remain as independent as possible.
“People were supported in line with their choices and preferences.” from the report
Good food and health support
People's dietary needs were assessed and specialist advice was obtained when needed. The home worked with a range of health and social care professionals.
“Kitchen staff had a good understanding of people's individual needs and the type of support they needed to eat a healthy and balanced diet.” from the report
Activities and relationships
People could take part in group and one-to-one activities, including exercise, crafts, quizzes and reminiscence work.
“People were engaged in activities when they wished and appeared to enjoy the range of activities available.” from the report
Medicine safety
seriousMedicine records did not always match the stock held. Timing, availability, thickener records and instructions for giving medicines in another way were not consistently safe or clear.
“Medicines were not always managed safely.” from the report
Staffing during pressure
needs fixingInspectors observed enough staff during the visit, but people and staff said staffing could be difficult during sickness or when needs increased. The service was asked to keep staffing levels under close review.
“We recommend that the service continue to closely review that staffing levels are sufficient to meet the needs of the people living at Brook View.” from the report
Care records needed more detail
needs fixingSome care plans and risk assessments did not bring all relevant risks together or give enough detail for a consistent approach.
“Care plans were specific to individual needs but did not always given enough specific detail to ensure a consistent approach was provided.” from the report
Follow-up after hospital stays
needs fixingStaff did not always follow up and clarify medicine instructions when people returned from hospital.
“We identified that when people had been hospitalised, staff did not consistently follow-up and clarify discharge plans in relation to medicines.” from the report
- 01How do you now check that medicine stocks match the Medicines Administration Records?
- 02How do you make sure time-specific medicines are given at the right time and any agreed changes are recorded and discussed with the prescriber?
- 03What guidance is available for medicines given in a different way, and how is staff competence checked?
- 04How do you record fluid thickener so staff know people are receiving drinks at the correct consistency?
- 05How do you maintain safe staffing levels when staff are off sick or a person needs one-to-one support?
This began as a targeted inspection of medicines and personalised care, then became a comprehensive inspection covering all five key questions, including infection prevention and control. This explanation was written from the published report of 16 June 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 Brook View
Each visit the CQC has published, newest first, back to the day the home was registered.
- January 2022Inspected but not ratedcurrent ratingSafe: Inspected but not rated
- June 2021Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- August 2019
Registered with the Care Quality Commission on 9 August 2019.
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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