CQC report explained · a nursing home
What the CQC found at Brunel House
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, December 2021
Brunel House was rated Requires Improvement; inspectors found staffing, risk management and leadership problems, despite good infection control.
The inspection was unannounced and took place on 12 and 20 October 2021. Inspectors spoke with people, relatives, staff and professionals. They reviewed care records, staff records, medicines information and management records, and observed care.
The home did not always have enough staff to meet people's needs. This meant care was sometimes delayed, staff felt rushed, and person-centred care was harder to provide. Risks were not always assessed or managed properly, including after falls, incidents and an allegation of abuse.
Managers did not have effective checks to identify and correct problems. Medicines records were not always accurate, and one person did not always receive time-specific medicine at the right time. Infection prevention arrangements were good, and staff showed understanding of people's individual needs.
The overall rating was Requires Improvement. Safe and Well-led were both rated Requires Improvement. The report says the service had deteriorated since a targeted inspection in February 2021, although a service support team and improvement plan had been introduced.
Infection control
Inspectors were assured that the home had suitable arrangements to prevent and control infections, including during the COVID-19 pandemic.
“We were assured that the provider was preventing visitors from catching and spreading infections.” from the report
Staff recruitment checks
New staff were checked before starting work. Records included criminal record checks, references, employment history and confirmation of the right to work in the UK.
“The provider had completed a criminal record check and obtained references from previous employers of new staff before they started supporting people.” from the report
Understanding people's needs
Staff showed knowledge of people's individual needs and wanted to provide person-centred care, although staffing problems made this harder.
“Staff demonstrated a good understanding of people's individual needs and a commitment to provide person-centred care.” from the report
Improvement work started
The regional director had brought in extra staff to identify and put improvements in place. Shortfalls found during the inspection were added to an improvement plan.
“These were additional staff tasked with identifying and implementing improvements to the service.” from the report
Risks and safeguarding
seriousSome incidents were not fully recorded or followed up. Inspectors also found that an allegation of abuse had not been reported to managers or the local safeguarding team.
“The provider had failed to consistently identify and assess risks so that action could be taken to keep people safe.” from the report
Medicines records
needs fixingMedicines received for two people were not recorded correctly. One person regularly received time-specific medicines up to an hour early or late.
“There was not always an accurate record of medicines held in the service and one person regularly received time-specific medicine either early or late.” from the report
Weak management checks
seriousImportant meetings and audits were missed, so managers did not have a clear view of the quality and safety of the home. There was also no registered manager at the time.
“The provider had failed to have effective systems to assess, monitor and improve the quality of the service provided.” from the report
- 01How many care and nursing staff are scheduled for each shift now, and what happens when someone is absent?
- 02How do you check that people's risks, falls and incidents are reviewed and acted on promptly?
- 03How are time-specific medicines and medicines stock checked for accuracy?
- 04What progress has the service support team made on the home improvement plan?
- 05Has a registered manager now been appointed and registered with CQC?
This inspection examined Safe and Well-led because of concerns about staffing and management; the other three key question ratings were not given in this report. This explanation was written from the published report of 2 December 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.
What inspectors found, April 2021
Brunel House was inspected but not rated; inspectors found improved medicines safety and strong infection control, with one medicines recording issue corrected.
This was an unannounced, targeted inspection on 11 February 2021. Inspectors looked at infection prevention and control, and whether earlier problems with medicines had been fixed. They visited the home, checked records and spoke with relatives, staff and health and social care professionals.
Inspectors found that medicines were generally ordered, recorded and given safely. Staff had training and checks of their competence. One medicine had been recorded incorrectly and staff had not spotted this, but it was corrected when brought to the manager's attention. Missing guidance for some as-required medicines was also addressed after the inspection.
The home had strong infection control measures. Staff used protective equipment correctly, followed cleaning and social distancing procedures, and took appropriate action during a COVID-19 outbreak. Visiting was restricted in line with government guidance, which relatives found difficult, but families were kept updated as much as possible.
The home was inspected but not rated at this visit. Its previous overall rating was Requires Improvement, and the Safe question remained Requires Improvement because inspectors only looked at selected areas. The earlier breach of Regulation 12 had been addressed, so the home was no longer in breach.
Improved medicines management
Medicines were available when needed and records showed they had been given as prescribed. Staff had received relevant training and their competence had been assessed.
“Staff had fully completed the medicine administration records to show people had taken their medicines as prescribed.” from the report
Infection control
The home had up-to-date procedures, appropriate protective equipment, cleaning schedules and social distancing measures. Inspectors were assured that infection outbreaks could be prevented or managed.
“We were assured that the provider was making sure infection outbreaks can be effectively prevented or managed.” from the report
Managing the COVID-19 outbreak
The outbreak was reported appropriately. Staff who had the virus self-isolated, and testing was arranged for people and staff who consented.
“Additional guidance was sought and implemented, to minimise the risk of transmission throughout the home.” from the report
Clean environment
Inspectors found the home clean, without unpleasant odours. Cleaning included extra attention to frequently touched areas, and furniture had been replaced where needed to make cleaning easier.
“There were stringent cleaning schedules, which included additional cleaning of high touch areas.” from the report
One medicines recording error
needs fixingStaff had not identified a discrepancy in the recording of one medicine that needed additional storage. The issue was corrected after it was brought to the manager's attention.
“There was a discrepancy in the recording of one medicine, which required additional storage.” from the report
Inspection did not cover all safety issues
needs fixingThe Safe question remained Requires Improvement because this was a targeted inspection. The full range of safety arrangements will only be assessed at a later comprehensive inspection.
“We will assess all of the key question at the next comprehensive inspection of the service.” from the report
- 01How do you now check that medicines needing additional storage are recorded and stored correctly?
- 02How do you make sure as-required medicines have complete and up-to-date guidance?
- 03What checks are currently used to confirm staff remain competent to administer medicines safely?
- 04What infection control and visiting arrangements are currently in place?
- 05When will the next comprehensive inspection assess all parts of the Safe question?
This was a targeted inspection of infection prevention and control and the earlier Regulation 12 medicines concern; it did not assess the whole Safe question or the other four key questions. This explanation was written from the published report of 9 April 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 Brunel House
5 rated inspections over 6 years: the service has held its Requires improvement rating throughout.
- December 2021Requires improvementcurrent ratingSafe: Requires improvementEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- April 2021Inspected but not ratedSafe: Inspected but not rated
- January 2020Requires improvementstayed Requires improvementSafe: Requires improvementWell-led: Requires improvement
- November 2018Requires improvementstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- July 2017Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- August 2015Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- November 2013
Report published without a new overall rating.
- March 2013
Registered with the Care Quality Commission on 8 March 2013.
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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