CQC report explained · a nursing home
What the CQC found at Brunswick Court Care 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
- People generally felt safe and staff understood safeguarding and individual risks. However, some call bell response times were long, staffing levels did not always match people's needs, and records for some topical medicines were incomplete.
- Effective?
- Requires improvement
- The report does not give a separate rating for Effective. Inspectors noted that staff referred people to health professionals when needed, including a GP and dietician.
- Caring?
- Requires improvement
- The report does not give a separate rating for Caring. Inspectors found that some regular staff were kind and caring, but people described inconsistent support and sometimes felt isolated.
- Responsive?
- Requires improvement
- The report does not give a separate rating for Responsive. Care plans did not always give enough opportunity to record what was important to people, although new care planning software had been introduced.
- Well-led?
- Requires improvement
- Management had introduced changes and quality checks, but actions were not always completed or recorded clearly. Staff morale and the consistency of care were affected by staffing changes.
What inspectors found, May 2022
Requires Improvement; inspectors found safe care in many areas, but staffing, person-centred care and management systems were not consistent.
This was an unannounced inspection on 25 March 2022. Inspectors spoke with people living in the home, relatives, staff and professionals. They reviewed care records, medicines records, staff files and management records.
The home was rated Requires Improvement overall. Safe and Well-led were both rated Requires Improvement. People generally felt safe and medicines were given as prescribed, but some people experienced delays when using call bells and medicines records were not always complete.
Inspectors found that care could be inconsistent, particularly when agency workers were on duty. Some people felt isolated, and care plans did not always record what mattered to each person. Management audits identified problems, but actions were not always completed.
The rating was unchanged from the previous inspection in 2020. Improvements had been made and the home was no longer in breach of regulations, but new systems had only recently been introduced and needed to be sustained.
People generally felt safe
People and relatives said the care felt safe. Staff knew how to recognise and report abuse, and individual risks such as falls and choking were assessed.
“People and relatives told us the home provided care that felt safe” from the report
Medicines usually given correctly
Inspectors found medicines were administered as prescribed. Staff acted on requests for pain relief and audits identified and corrected some issues.
“medicines were being administered to people as prescribed” from the report
Improved infection control
Staff used suitable protective equipment and inspectors were assured that infection risks, visitors and outbreaks were being managed. The previous infection control breach had been resolved.
“Enough improvement had been made at this inspection and the provider was no longer in breach of regulation 12.” from the report
Links with health professionals
The manager had developed positive relationships with health professionals. Staff made referrals when people's needs changed, including when someone lost weight.
“The registered manager had built positive relationships with professionals” from the report
Inconsistent care and isolation
needs fixingPeople said support was less consistent when agency workers were on duty. Some people spent long periods without enough social contact or activities.
“People felt the support received by staff was inconsistent and at times felt isolated which affected their wellbeing.” from the report
Staffing and call bell delays
needs fixingStaffing levels did not always reflect people's needs. Call bell records showed that some people had to wait to be seen, sometimes for up to 20 or 30 minutes.
“call bell response at times showed people had to wait to be seen.” from the report
Incomplete medicines records
needs fixingRecords did not always show two staff signatures confirming that an old transdermal patch had been removed before a new one was applied. The manager provided learning and added checks.
“Records did not always have two staff signatures to demonstrate that two staff had removed the old patch before administering the new patch.” from the report
Care plans not always personal
needs fixingThe previous paperwork did not always capture how people wanted to be supported or what mattered to them. New software was being introduced, but the transfer was still in progress.
“The providers paperwork for care plans did not always allow the opportunity for people and staff to detail information about how they wanted to be supported and what was important to them.” from the report
- 01What has changed to reduce delays in answering call bells, and what are the current response times?
- 02How do you make sure agency workers understand each person's care needs, routines and preferences before working on the floor?
- 03How are you checking that the new care planning software records what matters to each person?
- 04What action have you taken to reduce isolation and increase activities for people who are cared for in bed?
- 05How do you ensure medicines records, including transdermal patch records, are completed correctly every time?
This was an unannounced focused inspection prompted partly by concerns about medicines and included Safe and Well-led; the report does not give separate ratings for Effective, Caring or Responsive. 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, October 2020
Requires Improvement; inspectors found improved care and management, but infection control and records were not consistently reliable.
Inspectors visited on 8 and 15 September 2020. They spoke with people living in the home, relatives, staff and visiting professionals. They reviewed care records, medicine records, staff files and management information.
The home had made improvements since the previous inspection. Staff generally understood people's needs, medicines were usually given safely, and people and relatives could give feedback. However, some staff did not wear PPE correctly, infection risks were not always managed well, and care plans did not always reflect people's current needs.
The overall rating stayed Requires Improvement. Safe and Well-led were both rated Requires Improvement. The other three questions were not assessed during this focused inspection, so this report does not give new ratings for Effective, Caring or Responsive.
Staff understood people's risks
Staff could explain people's individual risks and support needs. Inspectors also saw most staff supporting people safely and patiently.
“Staff where aware of people's risk. When asking staff about individuals they were able to explain the person's risks and identify their individual's needs.” from the report
Medicines were usually handled safely
Medicine records were generally clear and complete. Inspectors saw medicines being given when needed and in a respectful way.
“People received their medicines when they needed them. We saw staff administering medicines in a discreet and respectful manner.” from the report
People's suggestions were acted on
People and staff had opportunities to give feedback. The home could show that some suggestions had led to changes.
“Where suggestions had been mentioned, the management team were able to show this was listened to and actioned.” from the report
Management had made progress
The home had changed its management structure and added quality assurance support. Earlier breaches relating to safeguarding, governance, and nutrition and hydration were no longer in place.
“The provider had invested additional resources into the service following the last inspection from CQC.” from the report
Infection control was not reliable
seriousSome staff did not follow the home's PPE policy. Visitor temperature checks were not completed consistently, and inspectors were not assured that movement to the garden was safe during a COVID-19 outbreak.
“We observed several staff who did not always follow it, and managers had not identified these shortfalls.” from the report
Care plans did not always match current needs
needs fixingStaff often knew when people's support needs had changed, but these changes were not always recorded in care plans. Inspectors also recommended specific nutrition and fluid targets.
“Where people's needs changed, and risks emerged the staff team sought to amend the support of the person. This was not always reflected in the care plan.” from the report
Quality data was sometimes inaccurate
needs fixingThe home had quality checks and action plans, but some of the information used was wrong. This included fluid charts that were not always added up correctly.
“However, some of the data used was not always accurate. This meant the information gathered would not reflect the true picture of the service.” from the report
Some interactions were task-focused
minorMost interactions were positive, but inspectors saw some staff who did not fully listen or have meaningful conversations with people.
“However we observed some staff not fully listening to people, being task focused and not always having meaningful conversations with people.” from the report
- 01What changes have you made to ensure all staff wear PPE correctly throughout the home?
- 02How do you now manage movement to the garden when there is an infection outbreak?
- 03How are visitor temperature checks and other infection-control checks recorded and audited?
- 04How do you make sure care plans are updated promptly when a person's support, nutrition or fluid needs change?
- 05What checks do you now make to ensure fluid and other quality data is accurate?
This was a targeted inspection that became a focused inspection of Safe and Well-led, including infection control; the other question ratings were not assessed in this report. This explanation was written from the published report of 17 October 2020 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 Brunswick Court Care Home
6 rated inspections over 6 years: the service has slipped, from Good to Requires improvement.
- May 2022Requires improvementcurrent ratingstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- October 2020Requires improvementstayed Requires improvementSafe: Requires improvementWell-led: Requires improvement
- August 2019Requires improvementdown from GoodSafe: Requires improvementWell-led: Requires improvement
- December 2017Goodup from Requires improvementSafe: GoodEffective: GoodCaring: Requires improvementResponsive: GoodWell-led: Good
- February 2017Requires improvementdown from GoodSafe: Requires improvementEffective: GoodCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- February 2016GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- July 2014
Report published without a new overall rating.
- November 2013
Report published without a new overall rating.
- May 2013
Report published without a new overall rating.
- July 2012
Report published without a new overall rating.
- March 2012
Report published without a new overall rating.
- November 2010
Registered with the Care Quality Commission on 12 November 2010.
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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