CQC report explained · a residential care home
What the CQC found at Smallbrook Care Home
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
What inspectors found, September 2019
Rated Good; inspectors found safe, kind and well-organised care, with clear improvement since the previous inspection.
Inspectors visited the home without warning on 20 August 2019. They spoke with people living there, relatives and staff. They reviewed care records, medicines, recruitment files, accidents, meetings and quality checks.
The home was rated Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. Inspectors found enough staff, safe medicines systems, kind staff, personalised care and good support with health, food, activities and family contact.
The home had improved from Requires Improvement at the inspection on 6 March 2018. A new management team had improved communication, staff support, risk management and oversight of the service.
Improved management
The new management team had improved support for staff and communication with people and their families. The home had regular meetings and acted on suggestions.
“The management and leadership of the service had improved since our last inspection.” from the report
Safe staffing and risk management
Staffing levels were based on people's assessed needs. Risks such as falls, pressure ulcers, mobility and behaviours were assessed and managed.
“Staffing levels were sufficient to meet people's needs and keep them safe.” from the report
Kind and respectful care
Staff knew people well, offered choices and protected their dignity. Relatives described a calm and welcoming environment.
“People were supported and treated with dignity and respect and involved as partners in their care.” from the report
Personalised support
Care plans reflected people's needs, preferences and interests. Life history books helped staff understand people and personalise their care.
“People's care and support plans were individualised and person-centred.” from the report
Good health and nutrition support
Staff worked with health professionals and supported people with food, drink and special diets. Inspectors saw people being helped to eat in a dignified and unhurried way.
“People were supported to maintain good health and to access healthcare services when they needed them.” from the report
Memory boxes needed more development
minorSome memory boxes intended to help people living with dementia recognise their bedrooms were empty. The provider agreed to develop their use further.
“Some of these contained personalised items or photographs but others were empty.” from the report
- 01What improvements have been made since the new management team took over, and how are these improvements checked now?
- 02How do you use memory boxes to help people living with dementia recognise their bedrooms?
- 03How do you decide how many staff are needed on each shift, and how do you adjust this when people's needs change?
- 04How are falls, accidents, complaints and safeguarding concerns reviewed, and what changes have resulted from recent learning?
- 05What end-of-life care can you provide, and how would you work with the local hospice if this became needed?
This was an unannounced planned inspection covering all five CQC questions and the overall quality and safety of the home. This explanation was written from the published report of 10 September 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, April 2018
Rated Requires Improvement and now out of Special Measures; inspectors found kind care and clear progress, but further improvement was needed to make care and management consistently safe and effective.
The inspection was unannounced on 6 March 2018. Two inspectors and an expert-by-experience spoke with people living at the home, relatives, staff and a visiting pharmacist. They observed care and checked care plans, medicines records, staff files, training records, complaints and quality checks.
The home had made significant progress since the previous inspection in September 2017. Earlier concerns about risk management, medicines, staffing, training, consent, dignity, person-centred care and management oversight had been addressed. However, the improvements had only been in place for a few months, so inspectors wanted to see that they lasted.
People were supported by kind staff, had suitable activities and received their medicines safely. There were still shortfalls in some care plans, one sluice area was not secure or fully clean, some training records had gaps, and information for complainants needed improvement.
The overall rating was Requires Improvement. Safe, Effective and Well-led were also Requires Improvement. Caring and Responsive were rated Good. The home had been in Special Measures after the earlier inspection, but it was no longer rated Inadequate and had left Special Measures.
Kind and respectful care
Staff were observed giving sensitive, dignified care. They knew people's backgrounds, offered choices and supported people to remain as independent as possible.
“People were supported by kind and committed staff.” from the report
Activities and personal interests
The home offered several activities each day, including music, exercise, arts and crafts, discussions and themed events. Staff also adapted activities to individual preferences.
“People had access to a range of activities that suited their needs and interests.” from the report
Improved risk management
The home reviewed risks after falls and incidents, increased supervision where needed and involved healthcare professionals to reduce further risks.
“Risks to people were routinely assessed and plans were implemented to keep people safe.” from the report
Improvements not yet established
needs fixingThe main improvements had only been in place for a short time. Inspectors wanted evidence that standards would remain consistent before giving higher ratings.
“The improvements identified had only been in place for a matter of months and we will need to see evidence of sustained improvements at the service” from the report
Sluice room security and cleanliness
needs fixingOne sluice room was unlocked and had an unpleasant smell. Inspectors recommended that infection control arrangements for sluice areas be reviewed.
“We did note that one sluice room was not locked, which could present a risk to people living with dementia.” from the report
Care plan detail
needs fixingSome care plans did not fully describe people's needs and wishes. This included support for low mood and people's preferences about end of life care.
“We recommend that the provider reviews care plans to ensure they fully reflect people's needs and wishes.” from the report
Management transition
needs fixingThe registered manager had left shortly before the inspection and the provider was recruiting a replacement. The home had interim management and a deputy manager, but inspectors wanted to see sustained leadership.
“The registered manager had left the week before our inspection and the provider was in the process of recruiting a replacement.” from the report
Complaint information
minorComplaints were investigated, but in two ongoing cases people had not been told that they could approach the local government ombudsman if dissatisfied.
“In both cases, the provider had not yet informed people that they could approach the local government ombudsman if they were not satisfied with how their complaints were handled.” from the report
- 01How are you making sure the improvements found at this inspection have continued since March 2018?
- 02How do you check that each person's care plan includes their mental health needs and end of life wishes?
- 03What has been done to keep the sluice areas secure, clean and free from unpleasant odours?
- 04How do you ensure new staff complete all required training before supporting people with dementia and medicines?
- 05How will complaints information explain the option of contacting the local government ombudsman?
This was an unannounced inspection covering all five key questions, including the care and accommodation provided; the report also compared findings with the previous inspection in September 2017. This explanation was written from the published report of 18 April 2018 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 Smallbrook Care Home
5 rated inspections over 3 years: the service has held its Good rating throughout.
- September 2019Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- April 2018Requires improvementup from InadequateSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- October 2017Inadequatedown from Requires improvementSafe: InadequateEffective: InadequateCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate
- May 2017Requires improvementdown from GoodSafe: Requires improvement
- November 2016GoodSafe: GoodEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Good
- October 2014
Registered with the Care Quality Commission on 17 October 2014.
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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