CQC report explained · a residential care home
What the CQC found at St Brelades
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 were protected from abuse and risks were assessed more effectively. However, medicines were not always offered openly before covert administration, some risk information was difficult to find quickly, and accident patterns were not being identified effectively.
- Effective?
- Good
- This key question was not inspected during this focused inspection. Its previous rating was used when calculating the overall rating.
- Caring?
- Good
- This key question was not inspected during this focused inspection. Its previous rating was used when calculating the overall rating.
- Responsive?
- Good
- This key question was not inspected during this focused inspection. Its previous rating was used when calculating the overall rating.
- Well-led?
- Requires improvement
- Leadership and the culture had improved, but quality checks did not always find problems. Laundry concerns remained unresolved and improvement plans did not cover all issues or include completion dates.
What inspectors found, February 2023
Rated Requires Improvement; inspectors found important improvements, but medicines, records, laundry and management checks still needed work.
This was an unannounced focused inspection on 10 January 2023. Inspectors looked at Safe and Well-led, spoke with people, relatives and staff, and checked care, medicine, recruitment and management records.
The home had improved since the previous inspection. Medicines records were accurate, staff recruitment and training had improved, infection controls were effective, and people were protected from abuse. People had more freedom to use communal areas, and staff morale had improved.
Further work was still needed. Staff did not always offer medicines openly before giving them covertly. Risk information was not always easy to find, accident patterns were not being reviewed effectively, laundry problems continued, and management audits had not found all shortfalls.
The overall rating changed from Inadequate to Requires Improvement. The home is no longer in Special Measures and was no longer breaching regulations at this inspection. CQC said it would continue to monitor the home and check that improvements were maintained.
More consistent staffing
The home employed more staff and greatly reduced its use of agency staff. People and relatives said there were enough staff who knew people well.
“There's always plenty of staff. They know the residents and they know me” from the report
Improved medicines records
Medicine administration records had become more accurate and made it easier to identify missed doses. Patches were applied according to the manufacturer's instructions.
“Medication administration records had been changed to support staff to quickly identify when medicines had not been given.” from the report
Protection from infection
Inspectors were assured that infection prevention measures were effective, including the use of protective equipment and arrangements for visitors.
“We were assured that the provider was using PPE effectively and safely.” from the report
More respectful culture
People were no longer restricted from communal areas because of their needs. Staff supported people with choices, dignity and independence.
“People were now free to use all communal areas and were not restricted dependent on their needs.” from the report
Covert medicines
needs fixingSome people were given crushed medicines hidden in food without staff always offering the medicine openly first when appropriate. Care plans did not always contain the correct information for people with swallowing problems.
“Staff were not offering medicines overtly at each medicine's round where appropriate.” from the report
Risk and accident information
needs fixingImportant information about epilepsy and diabetes was not always stored in the same place for quick access. The manager could also be delayed in learning about accidents and could not use the computer system effectively to identify patterns.
“Information about epilepsy was not recorded in the same part of each person's care plan to make sure it was easily accessible to staff.” from the report
Management checks
needs fixingNew audits and checks were still developing and had not identified every problem inspectors found. Improvement plans also lacked dates and did not include all suggestions from relatives and staff.
“Further improvements were required to ensure checks and audits effectively identified and resolved shortfalls.” from the report
Recruitment records
needs fixingRecruitment checks had improved, but suitable references from previous employers had not always been obtained. The manager dealt with this after the inspection.
“However, appropriate references had been not been consistently obtained from previous employers.” from the report
- 01How do you make sure medicines are offered openly before they are given covertly, where appropriate?
- 02Where will staff find each person's epilepsy, diabetes and other urgent risk information during an emergency?
- 03What has changed to stop residents' clothes going missing or being mixed up in the laundry?
- 04How do you now identify patterns in accidents and incidents, and who reviews them?
- 05What are the dates for completing the outstanding improvement plans, including the garden and dementia environment work?
This was an unannounced focused inspection of Safe and Well-led, with infection prevention and control also considered; the other key question ratings carried over from the previous inspection. This explanation was written from the published report of 17 February 2023 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, July 2022
Rated Inadequate and in special measures; inspectors found serious risks in medicines, care, staff checks and leadership.
This was an unannounced focused inspection on 10 May 2022. Inspectors spoke with people, relatives and staff, and reviewed care records, medicine records, recruitment files and management checks.
The home was not always safe. Risks were not consistently assessed or managed. Medicines were given incorrectly, including missed doses of an important blood-thinning medicine. Staff recruitment checks and training were also not strong enough.
Leadership was rated Inadequate. The provider's checks had not found important problems, feedback had not always led to action, and some significant events had not been reported to the CQC. The home was clean and infection control arrangements were judged reassuring.
The overall rating fell from Good at the previous inspection in January 2018 to Inadequate. The home was placed in special measures, and the CQC said it would monitor progress and usually re-inspect within six months.
Clean home and infection control
The home was clean and inspectors were assured that infection prevention arrangements were in place, including the use of protective equipment.
“The service was clean, and people were protected from the risk of the spread of infection.” from the report
Enough staff on duty
Inspectors found there were enough staff to meet people's needs, although they also found concerns about staff training and competence.
“There were enough staff to meet people's needs.” from the report
Some care arrangements worked
Some risks were assessed and managed well. Staff followed detailed moving guidance, and meals and drinks were prepared at the correct consistency for people at risk of choking.
“Staff followed detailed guidance around moving people safely.” from the report
Legal authorisations
The home had obtained the required legal authorisations where some people were deprived of their liberty.
“The registered manager had applied for and obtained appropriate legal authorisations to deprive some people of their liberty.” from the report
Missed and incorrect medicines
seriousOne person missed 19 doses of a blood-thinning medicine after receiving reduced doses. Inspectors also found problems with pain relief, medicated patches, covert medicines and stock records.
“Following our inspection, the provider found the person had missed 19 doses.” from the report
Risks were not properly managed
seriousCare plans did not always give staff the information needed to manage falls, epilepsy, diabetes and other risks. Hot water was often above a safe level and action had not been taken to reduce the risk of scalding.
“The registered person had failed to assess all the risks to service user's health and safety and take action to mitigate risks.” from the report
Staff checks and training
seriousSome recruitment checks were missing or inadequate. Most staff had not completed in-depth dementia training, and other required training and competency checks were incomplete.
“Most staff had not completed in depth dementia training, which is essential at a service for people living with dementia.” from the report
Poor leadership and oversight
seriousThe provider's audits did not identify important safety and quality problems. Responsibilities were unclear and the management team had not acted effectively on known concerns.
“The provider and registered manager did not have the required oversight of the service.” from the report
People's views not acted on
needs fixingFeedback from relatives about laundry and people wearing other people's clothes had not led to effective action. Some staff had not been asked for their views, and concerns about feeling unappreciated continued.
“Effective action had not been taken and the concerns continued.” from the report
Poor reporting and display of rating
needs fixingThe registered manager had not reported all significant events to the CQC without delay. The home's latest rating had also not been kept displayed at the premises.
“The registered manager was unclear about what they were required to notify us of and told us they were "learning".” from the report
- 01What changes have you made to prevent missed or incorrect medicines, and how are medicine stocks and covert medicines now checked?
- 02How are risks such as falls, epilepsy, diabetes and hot water safety assessed and reviewed?
- 03Which staff have completed in-depth dementia, epilepsy and catheter care training, and how is their competence checked?
- 04What evidence can you show that management audits now identify and correct safety and care problems?
- 05How are you acting on feedback about laundry, people's clothing, mealtimes and staff support?
This was a focused inspection of Safe and Well-led only; the other key question ratings were carried forward from the previous inspection when calculating the overall rating. This explanation was written from the published report of 7 July 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.
Every inspection of St Brelades
4 rated inspections over 7 years: the service has slipped, from Good to Requires improvement.
- February 2023Requires improvementcurrent ratingup from InadequateSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- July 2022Inadequatedown from GoodSafe: InadequateWell-led: Inadequate
- March 2018Goodstayed GoodSafe: GoodWell-led: Good
- December 2015GoodSafe: GoodEffective: GoodCaring: OutstandingResponsive: GoodWell-led: Good
- May 2014
Report published without a new overall rating.
- April 2013
Report published without a new overall rating.
- July 2012
Report published without a new overall rating.
- December 2011
Registered with the Care Quality Commission on 16 December 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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