Brenan House Residential Home

Updated 19 May 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was undertaken by one inspector.

Service and service type

Brenan House is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Brenan House is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 6 people who used the service about their experience of the care provided. We spoke with four members of staff including the provider, registered manager, deputy manager and care worker. We observed staff interactions with people.

We reviewed a range of records. This included 4 people’s care records and multiple medication records. We looked at 2 staff files in relation to recruitment. A variety of records relating to the management of the service, including policies and procedures were reviewed.

Updated 19 May 2023

About the service

Brenan House is a residential care home providing personal care to up to 16 older people in one large adapted building. At the time of our inspection there were 13 people using the service.

People’s experience of using this service and what we found

People told us they felt safe living at the service. However, the improvements found at the last inspection had not been maintained and the quality of the service has deteriorated.

When people had been admitted to the service, potential risks to their health and welfare had not been assessed. Risk assessments had not been robust and there was no guidance for staff to mitigate the risks.

Accidents and incidents had been recorded but these had not been analysed for patterns and trends. Checks had been completed on the environment and equipment, however, not all fire checks had been recorded and staff had not completed fire drills.

Medicines had not always been managed safely, some people had not received their medicines as prescribed. Checks and audits had not been completed consistently, when shortfalls had been identified action had not always been taken. Staff had not received regular supervision and staff did not have up to date training.

The service was clean and odour free, however, the service was cluttered with equipment and furniture restricting people’s use of communal space. There were enough staff to meet people’s care needs but there was no opportunity provided for meaningful activities.

Quality assurance surveys had been sent to people and staff, but these had not been analysed and the results had not been acted on. People and staff had not been given the opportunity to attend meetings t make suggestions about the service.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 12 November 2021). The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We carried out an unannounced comprehensive inspection of this service on 5 October 2021. Though no breaches of regulation were found further improvements were still required.

We undertook this focused inspection to check they had continued to make improvements and to confirm they had improved. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has not changed and remains Requires Improvements. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Brenan House on our website at www.cqc.org.uk.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

We have identified breaches in relation to management of risk and good governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.