Brockworth House Care Centre

Updated 14 February 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

This inspection was carried out by one inspector, one (CQC) medicines specialist and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Brockworth House Care Centre 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. Brockworth House Care Centre is a care home with 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. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

The inspection was limited to 2 of the care home’s 3 units as one unit had an outbreak of COVID-19 infection. We sought feedback from infection, prevention and control professionals who had previously visited the service. We spoke with 1 person who used the service and their relative to gain their view of the care provided to them. We observed interactions and activity between staff and 6 other people who used the service. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We spoke with the operations manager, registered manager, deputy manager, a registered nurse, 2 care staff, head chef, head housekeeper, activities co-ordinator and training co-ordinator.

Updated 14 February 2023

About the service

Brockworth House Care Centre is a residential care home providing care to a maximum of 55 people. The service predominantly provides support to people who live with dementia. At the time of our inspection there were 46 people using the service.

People are accommodated in one purpose-built building across two floors; on two units upstairs and one-unit downstairs. The different units provide the opportunity for people to be supported at various stages of their journey in care. Providing the freedom for people who are more mobile and a quieter environment for people who are more physically and mentally frail.

Each unit has its own communal spaces comprising of a kitchenette, dining space and a selection of areas to sit and relax or take part in social activities. Each person has their own bedroom, toilet and washing facility and there are adapted bathrooms on each floor. A large enclosed garden supports people to safely enjoy the outside.

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

The information held about people’s medicines was not always sufficient to provide staff with clarity on the administration and use of some prescribed medicines, to ensure the risk of medicine errors occurring from this were fully mitigated. At the time of the inspection processes to ensure people’s prescribed medicines were obtained in a timely manner ready for administration, still required improvement to avoid gaps in people’s treatment.

Infection, prevention and control (IPC) practices and arrangements were not always supporting the prevention of infection spreading.

The provider’s quality monitoring processes were not fully effective. They had not identified the shortfalls found at this inspection, in relation to medicines and IPC. This had not resulted in necessary improvement action being taken to address these shortfalls. Managers were not using enhanced monitoring processes to assure themselves that an outbreak of COVID-19 in the home was managed safely.

Improved scrutiny was needed to ensure the provider’s quality monitoring and governance systems were effectively implemented to ensure the service remained compliant with necessary regulations and best practice.

The service experienced significant challenges during the pandemic and since and the provider had taken action to provide staff with leadership and enough staff to keep people safe.

Risks which otherwise may impact on people’s physical and mental health were assessed and managed. These included those associated with the premises and environment, people’s mood and behaviour, poor mobility and falls, eating and drinking, potential choking and pressure ulcer development.

Arrangements were in place to protect people from abuse and to act if abuse was suspected. Processes were in place to ensure people, relatives and staff felt comfortable in reporting poor care or discrimination so this could be acted on. People were supported to live safely with dementia. Staff supported people’s preferences in relation to their protected characteristics.

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.

We observed interactions and actions taken by staff which demonstrated a dementia friendly and person-centred culture was in place. Joint working with social care and health care professionals, community and church leaders took place to support people’s health and wellbeing needs.

Staff felt supported by senior staff and had access to training which suited their learning needs, and which helped them perform their roles safely.

Relatives were kept informed of their relative’s health needs and informed of any accidents or incidents involving their relative.

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 good (published 10 August 2018).

Why we inspected

The inspection was prompted in part by notification of an incident following which a person using the service required medical assistance. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risks associated with swallowing problems and potential choking. This inspection examined those risks.

Action had subsequently been taken to ensure the person received the right care and treatment to meet their needs. Processes and practices had been reviewed to ensure the safe use of thickeners (sometimes used in people’s drinks to help them swallow safely).

This focused inspection reviewed the key questions of safe and well-led only.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

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

For those key questions not inspected, we used the ratings awarded at the last rated inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement. 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 Brockworth House Care Centre on our website at www.cqc.org.uk

Enforcement

We have identified breaches in relation to the management of people’s medicines and quality monitoring processes at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.