Archived: The Brunswick

Updated 1 April 2021

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. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

As part of this inspection we also 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 completed by two inspectors and a medicines management inspector.

Service and service type

The Brunswick is a 'care service'. People in care services receive accommodation and nursing or personal care as a single package under one contractual agreement. Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The service did not have a manager registered with the CQC although an application had been made. This means that the provider is legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

Day one of this inspection was announced an hour before our visit. This was to check on the situation regarding Covid-19. Day two was used to complete telephone conversations with relatives and staff. We also took time to analyse further information we had asked to be forwarded.

What we did before inspection

Before the inspection we checked the information that we held about the service. This included statutory notifications sent to us by the provider about incidents and events that had occurred at the service. A notification is information about important events which the service is required to send us by law. We did not ask the provider to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.

We also obtained feedback from the local authority and healthcare professionals.

During the inspection

We looked around the premises, observed the interactions between people living at the service and staff, care delivery and activities provided at the service. Due to the increased risk of cross-infection we were unable to complete more extensive observations.

We spoke with five people living at the service, three relatives and ten staff, including the manager, deputy manager, care staff, ancillary staff including domestic staff.

We looked at a range of documentation including five people's care records, medication records, staff files, accident and incident records, safeguarding records, health and safety records, audits and records relating to the quality checks undertaken by staff and other management records.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data, risk assessments and quality assurance records.

Updated 1 April 2021

About the service

The Brunswick provides accommodation and personal care for a maximum of 58 residents. At the time of the inspection there were 26 people in residence.

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

At our last inspection we found breaches of regulations because the provider was failing to manage policy and practice related to medicine management, staffing and overall management and governance.

Enough improvement had been made at this inspection regarding staffing and governance and the provider was no longer in breach of these Regulations. There was continued concerns regarding medication management and the provider remains in breach of this regulation.

Although we saw some improvement in the management of medicines, these were not consistently implemented and embedded. This meant there was a risk some medicines for people were not monitored safely and there was a risk some people might not receive their medicines. This was an ongoing concern from the last inspection.

Arrangements were in place for checking the environment to ensure it was safe. We found good ongoing checks of the environment helped ensure people were safe. This was an improvement from the last inspection.

The home was staffed appropriately and consistently. This helped to maintain a consistency of care for people. People and their relatives told us they felt safe living at The Brunswick. This was an improvement.

There were a series of quality assurance processes and audits carried out internally and externally by senior managers. The new manager for the service had ensured the well-developed management systems had been applied in the home. There was a strong emphasis on communicating with relatives and getting people’s feedback to further improve the service. This was an improvement.

Some of the systems needed further embedding to ensure all aspects of care and safety were consistently monitored and improved.

The service was following good practice guidance regarding the management of COVID-19 and maintaining standards of hygiene and infection control.

People's experience of using the service was positive. Most people received the care and support they needed when required. Most of the feedback we received showed staff were helpful and kind and treated people with dignity and respect. Positive relationships had been developed between staff and people they supported.

A relative commented. “Communication was poor before the new manager but has now vastly improved. We have zoom calls and lots more updates and contact. I feel very reassured because of this. My relative seems very happy [living at the home].”

Risks associated with people’s care were identified and managed to minimise harm. Supporting care records mostly identified risks clearly and there were plans in place to help keep people safe.

Since the last inspection there had been changes of management. The current manager was providing effective leadership and was supported by a senior management team. The provider’s governance systems and organisational structure provided monitoring and support for the service.

Rating at last inspection and update

The last rating for this service was Requires improvement (published 8 October 2019). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been sustained to meet all of the breaches.

Why we inspected

We carried out an unannounced focussed inspection of this service on 27 August 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained Requires improvement. This is based on the findings at this inspection.

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 coronavirus and other infection outbreaks effectively.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified a breach in relation to medicines management 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.