Brewster House

Brewster House is a residential care home providing personal care to up to 71 people. The service provides support to older people, some of whom are living with dementia. At the time of our inspection there were 51 people using the service.

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

The provider had implemented a number of improvements since our last inspection. The service had a new registered manager and deputy manager in post who had a strong focus on driving improvements and creating a positive culture for people and staff.

The management of risks to people’s safety had improved. However, the processes in place did not always effectively identify risks or demonstrate what actions had been taken in order to address these. The registered manager was aware of the areas which still required development and was providing staff with additional training and support to ensure processes were improved. There was a service improvement plan in place which the registered manager was continuing to work through to identify what had been achieved and where action was still needed.

The provider completed relevant recruitment checks for new staff; however, some checks had not been fully documented. The registered manager was able to demonstrate how they were making improvements to this process to ensure staff were safely recruited.

There were enough staff available to meet people’s needs and the registered manager had improved how staff were deployed throughout the service to ensure consistency of support. Staff spoke positively about the improvements in the service and the support they received from the management team.

People were protected from the risk of abuse. Staff knew how to identify signs of abuse and felt comfortable raising concerns with the registered manager. People received their medicines as prescribed and the provider ensured staff were trained and competent to administer prior to supporting people. 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.

The managers and staff had developed positive working relationships with other healthcare professionals in order to support people’s changing needs. People’s relatives told us they felt able to feedback and raise any concerns and generally spoke positively about the improved culture of the service and the care people received.

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

Rating at last inspection and update

The last rating for this service was Inadequate (published 02 August 2021) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 02 August 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an unannounced focused inspection of this service on 23 June 2021 and 07 July 2021. 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 the management of risk, safeguarding people from the risk of abuse, staffing and the oversight of the service

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.

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 changed from Inadequate 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 Brewster House on our website at www.cqc.org.uk.

Follow up

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

Brewster House is a residential care home providing accommodation and personal care for up to 71 people. At the time of the inspection 66 people were living in the service, some of whom were living with dementia.

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

People were not protected from the risk of harm. The provider had not appropriately assessed or recorded all risks to people’s safety.

People were not protected from the risk of abuse. The provider had not ensured measures were promptly put in place to protect people during safeguarding investigations into allegations of abuse.

The provider had not ensured staffing levels, or the deployment of staff adequately met people’s needs. We could not be assured people were being supported with sufficient food and fluid intake or were receiving appropriate support to manage their pressure care or their end of life care needs.

People had not always received appropriate support with their personal care and this placed them at risk from infection and illness.

The provider did not have adequate oversight of the service and systems in place to monitor people’s safety and the quality of the care provided were not effective.

The culture of the service was not positive. Staff spoke of feeling bullied and unable to voice concerns. The provider had not always been open and honest when things went wrong and we received mixed feedback from relatives about their involvement with the service and the communication from the provider.

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 15 May 2018).

Why we inspected

We received concerns in relation to the management of safeguarding concerns, the understanding of people’s health care needs and the culture of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

The inspection was also prompted in part by notification of a specific safeguarding incident. This incident is subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident.

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 reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them.

Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Good to Inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. 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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Brewster House 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 breaches in relation to the management of risk, how the provider protects people from the risk of abuse, staffing and oversight of the service.

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The service accommodates up to 71 people across two floors, each of which have separate adapted facilities for people who may or may not be living with dementia. At the time of our visit, 63 people were residing at the home.

A long-standing registered manager was in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Brewster house has been inspected at yearly intervals over a three-year period due to it requiring improvement in a number of areas. During this inspection we found that the management and staff team had worked hard to continue making improvements at the service and that these had been maintained. We did find some areas that continued to require some improvement, and have made recommendations throughout the report to support the service in these areas. Where we did find areas that required improvement, the management team were able to demonstrate that they had also identified these areas and were working on how to improve. Consequently, we found that Brewster house has achieved a good overall rating.

Medicines had not previously been managed robustly. The deputy manager had made this a focus for improvement and we saw excellent processes were in place following best practice for managing medicines in care homes.

Staff had a good understanding of safeguarding vulnerable adults, felt confident, and supported to raise concerns to team leaders and managers at the service. However, on review of some complaints we identified certain incidents, which could have been investigated as a safeguard but had not been reported to the commission or local authority. We have made a recommendation for the service to improve in this area.

People's personal information was not always stored safely in line with the Data Protection Act, 1998.

Whilst the service had appropriate infection control processes in place, protective equipment for staff and safe disposable of waste, we did observe that bathroom areas of the home were not always clean. We have made a recommendation in regards to this.

Safe recruitment practices were in place and staff were provided with a robust induction and probationary period to prepare them for the role.

The management team accessed a variety of different training opportunities for staff that met with people’s changing needs. The service had good access to other health and social care professionals to support staff to care for people.

People told us that they enjoyed the food provided at the service and had plenty of choice. When people had additional requirement’s these were met. For those with a risk of poor nutrition and dehydration, specialist advice had been sought and care plans interventions were in place to manage these risks.

Staff demonstrated caring responses to people and people told us staff and managers where kind. Relatives told us they observed staff being kind and we observed some positive interactions between people and staff during every day routines and activities.

People were not always involved in running the service and but where possible were engaged in developing their care plans. The management team were able to demonstrate plans being developed to improve people’s involvement in how the service ran, including recruitment of new staff.

The management team were passionate about continuing to make improvements at the service and had worked hard to improve on areas where there had been previous concern. Staff and people living at the service all commented on how approachable the management team were.

Governance and oversight at the service was good, and the registered manager investigated incidents, accidents, and complaints in a robust way. The only exception to this was a concern that people's clothes would sometimes be misplaced or worn by others. In spite of this the service demonstrated that it was constantly learning and developing.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Overall people were provided with their medicines when they needed them and in a safe manner. However additional work was needed in relation to the secure storage of medicines and ensuring people received their medicines when they lacked the mental capacity to decide for themselves that it was in their best interests to take them.

People received person centred care from staff who generally had a good knowledge and understanding of each person, about their life and what mattered to them. Additional training in specific health conditions would further strengthen staff’s understanding of people’s support needs.

People were supported to maintain good health and had access to appropriate services which ensured they received ongoing healthcare support. Referrals for specialist advice had not always happened promptly which meant a delay in people receiving the support they needed.

There were sufficient numbers of staff to meet people’s needs and recruitment processes checked the suitability of staff to work in the service.

There was a positive, open and inclusive culture in the service. The ethos of care was person-centred and valued each person as an individual. People were consistently treated with kindness, dignity, respect and understanding. People were empowered to have choice, independence and control in their daily lives.

People presented as relaxed and at ease in their surroundings and told us that they felt safe. Staff knew how to minimise risks and provide people with safe care. Procedures were in place which safeguarded the people who used the service from the potential risk of abuse. People knew how to raise concerns and were confident that any concerns would be listened and responded to appropriately.

Care plans reflected the care and support that each person required and preferred to meet their assessed needs, promote their health and wellbeing and enhance their quality of life.

Staff understood the importance of gaining people’s consent to the support they were providing. The management team and staff understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

There was a person centred, open and inclusive culture in the service. The service had a quality assurance system in place which was used to identify shortfalls and to drive continuous improvement. The management team were open and responsive to issues we raised and immediately began work on making changes as a result.

During our visit, we spoke to 11 people who used the service and two relatives. We also spoke with the manager, regional care director and 13 staff. We carried out observations which included interaction between staff and people who used the service and their mealtime experience. We looked at people's care and support records and records relating to staffing levels.

Brewster House provided a service for 70 people at the time of our inspection. Some people who used the service were not able to tell us verbally about their views and experiences so we used observation and interaction to gain an understanding of their care and support.

We considered our inspection findings to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

This is a summary of what we found;

Is the service safe?

People were protected from harm because the staff were following the correct procedures in caring for people. People who used the service were kept safe because there were enough staff on duty during the day and the night to care for them safely.

Is the service effective?

People's care and health needs had been reviewed to ensure that their needs were met by sufficient staff. Systems were being put in place such as ‘protected mealtimes’ to make the service more effective in meeting people’s needs. Whilst we found there were enough staff on the day of this inspection, further action was required to ensure that the allocation of staff resources across the service met people's needs effectively at all times.

Is the service caring?

Most of the staff had a good knowledge of people's likes and dislikes, their everyday needs and their personalities.

We saw that most staff interacted and engaged with people who used the service. Staff were caring, respectful and considerate. However, further improvements were needed in the way some of the staff communicated with people who used the service to ensure people were cared for with dignity and respect.

Is the service responsive?

Regular checks on the health and personal care needs of people who used the service were being undertaken. There were sufficient staff on duty to respond to people's needs. However, people’s needs were not always responded to in an appropriate and prompt way.

The service had employed an activities coordinator who offered a range of activities for people to enjoy.

Is the service well-led?

The provider had made improvements to the service since our last inspection. Staff felt more involved in helping to make the improvements. The provider had put systems in place to ensure that sufficient staff were on duty to meet people’s needs, with specific staff training and development in areas such as dignity and respect.

We asked the provider to respond with an action plan telling us what they would do to achieve compliance. We received their action plan on 12 May 2014 which outlined the improvements they would make and the timescales.

The purpose of this inspection was to check if improvements had been made.

During our inspection we spoke with 15 people who used the service and two relatives. We also spoke with the manager, deputy manager and regional manager and ten staff. We looked at the care and support records for 11 people who used the service and records relating to staffing levels .

Brewster House provided a service for 70 people at the time of our inspection. Some people who used the service were not able to tell us verbally about their views and experiences so we used observation and interaction to gain an understanding of their care and support.

We considered our inspection findings to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

This is a summary of what we found;

Is the service safe?

People were not protected from harm because staff were not following the correct procedures in caring for people.

People who used the service were put at risk of harm because there were not enough staff on duty during the day and the night to care for them safely.

Is the service effective?

People's assessments showed that their care and support was planned. However, their care and support was not delivered in a way that met their needs effectively.

Some people’s care and support was not individualised and did not enhance their dignity, wellbeing and independence.

Is the service caring?

Most of the staff had a good knowledge of people's likes and dislikes, their everyday needs and their personalities.

We saw positive interaction between staff and people who used the service. Most of the staff spoke with people in a caring, respectful, considerate and encouraging way. However, we saw that some staff did not treat people with dignity and respect.

Is the service responsive?

Regular checks on the needs of people who used the service were not being undertaken as identified in their care plans as there were not sufficient staff on duty to respond to people's needs appropriately.

The service did not offer a range of activities for people to enjoy. There was very little to do during the day or evening.

Is the service well-led?

The provider had told us that staffing numbers had been considered and changes implemented. However, the provider had failed to consider people’s dignity and respect when determining staffing numbers. People’s needs were not being put first because there was not enough staff who were able to support them appropriately.

The service was not well led as it was continually failing to meet people’s needs effectively and safely.

People who lived at Brewster House and their families told us that they received good care, were provided with nice food and had a comfortable room. We saw that people had care plans and risk assessments in place and were assisted in a respectful and encouraging way with daily tasks. One person said: “There’s always something nice here to eat.” Another person said: “I think they are trying to make me fat with what they give me.”

We saw that staff were recruited, supported and trained in order to care for people in a safe and caring way. Records were securely stored and maintained to ensure that people's changing needs were met in the correct way. There were systems in place to monitor people's health and wellbeing.

A number of people were not able to tell us directly about their experiences but we observed that they were relaxed and they interacted positively in different ways with the staff. Life history books, memory boards and memory boxes were used to help people communicate their wishes and feelings.

Brewster House had all the necessary policy and procedures, records, quality assurance and monitoring systems in place for the protection of people who used the service. Staff were well trained and supported by the manager and deputy so that they could carry out their caring responsibilities effectively. People who used the service and their families were involved in their care and their lifestyles respected. Creative practices were in place to provide a better quality of life for people with dementia.