Brentwood Care Centre

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

People's care plans and risk assessments continued to contain contradictory information. Limited guidance for staff was found in areas such as catheter care and diabetes care. Where staff were updating risk information, they were not always ensuring all parts of the care plan were checked. Medicine processes required improvement. People were not always supported with their mobility in a safe way. Infection control processes required improvement. People were supported by staff who had been recruited safely. Safeguarding processes were followed, and staff were aware of reporting systems.

This service scored 56 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

Most people and relatives told us they felt safe. One person told us, “It would be strange if I didn’t feel safe here: it’s a ‘care home’ after all. There’s an acceptable turnover of staff which means they get to know who you are and what you need.” A relative said, “I know [family member] is settled here. They are well looked after and I feel confident when I leave them, that all will be well.” A couple of comments were made from people about staff not being as gentle with them as other staff when they are being supported with movement. We informed the interim manager about this feedback.

The staff we spoke with were aware of their responsibilities to report and act on any concerns. A member of staff told us, “I would talk to the patient and ask what has occurred, I will assess and pass to the senior in charge. I would report to CQC if I was still concerned.” Another staff member said, “I could report to the senior carer, unit manager, or go to the manager or if not, I would go to CQC. I know how to whistle blow and I am not afraid to report staff if I need to.” The interim manager told us any safeguarding concerns were shared with staff to promote learning and prevent reoccurrence.

During the assessment overall we observed staff delivering care safely. As recorded in the involving people with risk paragraph there were some concerns with manual handling practices on 3 occasions, but other staff supported people to move safely. Staff were observed to respond to people’s call bells and provide them with the support they needed.

The provider had a system in place for the management of safeguarding concerns. This meant people were protected from the risk of harm or abuse. Safeguarding concerns had been reported to the relevant authorities and CQC when required. The interim manager reviewed any trends and themes from incidents and accidents to reduce the risk of reoccurrence. The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). The provider was working in line with the Mental Capacity Act and staff had received training in this area. Conditions on people’s authorisations had been met.

During the first assessment visit at night, we observed people with catheters in situ. The catheters for 2 people were not positioned correctly to prevent urine from flowing back into the bladder from the tubing and urine bag, which could lead to infection. The nurse on duty told us they were waiting for the night catheter stands to arrive. When we looked at catheter care plans they contained limited information for staff. Care plans indicated that staff should record fluid input and output. Records found were poorly recorded and either had missing information or fluid targets set by the provider were not met and did not contain any evidence about what action staff were taking if people had not met fluid targets set for them. Following the assessment, the provider sent us updated care plans for catheter care and improved monitoring charts. Other care plans contained limited guidance about specific risks. Concerns were identified with the management of diabetes. For example, when people’s blood sugars were recorded as high, there was no action taken to reduce this with diet and we found people were still given food high in sugar and carbohydrates. Other care plans viewed had contradictory information about risk. Information was not always updated to all sections of the care plan. We observed staff using unsafe moving and handling techniques on 3 occasions when supporting people with their mobility. This placed both people and staff at risk of harm. People's care records contained personal emergency evacuation plans (PEEPs). These provided guidance for staff should they need to help evacuate people from the building in the event of an emergency such as a fire. A fire risk assessment was completed in November 2023, and we were sent information that all recommendations had either been completed or were in progress. Environmental risk assessments were in place and health and safety checks were carried out which included maintenance of equipment.

People were involved in planning their care and managing risks. However, some people did tell us the systems in place to reduce risk were not always effective. A person told us, “Changing my juice jug can be irregular. It’s not always changed every day.” Another person told us, “I come up and sit with my [family member], sometimes I get annoyed, the untrained nurse was rushing them to eat, I had to tell [staff member] to slow down, this was just after admission.” Other people were positive about involving them with risk and a person told us, “They help me when I use my walker so that I’m safe. They certainly seem to understand how I need help.” A relative said, “My [family member] is well looked after. They are turned every two hours and they have done that while we’ve been here.”

We observed staff using unsafe moving and handling techniques on 3 occasions when supporting people with their mobility. Two of these occasions involved staff not ensuring people’s feet were positioned safely on the footplates of their wheelchairs. This places people at risk of their feet dragging and becoming trapped which may cause significant injuries. The third unsafe technique observed was a staff member who placed their right arm under the service user’s right armpit to transfer the person. This placed the person and staff at risk of harm. The provider took action immediately following our feedback which included additional training for staff and reassessing their competencies.

Systems were in place to update staff about people’s risks and needs. This included handover meetings and staff meetings. A staff member told us, “When I come in, I will speak to the senior and ask about people’s diets and falls risks etc. I double-check anyway.” Another staff member said, “They have their care plans, when I came, I could read about them, and they told me about the risks. We do a handover in the morning and the evening. We make sure we are present for the handover.”

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

At our last inspection, we identified there were not enough suitably qualified, competent, and experienced staff to support people's needs. At this assessment, the interim manager and nominated individual told us they had recently increased staffing in 3 areas following a review of dependency scores. Whilst we did not identify any significant concerns related to staffing during our assessments, feedback from people remained mixed about how much time staff had to spend with people. We also were concerned that in 2 areas of the home, there was a significant amount of time from the food arriving to the last person being served or supported to eat. At our last inspection applicants did not always have a full employment history documented. This has improved and the recruitment files we looked at had all the information required to ensure staff were recruited safely.

The staff we spoke with told us staffing had improved recently in some areas. A staff member told us, “Compared to my former care home this is better, they do the allocations, so you know what you are doing. It depends on the day; I chat to people when I am doing their bath.” Another staff member said, “I would say now we have enough staff we have just increased staffing levels. We do need another clinical lead which is being advertised for additional support.” Whilst most staff felt the recent increases were helping a couple of staff on the nursing floor felt more staff was required. A staff member told us, “It is like this [busy] most of the time, we are always under pressure, it is very stressful here.” Another staff member said, “I feel if we had another carer, we could do so much better.”

We received mixed feedback from people and relatives about staffing. A person told us, “It’s very rare for a carer to stay and talk to me. They are just so busy.” Another person said, "I don’t worry, but it’s not good to see carers under so much pressure. They seem to be doing three jobs at once. They’ll say, ‘I can’t stop now. I’ll be back.’ In fairness, they do usually remember to return.” A third person said, “I am absolutely pleased with things here. They look after me well and know the support I need. They change my water regularly and they keep my room clean.” A relative told us, “[Family member] is safe here now, no incidents, now better on the number of staff.”

Our observations of staff deployment were positive during the assessments. Staff responded to people’s requests for support in a timely way. However, on both the nursing floor and residential floor there were delays to people receiving their food. For example. On the nursing floor lunch began at 12.45 and at 13.49 staff had 4 people still to assist with eating in their bedrooms. Whilst this did not appear to impact on people this demonstrated more staff support might be needed at mealtimes. The nominated individual told us they would immediately include a whole home response at mealtimes so all staff would be made available to provide support to people. Call bells were answered within a reasonable time frame, and we observed staff being attentive and checking the call bell system straight away when alerted.

People were not always protected from the risk of infection as staff were not following safe infection prevention and control practices. During the assessment, a person on the nursing floor told us staff were cleaning their commode in a communal bathroom, and 2 staff we spoke with confirmed this. We spoke with other staff in different areas of the home who all confirmed they were following the correct process. The nominated individual responded to this concern and stopped this practice immediately. They told us they would monitor this carefully through supervision with staff and observational practice. Other concerns were observed during the assessment we found 1 room had a heavily soiled carpet, some soap dispensers were dirty, a privacy screen in a bathroom required cleaning, and in 1 toilet there was a gap between the flooring and the wall where dirt could accumulate. Following the assessment, the interim manager informed us the room with the heavily soiled carpet was in the process of being fully refurbished which included new flooring.

Although infection control audits were in place, improvements were needed to some parts of the service environment and most concerns found were on the top floor as described in Observation.

There was a paper-system in place to support staff to administer people’s medicines safely, this included person centred protocols to support the use of ‘when required’ medicines. However, records for medicated patches were not being completed accurately. The provider had recently introduced a new form on which staff had not recorded the position of the patch consistently or the date applied in all cases. Care plans were in place to support medicines use however, for some high-risk medicines such as insulin for diabetes management, there was not enough detail to inform staff how to support the person. Records were not always accurate or reflective of the person’s needs and how the medicines should be administered. This could put people at risk of not receiving their medicines as prescribed. Where medicines were administered via a PEG for one person, there was a discrepancy in how much fluid should be used to flush the PEG. Records gave 3 different fluid amounts and a nurse we spoke with gave a 4th. Although there was no immediate risk there was a lack of consistency in record keeping. The deputy manager contacted the dietitian and spoke to the GP on the day of the inspection for advice. Records for people receiving insulin, on the floor for people living with dementia, lacked detail. The care plan for 1 person was incorrect. Records stated blood sugars should be checked 4 times a day and insulin could be given hourly if blood sugars were unstable. Staff told us they did not check blood sugars as the person had their diabetes managed by district nurses. Records showed blood sugars were only checked in the morning by the district nurses. The dose of the insulin in the care plan did not match the administration records. There were clear policies and procedures in place including for covert medicines. These medicines were being administered in line with current best practice and legal requirements.