Brookdale Nursing Home

Brookdale Nursing Home is a care home providing personal and nursing care to people aged 65 and over who may have a physical disability and/or who may be living with dementia. The service can support up to 40 people, at the time of the inspection 32 people were living in the home.

Brookdale Nursing Home accommodates 40 people in one adapted building which is over two floors.

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

People told us they felt safe and supported by the staff who worked in the home. Staff recognised different types of abuse and how to report it. The registered manager understood their safeguarding responsibilities and how to protect people from abuse. Potential risks to people's health and wellbeing had been identified and managed. People, and where appropriate, their relatives, had been involved with decisions in how to reduce risk associated with people’s care. There were sufficient staff on duty to keep people safe and meet their needs. People's medicines were managed and stored in a safe way. Safe practice was carried out to reduce the risk of infection.

People's care needs had been assessed and reviews took place with the person and where appropriate their

relative. Staff had the training and support to be able to care for people in line with best practice. People were supported to have a healthy balanced diet and were given food they enjoyed. Staff worked with external healthcare professionals and followed their guidance and advice about how to support people following best practice. 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 did support this practice.

People were supported by staff who treated them well. Staff treated people as individuals and respected the choices they made. Staff treated people with respect and maintained their dignity.

People's care was delivered in a timely way, with any changes in care being communicated clearly to the

staff team. People were supported and encouraged to maintain their hobbies and interests. People had access to information about how to raise a complaint. The provider responded to complaints in line with their policy and procedure. People's end of life care needs were met in line with their preferences and done so by staff in a respectful and dignified way.

All people, relatives and staff felt the registered manager had made positive improvements to the home and the way the service was run. The registered manager was visible within the home and listened to people and staff's views about the way the service was run. The provider had put checks into place to monitor the quality of the service provision.

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 21 January 2019).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Brookdale Nursing Home is registered to provide personal care to older people including people living with dementia. Brookdale Nursing Home is a nursing home, which provides care for up to 40 people across two floors. At the time of our inspection there were 31 people living at Brookdale Nursing Home. People had their own bedroom and not all the bedrooms had en-suite facilities and four bedrooms were for shared occupancy. People had the use of shared communal lounges, dining rooms and bathrooms on each floor. To aid people’s movement around the home, a passenger lift and stairs helped people move between floors.

People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

At our last inspection we rated the service Good overall. Prior to and immediately following this inspection visit, we received information raising concerns about continence care, infection control and limited opportunities for people to pursue their interests. We looked at these concerns at this inspection and we found standards in how people were cared for had not been consistently maintained. In Well Led, people and staff told us changes to the feel and culture of the home had changed and although some improvements were noted, these needed to be embedded further to determine if they improved people’s care and welfare. Overall, the rating has now changed to Requires Improvement.

The service did not have a registered manager, although a manager was appointed at the home in September 2018 and was in the process of applying for registration with us. 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.

Not all staff were positive about the changes in management, however staff agreed the changes being implemented by the manager were to improve people’s experiences and care outcomes.

Staffing levels helped ensure people received the consistent care they needed, although staff said the use of agency staff meant the shift did not always operate effectively. The regional manager was confident staff levels were right and said staff needed to be deployed and managed more closely to improve the delivery of care. Staff did not always have time to sit and spend time getting to know people more. Our observations during this visit, were of positive and friendly interactions between staff and people but they were limited.

Staff did not always treat people with dignity and respect. Relatives and staff told us people wore other people’s clothes and the laundry system was not effectively managed to ensure people’s own laundry items were returned. People’s clothing was transferred to other areas of the home in black bin bags which showed no respect for people’s personal property. Some people said staff entered their rooms without knocking which they did not appreciate.

Staff had a good understanding of abuse and the safeguarding procedures that should be followed to report abuse and incidents of concern. Risk assessments were in place to manage potential risks within people’s lives, whilst also promoting their independence.

People’s care plans provided information about the person’s preferences and included some knowledge staff had gained about the person’s interests and life history. Care records were reviewed and evaluated to ensure they remained up to date and changes made as required. However, some care plans we reviewed required more specific details to ensure staff provided consistent care. Staff had a hand over meeting held daily but some of the descriptions about people, were not always accurate. Staff said if people’s needs changed, they were informed by way of a handover, however this needed to be more reflective of people’s needs.

A process was in place which ensured people could raise any complaints or concerns. Concerns were acted upon and lessons were learned to reduce potential for similar complaints. The provider had systems to monitor the quality of the service. Actions were taken and improvements were being made, although some of the issues we found had not been identified. During and following our visit, the manager had taken action to make some improvements.

People were safe and satisfied with the support they received although most people said there was limited stimulation to keep them occupied. There were times people sat in different parts of the home with very little to do. The manager following their appointment, had begun to improve people’s access to hobbies and interests.

Training records showed staff training was being completed and staff were equipped with the skills and knowledge to look after those in their care.

Staff worked within the principles of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff for the majority of time, sought people’s consent before any care and support or choices were provided but there was inconsistency in staff practice.

People received support from nursing staff and other health care professionals. People were registered with a GP practice who visited people when needed. If people required other healthcare support in an emergency, staff were available 24 hours a day to seek that help or medical intervention.

People received their medicines safely by trained staff and regular checks on administration and storage ensured medicines were given safely and as prescribed.

There were examples of completed audits and checks that gave the provider confidence people received a safe, responsive and effective service. However, some of these audits were not accessible to us until following our visits because they were unable to be located, or IT problems meant they could not be accessed or shared. Significant changes in the management of the home and the staff team meant that changes needed to become embedded within the practice of the home. Changes with the manager and the care staff within the home becoming ‘one team’ needed more time to embed as some staff raised concerns with that poor communication and a lack of consistent teamwork impacted on the quality of care people received.

Further information is in the detailed findings below.

The inspection took place on the 2 August 2016 and was unannounced.

We completed an unannounced comprehensive inspection of this service on 7 and 10 July 2015. We found there was a breach in the legal requirements and regulation associated with the Health and Social Care Act 2014. The provider did not have suitable arrangements in place to prevent people being unnecessarily deprived of their liberty. We asked the provider to send us an action plan to show how they would meet the legal requirements of the regulation and when their actions would be completed by. We completed a focussed inspection on16 December 2015 and we found the actions required had been completed and these regulations were now met.

There was a registered manager at this home. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered providers and registered managers 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.

People and their relatives said there was sufficient staff available to support people living at the home safely. They told us staff were caring and promoted people’s independence as much as possible. People said they were able to maintain important relationships with family and friends. We saw people had food and drink they enjoyed and had choices available to them, to maintain a healthy diet. They were supported to eat and drink well in a discreet and dignified way. People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage them. People and their relatives told us they had access to health professionals as soon as they were needed.

Relatives said they felt included in planning for the care their relative received and were always kept up to date with any concerns. They told us an assessment of their family member’s needs before and when they arrived at the service supported staff to provide the care they needed. People living at the home were able to see their friends and relatives as they wanted. They knew how to raise complaints and felt confident that they would be listened to and action taken to resolve any concerns. We saw the registered manager acknowledged when things had not gone well and put actions in place for improvements.

Staff we spoke with knew how to recognise signs of abuse, and systems were in place to guide them in reporting these. They were knowledgeable about how to manage people’s individual risks, and were able to respond to people’s needs. Staff had up to date knowledge and training to support people. We saw staff treated people with dignity and respect. They knew people well, and took people’s preferences into account and respected them.

The management team had assessed people’s ability to make specific decisions about their daily life when they needed to. They had put in place support for people to ensure decisions were made in a person’s best interest within the legal framework. Staff we spoke with understood how to work with people to ensure they made their own decisions where possible.

People who lived at the home and staff were encouraged to share their views and concerns about the quality of the service. People and their relatives thought the service was well managed. The provider and registered manager had systems in place to monitor how the service was provided, to continuously improve the quality of care.

Is the service safe?

People were treated with dignity and respect by staff. People told us they felt safe. We observed a relaxed atmosphere and positive relationships between the people who used the service and staff. There were risk management plans in place for people and health and safety. There were appropriate and safe arrangements in place to ensure people received their medicines as they were prescribed by a doctor. Recruitment practices were thorough and all necessary safety checks had been carried out. Newly recruited staff did not work by themselves until they felt confident and when they had been assessed to do so.

CQC monitors the operation of Deprivation of Liberty Safeguards which applies to care homes. We found that one application had been submitted to a registered assessor through the appropriate channel. Proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

People's health and care needs had been assessed and care plans were in place. There was evidence of people and or their relatives or an advocate being involved with the development of care plans. We found that other assessments had been carried out in relation areas such as nutrition, mobility and skin condition. All assessments had been regularly reviewed. Appropriate systems were in place to ensure specialist diets were given to people who had long term conditions. A process for monitoring people who failed to eat or drink enough was in place.

It was clear from what we saw and from speaking with staff that they understood people's care and support needs and that they knew them well. Staff encouraged and supported people in leading interesting and enriched lifestyles. The person we spoke with said they received the standard of care that matched their needs. A relative told us, "They (staff) have been lovely to me and so supportive."

Is the service caring?

The person we spoke with was positive about the way they were cared for and supported. They told us, "I am very satisfied, it's (care) excellent." People were cared for by kind and attentive staff. We observed people asking staff to do things for them. Staff responded to the requests promptly and efficiently. There were signs on each bedroom door to advise when a person was receiving personal care to protect their privacy and that staff should not attempt to enter.

People were offered a range of activities and staff spent one to one time with people. Staff assisted people in maintaining communications with relatives even when they lived in another country. Staff were supported by a team of health and social care professionals who worked closely with them in providing people's care needs.

Is the service responsive?

Staff respected people's confidentiality and asked for permission before sharing personal information with other organisations. Staff had obtained written consent from people or their relatives for a range of procedures such as personal care. When people who lived in the home made suggestions for changes action had been taken as far as practically possible. We found evidence that people were able to make choices about their care and activities. One person said, 'I am asked if I want to join in the activities.' Records' confirmed people's preferences and interests had been recorded and care and support had been provided in accordance with people's wishes.

We found evidence that staff sought professional advice when they had identified concerns about people's health and safety. Staff followed the guidance provided by healthcare professionals to ensure that people received appropriate care and support.

Is the service well led?

The service had a quality assurance system in place. Records showed us that improvements had been made when they were identified through monitoring processes. There were clear processes in place for dealing with complaints. Regular audits had been carried out that enabled staff to make changes that could be of benefit for the people who used the service. A relative told us, "Everything is well managed."

Staff told us they were clear about their roles and responsibilities, the ethos of the service and the quality assurance processes. There were clear lines of responsibility and staff knew who they could seek guidance from if they were unsure about something. Staff told us they received good support from senior staff to help them when they had a problem and to carry out their role effectively.

The people we spoke with were complimentary about the home and the staff. One person told us: 'It's alright here. I get on very well with everyone and the staff are very nice.' One of the visitors told us: 'It's very good. The staff are all very helpful.'

We watched staff as they cared for people. They provided care and support that met people's needs.

We found that staff knew about the needs of the people they were caring for. We looked at care records for three people and found that these contained guidance for staff on how to meet their needs. We saw that people's needs were reviewed regularly.

We found that the equipment that was used in the home was maintained appropriately and that staff had been trained in its use.

We saw that staff were supported to be trained to an appropriate standard.

There was a system in place for people to make complaints if they were not happy with any aspect of the service.

The people we spoke with told us that they were happy with the home and the staff. One person told us, 'I can't complain about anything.' One visitor told us,'It's got a homely feel. They make you feel at home as a visitor.' Another visitor said, 'Nothing's too much trouble. No matter what time you go in they're all brilliant.'

Staff knew about the needs of the people they were caring for. We looked at care plans for four people and found that these contained guidance for staff on how to meet their needs. We saw that people's needs were reviewed regularly.

People told us that they felt safe living at the home and knew who to speak to if they had any concerns. Staff had been trained how to recognise signs of abuse and knew how to report concerns.

People were protected from the risk of infection and their medicines were managed appropriately.

We saw that sufficient numbers of appropriately skilled and qualified staff were employed to meet people's needs. We looked at records which showed that the provider was regularly monitoring the quality of its service.