Archived: Brook House Care Centre

We also served requirement actions in respect of a number of other regulations. We found people were not always protected from abuse or neglect, people’s care plans did not always meet their needs or reflect their preferences, arrangements to comply with the Mental Capacity Act and Deprivation of Liberty Safeguards were not always followed and the provider had not ensured that CQC were informed of all relevant and notifiable incidents as required under the regulations.

Brook House Care Centre is registered to provide accommodation and nursing care for up to 74 adults. People using the service include adults with a range of disabilities including brain injury, people with nursing needs and people with dementia. At the time of this inspection there were 47 people using the service.

At this inspection there was no registered manager in place. The previous registered manager had left the home after the last inspection. A new manager had started work in November 2016. 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. The new manager was aware of the requirements to notify CQC about particular events.

At this inspection on 26 to 28 April 2017, we found the serious concerns we had about people’s health and safety had been addressed. Possible risks to people were identified and monitored to reduce risk of the occurring. Staffing ratios at the home had improved as staffing levels had not been amended to reflect the reduced numbers of people currently living at the home. We are in discussion with the provider about their plans for future staffing levels at the home. Staff had received training on a wide range of areas to help them develop their skills. We found the new manager had been instrumental in making significant improvements across all aspects of the home which had a clear positive impact on people’s care.

There had been a considerable amount of change required much of which had been implemented. However, there was a continued breach of regulations, as we found there remained some areas for improvement needed with the provider’s quality assurance system. The provider’s application form did not request an applicant’s full employment history. The audit of staff training had not identified a need for mental health training for some staff. improvements to records to evidence effective systems to reduce the risk of legionella. The provider's admission policy had been reviewed but did not fully reflect learning from recent safeguarding investigations. You can see the action we have asked the provider to take at the back of the full version of this report.

There were also areas for improvement identified which included improvements to some risk management records and care plans were required, in particular on the ground floor unit of the home; this included better archiving of old records. Some improvements were also needed to meet people’s needs for stimulation on one unit at the home, although, this had been identified as a work in progress by the manager. Aspects of medicines management on one unit of the home also required addressing.

There were marked significant improvements to people’s care and to the environment at the home. People told us they felt safe and well looked after. Staff knew how to identify and respond to any safeguarding concerns. We saw people felt comfortable in staff presence and interactions were positive and we heard laughter and evidence of good relationships between staff and people. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible. People’s dietary needs were met and a range of health professionals were available to support their health needs.

People and their relatives told us they were treated with dignity and respect and that they were now more involved in their care planning. Improvements had been made to the activities on offer at the home. Complaints were managed appropriately.

People, their relatives and staff told us they thought the home was well run and improvements had been made. There was a range of meetings to ensure effective communication between staff at the home and people’s views were sought through regular residents and relatives meetings.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Brook House Care Centre is registered to provide accommodation and nursing care for up to 74 adults. People using the service include adults with a range of disabilities, people with nursing needs and people with dementia. At the time of this inspection there were 62 people using the service.

There was a registered manager who had managed the home since November 2015. 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.

At this inspection we found some serious breaches of regulations in respect of identifying, assessing and managing risks to people; systems to monitor risk and the quality and safety of the service and a lack of adequately trained and competent staff at all times. Full information about CQC’s regulatory response to these serious concerns, found during inspections, is added to reports after any representations and appeals have been concluded.

We were aware that the home was in the process of drawing up an action plan with the local authority to address concerns raised through the local authority provider concerns process.

We found other breaches of regulations in respect of safeguarding concerns not always being identified or reported. There were ineffective arrangements to comply with the Mental Capacity Act (2005) and in relation to a lack of person centred care. People’s care plans were not always personalised and care in relation to some needs was not always identified or assessed. CQC were not always informed by the provider of notifiable incidents as required.

You can see the action we have asked the provider to take in respect of these breaches at the back of the full version of this report.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe, so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to consider beginning the process of preventing the provider from operating this service. This may lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we may take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.”

Some people’s care plans did identify risks and there was guidance for staff on how to reduce risk. Most people told us there was enough to eat and drink and that they had some choice about their food; however some improvements were needed to make the meal time experience more pleasurable. Medicines were safely managed. People were able to access health professionals when they needed to. Some health professionals had commented on the positive response from staff to training they had delivered at the home.

People had mixed views about how they were cared for. Some people told us they were happy with the care provided, they felt safe and were happy with the way the staff supported them. However, other people felt there was room for improvement. We saw some glimpses of care sensitively provided but overall observed little in the way of positive interaction between people and staff at the home. People told us there was not always enough to do and we saw little in the way of organised activities provided to help stimulate people.

There were mixed views about the management of the service. Most people felt the registered manager and senior team were approachable and listened to them. Staff also felt that the registered manager was approachable. However they told us the staff group did not work well as a team. There were systems to gather feedback from people, relatives and visitors to improve the quality of the service through questionnaires and meetings. However these did not work effectively to improve the quality of the service.

Brook House Care Centre is registered with CQC to provide accommodation and nursing care for up to 74 adults, including adults with disabilities and people with dementia. At the time of this inspection the home was providing nursing care and support to 58 people.

The home had 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 and associated Regulations about how the service is run.

People using the service said they felt safe and staff treated them well. Appropriate recruitment checks took place before staff started work. There were enough staff on duty and deployed throughout the home to meet people’s care and support needs. Safeguarding adult’s procedures were robust and staff understood how to safeguard the people they supported from abuse. There was a whistle-blowing procedure available and staff said they would use it if they needed to. People’s medicines were managed appropriately and people received their medicines as prescribed by health care professionals.

Staff had completed an induction when they started work and they were up to date with the provider’s mandatory training. The manager and staff understood the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and acted according to this legislation. There were appropriate arrangements in place to ensure that people were receiving the food and fluids as recorded in their care plans. People had access to a GP and other health care professionals when they needed them.

Staff spoke to and treated people in a respectful and dignified manner and people’s privacy was respected. People using the service and their relatives, where appropriate, had been consulted about their care and support needs. Care plans and risk assessments provided guidance for staff on how to support people with their needs. There was a range of appropriate activities available for people to enjoy. People and their relatives knew about the home’s complaints procedure and said they were confident their complaints would be fully investigated and action taken if necessary.

People using the service, their relatives and visiting professionals told us there had been many improvements made since the manager started working at the home. Staff said they enjoyed working at the home and received good support from the manager. The provider took into account the views of people using the service and their relatives about the quality of care provided through relatives and residents meetings and surveys. The manager used the feedback from the meetings and surveys to make improvements. The manager carried out unannounced visits to the home to make sure people where receiving appropriate care and support.