Brockfield House

Brockfield House is a nursing care home providing personal and nursing care for up to 45 people, in one adapted building. The service provides support to older people, many of whom are living with dementia. At the time of our inspection there were 44 people using the service.

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

People were safely cared for. Staff understood safeguarding procedures and were confident in reporting any concerns. Risks to people's safety were assessed and well managed, and people’s care plans detailed current risks and individual needs.

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.

There were sufficient numbers of staff who had been safely recruited to meet people's needs.

People’s medicines were safely managed. Systems were in place to control and prevent the spread of infection. The provider ensured that lessons were learned when things went wrong, so that improvements could be made to the service and the care people received.

Staff received an induction and ongoing training that enabled them to have the skills and knowledge to provide effective care.

The service was well managed. People, relatives and staff were very positive about the leadership of the service and praised the registered manager highly.

There were systems in place to monitor the quality of the service and actions were taken, and improvements were made when required. Staff felt well supported and said the registered manager was open and approachable.

The service worked in partnership with outside agencies.

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 17/11/2021).

Why we inspected

We undertook this inspection to check improvements had been made.

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

Follow up

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

We found the following examples of good practice

Safe arrangements are in place for professionals visiting the service. This included a confirmed negative lateral flow test, vaccination against COVID-19, COVID pass, hand sanitisation and wearing personal protective equipment (PPE). There are plentiful supplies of personal protective equipment (PPE) throughout the home which includes gloves, masks and aprons.

There are PPE stations located around the home and close to bedrooms where people are required to isolate.

Isolation, cohorting and zoning are being used to manage any potential spread of infection.

Staff participate in a daily and weekly testing regime prior to commencing work. All staff have a designated area to change their clothes before and on completion of their shift.

We saw various cleaning and disinfection records which included regular high touch point cleaning to ensure the potential for cross infection had been reduced.

Policies, procedures and risk assessments related to COVID-19 were up to date which supported staff to keep people safe.

Staff had completed training in relation to infection control, and recently received training about the correct use of PPE including donning and doffing. Spot checks will be used to ensure staff adhere to the training provided.

Brockfield House is a nursing home providing personal and nursing care for up to 45 people aged 65 and over, many of whom are living with dementia. The service was supporting up to 41 people at the time of inspection.

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

Processes to follow up accidents, incidents and falls required strengthening to ensure consistency in completing incident forms, undertaking investigations and reporting to external agencies when necessary. Records of physical intervention, which can be required to keep people safe if they are at risk of harm or require essential care, needed improvements. The manager took action immediately when this was brought to their attention.

Some gaps were found in quality assurance processes. The manager implemented an action plan and made improvements during the inspection to strengthen oversight of physical intervention and accidents, incidents and falls. A range of other quality assurance checks were in place and completed regularly.

Safe recruitment processes were followed and sufficient staffing levels were observed. The management team were working to fill staff vacancies and the staff team, along with agency staff, covered additional shifts as needed.

Medicines practices had improved since the last inspection. Good practice was followed for the receipt, storage, administration, recording and disposal of medicines. Good practice was observed to support infection prevention and control.

Risk assessments were in place and were usually reviewed regularly and as people's needs changed. Some gaps were identified but no negative impact was found upon people's care.

Care plans were personalised and a programme to review and refresh care plans, and discuss with people and their representatives, was ongoing. The complaints process was followed when necessary.

Positive feedback was received about the approachability and support offered to staff by the new manager. Team meetings took place regularly. People attended resident meetings and relatives were kept up to date with important information.

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 requires improvement (published 9 September 2020) and there were breaches of regulation in the areas of good governance and people receiving safe care and treatment. 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.

Why we inspected

We received concerns in relation to the management of medicines and people receiving poor care. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only.

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.

We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this report.

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

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.

Brockfield House is a residential care home providing personal and nursing care to up to 45 people aged 65 and over. At the time of our inspection there were 35 people using the service.

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

Medicines were not always safely managed. People were at increased risk due to a lack of understanding around the management of their known health conditions.

Risks to people were not always safely managed. People were left at increased risk due to inconsistent information around personal emergency evacuation plans (PEEPs). People were also at increased risk of legionella and scalding due to a lack of maintenance in these areas.

The provider had quality control systems in place, however they were not effective as records were not correct and audits had not always identified errors in records. The provider did not always learn lessons when things went wrong; where audits had identified errors, action plans had not resulted in improvements.

There were enough skilled and experienced staff to meet people’s needs. Staff were adequately trained and had regular competency checks. Staff told us that they felt supported by the management team.

Care records were person-centred and contained sufficient information about people’s preferences, specific routines, their life history and interests.

People and their representatives were involved in the planning of their care and given opportunities to feedback on the service they received. People’s views were acted upon.

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.

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

Why we inspected

The inspection was prompted in part due to concerns received about moving and handling practices and unexplained injuries. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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 requires improvement. 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 Brockfield 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 two breaches in relation to the management of medicines and the accuracy and oversight of records at this inspection. We also found that when the provider identified that improvements were needed, action plans were created but improvements were not always made as a result.

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.

At the last Care Quality Commission (CQC) inspection in October 2015, the service was rated Good in all domains and overall with Requires Improvement in Well-led because the service did not have a registered manager. Since that inspection a registered manager had been appointed and we have rated Well-led as Good.

Brockfield House is a residential nursing home for up to 45 people older people some of who are living with dementia or have issues with mental health. It is located in Stanwick, a village near Wellingborough. Accommodation is on two floors. There are four communal lounges and a dining area. People have access to an enclosed courtyard garden. At the time of our inspection 43 people were using the service.

The service was managed by a registered manager. 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. The registered manager understood the responsibilities associated with their registration.

Staff understood and put into practice the provider’s procedures for safeguarding people from abuse and avoidable harm. Only staff that were assessed as suited to work at the service were recruited. There were enough suitably skilled staff to meet the needs of people using the service.

Suitably trained staff supported people to take their medicines. The management of medicines including administration, storage and recording were safe.

People using the service were supported by staff who had received relevant and appropriate training. Staff were supported through effective supervision and training. Staff understood the relevance to their work of the Mental Capacity Act 2005. They sought people’s consent before they provided care and support. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible: the policies and systems in the service support this practice.

Staff understood people’s dietary requirements and supported people to eat a balanced diet and promote healthy eating. Where required, people’s food and fluid intake was recorded and monitored. People were supported to access the relevant health services when they needed to.

We saw several interactions between people and staff and it was evident that staff were considerate and caring. People were able to participate in a variety of meaningful activities that reflected their hobbies and interests. People received care that reflected their preferences.

People were involved as far as they could be in the assessments of their needs and in regular reviews of their plan of care. They were provided with information about their care and support options and were involved as far as they could be in decisions about their care and support. Relatives told us they felt involved.

Staff respected people’s privacy and dignity.

People knew how to raise concerns if they had any. The provider acted on concerns people had raised.

Social activities helped people at Brockfield House become an integral part of the local village community.

There were effective procedures for monitoring and assessing the quality of service that promoted continuous improvement.

Further information is in the detailed findings below.

We spoke to family members and they told us, 'The home is very clean and X is well cared for.'

Another person said, 'The staff are very pleasant and seem to cope extremely well.'

However, we were also told of some concerns via the Care Quality Commission website. One person told us they were worried about care provided to their friend, and 'they were not being treated with dignity.'

We looked at how staff were supported and training needs assessed and delivered. The staff we spoke with told us that they enjoyed their work, they told us, 'It is very busy, but I love what I do.'

Finally, we reviewed how the home dealt with information and records of the people who lived at the home and of the staff members. We found that the Provider had clear policies and procedures dealing with information management. However, we did see that storage arrangements for care plans for the people who lived in the home should be reviewed to ensure they were always stored securely and the Manager agreed to address this immediately.

Family members who visited their relatives at the home told us they were happy with the care and support provided.

One relative told us, 'The staff are brilliant with X.'

Another family member told us, 'The staff are pleasant and always smiling.'