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Inspection carried out on 18 September 2017

During a routine inspection

We carried out our inspection on 18 September 2017. The inspection was unannounced.

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.

Inspection carried out on 15 & 16 October 2015

During an inspection to make sure that the improvements required had been made

This unannounced inspection took place on 15 & 16 October 2015. Brockfield House provides support and nursing care for up to 45 people living with dementia or a mental illness. At the time of our inspection 34 people were living at the home.

Following our inspection in April 2015 the service was rated as ‘Inadequate’ due to serious concerns about the safety and well-being of the people who lived there. The commission placed the service in special measures and the provider agreed not to admit any new people until they had improved the care provided. The provider was also issued with a warning notice to ensure people received safe and proper treatment.

At the time of this inspection we found that there has been significant progress in the way that the home operated and in relation to the way in which care was being provided.

The service is required to have a registered manager. At the time of our inspection there was an appointed manager who was currently managing the home and was undertaking the process to become 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 2008 and associated Regulations about how the service is run.

People told us that they felt safe in the home and there were clear lines of reporting safeguarding concerns to appropriate agencies; staff were knowledgeable about safeguarding adults.

Staff understood the need to protect people from harm and abuse and knew what action they should take if they had any concerns. Staffing levels ensured that people received the support they required at the times they needed. We observed that on the day of our inspection there were sufficient staff on duty. The recruitment practice protected people from being cared for by staff that were unsuitable to work at the home.

Care records contained risk assessments to protect people from identified risks and help to keep them safe. They gave information for staff on the identified risk and informed staff on the measures to take to minimise any risks.

People were supported to take their medicines as prescribed. Records showed that medicines were obtained, stored, administered and disposed of safely. People were supported to maintain good health and had access to healthcare services when needed.

People were actively involved in decision about their care and support needs There were formal systems in place to assess people’s capacity for decision making under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).

Care plans were in place detailing how people wished to be supported and people were involved in making decisions about their care. People participated in a range of activities both in the home and in the community and received the support they needed to help them do this. People were able to choose where they spent their time and what they did.

Staff had good relationships with the people who lived at the home. Complaints were appropriately investigated and action was taken to make improvements to the service when this was found to be necessary. The registered manager was visible and accessible. Staff and people living in the home were confident that issues would be addressed and that any concerns they had would be listened to.

Inspection carried out on 21 and 23 April 2015

During a routine inspection

This unannounced inspection took place on the 21 and 23 April 2015.

Brockfield House provides accommodation for people requiring nursing care. The service can accommodate up to 45 people. At the time of our inspection there were 41 people using the service. The service provides nursing care to people that are living with dementia and enduring mental health and physical conditions.

There was no registered manager in post. The provider had appointed an interim manager to manage the home, while they appointed a new 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 2008 and associated Regulations about how the service is run.

Staff were not always deployed effectively to preserve people’s health or safety. There was a lack of risk assessment and measures in place to mitigate risks to people’s safety. Staff had an inconsistent level of knowledge to ensure safeguarding procedures were adhered to. Medicines were not always given as they were prescribed. There were safe recruitment practices in place to protect people from the risk of unsafe staffing.

People could not always be assured that consent had been obtained in line with legal requirements. There was a system of basic staff training but this did not equip staff to care for people. There were systems to monitor people at risk of not eating and drinking; however these were not applied consistently. The premises were not maintained to an acceptable standard. People did not always receive safe and effective support to access a range of health and welfare services.

The systems for communicating with people and their relative’s needed further work to be effective. People were not always given choices about their care and the arrangements for people’s privacy and dignity and supporting independence required improvement.

The systems for planning people’s care needed developing to show how people and their relatives had been involved. There were some arrangements in place to support people to undertake a range of social activities and pastimes. The provider had a complaints system; however staff were unaware of the need to report complaints and concerns to the interim manager.

The management and monitoring of the service had been unstable and there was a lack of leadership. The systems in place for measuring the quality of the service needed to be re-established to become operational. The arrangements for supporting staff to understand whistle-blowing procedures needed further work.

The provider took a range of actions following our inspection and is working with an external management consultancy company to support the improvement in the home. They have also stopped admissions into the home while improvements are being made.

We identified a number of areas where the provider was in breach of Regulations of the Health and Social Care Act 2008 (regulated activities) Regulations 2014 (Part 3) and you can see at the end to this report the action we have asked them to take.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC.

The purpose of special measures is to:

· Ensure that providers found to be providing inadequate care significantly improve.

· Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

· Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will 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 we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

Inspection carried out on 11 December 2013

During a routine inspection

Our inspection looked at how the people who lived in the home were involved in decisions about their care and welfare at the home. We looked at care plans of the people who lived in the home and talked to the people who lived there or their family members and staff.

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.

Inspection carried out on 8 February 2013

During a routine inspection

As we walked around the home we saw the staff approached their work in a caring and supportive manner. When we spoke with the staff they were able to explain their role to us and understood their responsibilities to ensure people were cared for appropriately and their needs were met.

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.”

Inspection carried out on 23 November 2011

During an inspection in response to concerns

We carried out this inspection visit because we had not visited this service since 24 February 2009.

Many of the residents at Brockfield have dementia and therefore not everyone was able to tell us about their experiences. To help us to understand the experiences of residents we used our SOFI (Short Observational Framework for Inspection) tool. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time, the type of support they get and whether they have positive experiences. Some people using the service were able to tell us about their experiences and we also spoke with visitors to the service.

We saw residents talking and laughing with staff. We saw that staff spoke respectfully to residents and were attentive to their needs. We noticed that although staff were attentive to residents’ needs, conversation was focused more on residents who were able to communicate more easily.

A resident was able to tell us that they received good care and that they did not have any concerns about the way that they were treated by staff at Brockfield.

Reports under our old system of regulation (including those from before CQC was created)