Archived: Brookdale House Care Home

During our inspection we looked at care plans, policies and procedures, training records and staff records. We spoke with three people using the service and one relative. We also spoke with the registered manager, deputy manager and three members of the care staff. This is a summary of what we found.

We considered our inspection findings to answer questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

Is the service safe?

The service was safe. The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLs) which applies to care homes. Policies and procedures were in place and relevant staff had been trained to understand when an application under DoLs should be made, and how to submit one.

Is the service effective?

The service was effective. We looked at two care plans for people who had come to live at the home since our inspection in April 2014. Each care plan demonstrated that the provider had undertaken pre-admission assessments and included information, personal histories, risk assessments, dietary needs, cultural needs and social needs. This enabled the service to reach judgements about whether they could effectively meet people's needs.

Is the service caring?

The service was caring. We observed positive interaction between people who use the service and care workers. For example when care workers were talking with people sat in chairs the care workers 'knelt down' to be at 'eye level' with the person they were talking with. One care worker explained: 'It is respectful to talk to people and to have them engage with us in a way that they are comfortable. Kneeling down and engaging with people at 'eye level' also helps people to understand especially if they have a hearing or visual impairment'.

Is the service responsive?

The service was responsive. Clear and detailed daily care records were completed by care staff to show people had received help and support in accordance with their care plans.

Is the service well led?

The service was well led. Arrangements were in place to deal with foreseeable emergencies. The service maintained a personal emergency evacuation plan for each person and had developed a contingency plan that would ensure that the needs of people using the service would be met in the event of an incident affecting the safe running of the home.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This is a summary of what we found-

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People's care records contained assessments which covered the risks associated with staff providing the care and support they needed. This helped to ensure that people who used the service were safe because staff had taken action to identify and assess the risks to their health and wellbeing. We did however find some examples where robust management plans had not been put in place to manage the risks identified to some people's health and well-being. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

People told us that they felt safe. Safeguarding procedures were in place and staff understood how to safeguard the people they supported. Where people were subject to Deprivation of Liberty Safeguards (DOLs), the provider had taken appropriate steps to act in accordance with legal requirements which ensured that people did not have their freedom restricted unless this was in their best interests.

Is the service effective?

We found that overall improvements had been made to ensure that the service acted in accordance with the requirements of the Mental Capacity Act (MCA) (2005). The provider had a MCA (2005) policy which described the arrangements that would be followed should a person be unable to provide valid consent to their care and treatment. Where people lacked capacity to make decisions about their care, mental capacity assessments were carried out and documented.

Arrangements were in place to undertake pre-admission assessments which enabled the service to reach judgements about whether they could effectively meet people's needs.

People and their relatives told us they received the help and support required.

We found that progress had been made to ensure that staff received training in the Mental Capacity Act (MCA) (2005) and in safeguarding vulnerable adults. Where shortfalls in the provision of some training still existed, the provider had made arrangements for this to be completed by 31 May 2014. Systems were in place to ensure that staff recieved supervision on a regular basis.

Is the service caring?

People were supported by kind and attentive staff. Staff treated people with dignity and respect.

The service had taken action to ensure that care and support was provided in accordance with peoples wishes.

People we spoke with during the inspection were positive about their care. One person told us, 'They [care workers] are all caring and kind'. Another person said, "If all places are like this, they would be doing well'. A relative told us, 'She [their relative] is really happy here, the staff are brilliant with her'.

Is the service responsive?

The service worked well with other providers to ensure that people received co-ordinated care, treatment and support.

People told us that they felt they could raise concerns with the registered manager and that these would be listened and responded to appropriately.

Staff told us that the provider was responsive and supportive to requests for additional training to improve their skills and knowledge.

Is the service well led?

The service had a consistent management structure that maintained oversight of the home and provided leadership to the staff team. One care worker told us, 'The leadership here is strong'. Another care worker told us, 'I can raise whatever I want and they [the registered manager] would listen'.

The registered manager was able to demonstrate a good knowledge of the needs of people who used the service and their care and support needs.

We found that the service had taken action to bring about improvements to the systems for assessing and monitoring of the quality of the service where we had identified non-compliance at the previous inspection. These improvements still needed to be fully embedded in practice and sustained to ensure that the services' quality assurance systems are robust and more tailored to the needs of the service. However, overall improvements had been made to demonstrate that the provider had complied with the compliance action.

People were positive about their care and told us they were treated with dignity and respect. A relative told us that 'when they had come through the door, they knew this was the place to care for their father'. Another relative told us 'it's pretty amazing here'.

However, we found that there were not adequate arrangements in place to make sure that staff acted in accordance with legal requirements where people lacked capacity to consent to their care. Care plans did not provide sufficient detail about the key risks to a person's health and how these should be managed. People were not adequately protected from the risk of abuse as staff were not adequately trained. The arrangements in place for reviewing the DOLS required improvement. Supervision was not always taking place as planned and appropriate training was not always available. We also found that the quality monitoring arrangements were not sufficiently robust.

In this report the name of a registered manager (Susan Hammond) appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time.

We looked at six medicine administration records available in the home, which kept a record of medicines staff had administered to people. These had been fully completed. All medication administration records included a photograph of the person for whom the medication related to.

Appropriate checks were undertaken before staff began work. We looked at five staff files and saw that the necessary checks had been made before people commenced work. We saw that Criminal Records Bureau checks (CRB) had been completed.

Relatives and residents meetings were held every three months and were advertised on the home notice board and in the "Brookdale Buzz', a quarterly newsletter the home provides. A relative of a person using the service told us that if they had any concern or cause for complaint, then they would speak to staff and they were confident their concerns would be dealt with promptly by senior staff.