Brook House Residential Home

We found the following examples of good practice:

The registered manager had made a decision to change their visiting policy to stop all but essential visits to people. This was in response to rising COVID-19 infection levels and cases of a variant of concern in the local area. The registered manager explained that this concern and the vulnerability of the people using the service had led them to making this decision.

However, this decision had been made in consultation with people, their relatives, the local authority and public health teams. Risk and capacity assessments were put in place for people. Relatives were able to discuss any circumstance where they wished to see people inside the home and the registered manager supported them to do this in spite of the change to visiting policy. We were assured that this decision had been made in people's best interest.

Staff were trained and confident in infection control practices and the use of personal protective equipment (PPE). Staff spoke positively about how well supported they had been working at the service. People and staff took part in regular COVID-19 testing and had been supported to take part in the COVID-19 vaccination program.

The service was clean and well ventilated. Cleaning schedules and audits had been updated in response to the COVID-19 pandemic. Audits were used to identify where any improvements could be made.

People were supported to see their family and friends for outside visits as well as virtually using media devices and a large virtual activity board.

The registered manager completed risk assessments for people and the staff team regarding COVID-19 to help mitigate risk and keep them safe.

Brook House Residential Home is a residential care home for up to 20 people. At the time of this inspection 17 people were using the service who had a range of needs including dementia. Short term (respite) care was also provided and two people were receiving respite care.

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

The service did not always follow the correct legal decision-making processes for people lacking capacity to make their own decisions about key areas, such as refusing medicines or sharing bedrooms. We also found some environmental challenges for people, such as those living with dementia or those at risk of falling.

Despite this, staff understood how to keep people safe and protect them from harm and abuse. Risks to people were managed, to ensure their safety and protect them from harm and they were protected by the prevention and control of infection. There were enough staff to meet people’s needs and checks were undertaken to make sure new staff were suitable to work at the service.

Staff had the right skills and training to carry out their roles. They were caring and treated people with kindness, respecting their privacy and dignity too. People were supported to have maximum choice and control of their lives in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were supported to stay healthy. Staff ensured they had a choice of food and had enough to eat and drink. They also helped people to access healthcare services when they needed to and supported their social needs through a variety of arrangements and activities.

There was strong leadership at the service who regularly sought feedback from people, relatives and staff, to improve the service. Since the last inspection the provider had made several changes to improve people’s experience. This included a new electronic care planning system and making changes to the environment to promote people’s safety and well-being.

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 Good (published 14 August 2017).

During this inspection we have found evidence that the provider needs to make improvements. Please see the effective and well-led sections of this full report.

We found no evidence during this inspection that people were at risk of harm from our findings. However, the overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection. This is the fourth time since 2015 that the service has been rated Requires Improvement, although not all following consecutive inspections.

The provider confirmed soon after this inspection they had already acted, or had plans to address, the issues identified for improvement.

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

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.

Brook House Residential Home provides a service for up to 20 older people who may also be living with dementia. The registered manager reported this to be more than 80% of the 19 people living in the home on the day of the inspection. Respite care is provided at the service, but there was no one receiving respite care on the day of this inspection.

A registered manager was 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 2008 and associated Regulations about how the service is run.

Staff had been trained to recognise signs of potential abuse and keep people safe. People felt safe living at the service and staff were confident about reporting any concerns they might have. Processes were in place to manage identifiable risks within the service to ensure people were supported safely and did not have their freedom unnecessarily restricted.

There were sufficient numbers of suitable staff to keep people safe and meet their needs. People had their needs met in a timely way and staff provided care and support in a patient and unhurried way.

Checks were being carried out on new staff to make sure they were suitable and safe to work at the service.

People received their medicines when they needed them and in a safe way.

Staff received the right training to ensure they had the necessary skills and knowledge to meet people’s needs.

Systems were in place to ensure the service worked to the Mental Capacity Act 2005 key principles, which state that a person's capacity should always be assumed, and assessments of capacity must be undertaken where it is believed that a person cannot make decisions about their own care and support.

People had a choice of food, and had enough to eat and drink. Assistance was provided to those who needed help with eating and drinking, in a discreet and helpful manner.

The service worked with external healthcare professionals, to ensure effective arrangements were in place to meet people’s healthcare needs.

Staff provided care and support in a caring and meaningful way. People were supported to have choice and control of their lives as far as possible, and were treated with kindness and compassion. Staff respected their privacy and dignity at all times.

People were given opportunities to participate in meaningful activities.

Arrangements were in place for people to raise any concerns or complaints they might have about the service. These were used by the service as an opportunity for learning and improvement. We saw that people and relatives were given regular opportunities to express their views on the service they received and to be actively involved in making decisions about their care and support.

The management team provided effective leadership at the service, and promoted a positive culture that was open and transparent.

Systems were in place to monitor the quality of the service provided and drive continuous improvement.

Brook House Residential Home provides a service for up to 20 older people who may also be living with dementia. There were 19 people living at the service on the day of the inspection.

We carried out an unannounced comprehensive inspection of this service on 23 June 2016 and found that three legal requirements had been breached. We found that recruitment procedures to ensure staff working in the service had legally required checks in place before they were employed, were not adequate. We also found the arrangements for obtaining consent from people, prior to providing care and support, needed to improve, as did the arrangements to monitor the quality of service, in order to drive continuous improvement.

After the inspection the registered manager submitted an action plan which outlined the improvements they planned to make to address these areas.

We carried out this inspection to check the progress with the improvements detailed in the action plan. This report only covers our findings in relation to these areas. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Brook House’ on our website at www.cqc.org.uk.

During this inspection, we found improvements had been made in all three areas.

A registered manager was 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 2008 and associated Regulations.

Improvements had been made in regard to staff recruitment checks; to ensure all staff working at the service were safe to do so.

Action had been taken to strengthen the arrangements in place to ensure people’s consent to care and treatment is always sought in line with legislation and guidance. Staff supported people to make their own day to day decisions as far as possible, such as what to eat and where to sit. Steps had also been taken to demonstrate that decisions made on behalf of people who lacked capacity, were in their best interests.

The arrangements for monitoring the quality of the service provided had also been strengthened; to mitigate identified risks to people and ensure their health and wellbeing. We saw that a number of new checks had been introduced to improve the management and oversight of the service.

Although we found that improvements had been made during this inspection, more time was needed to fully implement and embed some of changes that had been introduced. We have therefore not changed the overall rating for the service on this occasion, because to do this would require consistent good practice over a sustained period of time. We plan to check these areas again during our next planned comprehensive inspection.

Brook House Residential Home provides a service for up to 20 older people who may also be living with dementia. The registered manager reported this to be more than 75% of the 19 people living in the home on the day of the inspection.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

We found that improvements were needed to ensure people were safe. This included the processes to check staff were suitable to work at the home, and the way in which identified risks to people were being managed.

There were sufficient numbers of suitable staff planned. However, due to staff sickness, there were times when staffing levels were insufficient to meet the needs of people on the day of the inspection. We also found that further work was required to ensure all staff working at the service had the right skills and training to meet people’s needs.

The service worked to the Mental Capacity Act 2005 key principles however, improvements were needed to gain people’s consent to the care and support provided to them. In addition, we found that people’s privacy and dignity was not always adequately respected and promoted.

People were supported to have sufficient to eat and drink, but some improvements were needed to ensure their individual food and drink preferences were taken into account and followed.

People received personalised care that was responsive to their needs. However, some care records needed reviewing; to ensure the care recorded met each person’s current needs and also reflected their involvement in the assessment and planning of their care.

The arrangements in place to monitor the quality of service, in order to drive continuous improvement, were not adequate.

People felt safe living at the service. Staff had been trained to recognise signs of potential abuse and keep people safe.

Systems were in place to ensure people’s medicines were managed in a safe way and that they got their medication when they needed it. They were also supported to maintain good health and have access to relevant healthcare services.

Staff were motivated and provided care and support in a caring and meaningful way. People were also given opportunities to participate in meaningful activities.

There was a registered manager in post who provided effective leadership at the service, and promoted a positive culture that was open and transparent. Systems were in place to enable people to raise concerns or make a complaint, if they needed to.

You can see what action we told the provider to take at the back of the full version of the report.

We found that staff respected people's capacity to consent to their care and where formal arrangements had been made these were recorded. Care plans were written using phrases such as "I would prefer..." or "I usually like..." this approach to recording people's needs meant that the plan reflected people's needs in an individualised way.

We looked at the medication system in place and the audits carried out by staff at the home. We found the system was robust and staff were able to tell us how it operated, including the ordering process. Staff who administered medication received training to enable them to do this safely.

Many of the staff had been at Brook House for several years and told us they were happy in the work they did. New staff we spoke with informed us that they were provided with induction and on-going training to work at the service.

We saw that Brook House had received a number of compliments about the care, with people sending thank you cards. We look at a selection of these and noted that relatives had written "Thank you for taking so much care of (person's name)", "Thanks to you and your lovely staff." The complaints procedure was displayed; at the time we inspected there were no complaints under investigation.

We saw care and treatment was planned and delivered in a way that was intended to ensure peoples' safety and welfare. Work was underway to redevelop the care plan documentation and where appropriate mental capacity assessments. We were told that all of the food was home cooked each day and locally produced fresh produce was used along with vegetables and fruit that were home grown in the care home's garden.

We saw the results of a feedback questionnaire which had recently been carried out with relatives and healthcare professionals. The manager told us that she had just completed the analysis of these. We saw that feedback was very positive about the care delivered and the actions of staff.