All inspections: Brookholme Croft Nursing Home

This inspection was unannounced and took place on the 22 July 2015.

Brookholme Croft Nursing Home provides accommodation, nursing and personal care for up to 45 older adults. This includes care for some people who may be living with dementia or receiving end of life care. At the time of our visit, there were 44 people living in the home, including 22 people receiving nursing care and some people living with dementia. There was a registered manager at this service. 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 our last inspection in March 2014, people were not fully protected from risks associated with unsafe or unsuitable premises. This was a breach of Regulation 15 of the Health and Social Care Act (Regulated Activities) Regulations 2010, which corresponds with Regulation 12, of the Health and Social Care Act (Regulated Activities) Regulations 2014. Following that inspection, the provider told us what action they were going to take to rectify the breach and at this inspection we found that improvements were made.

People said they felt safe in the home and relatives and staff were confident that people received safe care in safe surroundings.

People were protected from the risk of harm and abuse and they were safely supported in a clean and well maintained environment. Arrangements for staff recruitment and deployment and for managing known risks to people’s safety helped to protect people from harm and abuse. People’s medicines were safely managed.

Emergency plans were in place for staff to follow in the event of any forseen emergencies in the home. Fire safety improvements previously required by the local fire authority were completed by the provider in May 2015.

People were happy with and regularly consulted about their care and the meals provided. People’s health and nutritional needs were being met. People were supported to improve and maintain their health in a way that met with their preferences and any instructions and advice from external health professionals when required. The provider’s arrangements helped to make sure that people received care based on recognised practice, which met their needs and was delivered by appropriately trained and supported staff.

People’s consent was sought before they received care and where people lacked capacity to consent to their care and treatment, appropriate authorisation was sought.

People were treated with kindness and compassion by staff that maintained their dignity and privacy and mostly but not always treated people with respect. Staff understood and usually followed the provider’s aims and values for people care to promote their equality, rights, safety and involvement. Related training, support and regular checks of care practice helped to promote this.

People, their relatives and staff were mostly informed and involved in understanding and agreeing people’s care needs. However, they were not always fully informed or involved in relation to people’s end of life care needs, which were otherwise met by kind, compassionate staff, who were appropriately trained and supported.

People received care in a timely manner when they needed assistance from staff who knew them well. Staff understood and supported people’s known daily living preferences, routines and choices and their independence. Further environmental improvements were in progress to help to promote people’s inclusion and independence.

The home was usually well managed and run and people, relatives and staff were confident about this. The provider’s arrangements for consultation and to regularly check the quality and safety of people’s care helped to make sure people received safe and effective care. Staff understood their roles and responsibilities and they were supported to raise any concerns they may have about people’s care.

Records were accurately maintained and securely stored. The provider had usually notified us of important events that happened in the service.

At our visit there were 43 people living at Brookholme Croft, including 23 people who received nursing care. We spoke with some people using the service, their relatives and staff there. We also spoke with the registered provider.

When we inspected Brookholme Croft in November 2013 we found concerns about the provider's systems for ensuring people's protection from the risks of acquiring a health associated infection and cleanliness and hygiene of the home. We also found that people were not protected from the risks of inappropriate or unsafe care and treatment and their views and experiences about their care were not acted on. We served two warning notices on the provider on 12 December 2013 requiring them to be compliant with the relevant regulations by the 14 and 31 January 2014.

At this inspection we found people were consulted about their care and the provider acted in accordance with legal requirements for this when needed. People received care from staff that were effectively recruited and were satisfied with the cleanliness of the home. One person told us, 'The standard of cleanliness is much improved. It's far better and so much tidier and fresher.'

We found the provider had made the required improvements from our warning notices. These ensured people's views were acted on; that they were better protected from risks associated with unsafe care and that they were cared for in a clean and hygienic environment.

At our visit there were 44 living at Brookholme Croft. This included 17 people receiving nursing care. We spoke with three people using the service and two relatives. We found that we were not able to speak with many people because of their medical conditions. We looked at people's care records and their environment; observed how they were supported and spoke to staff about their care.

We found that people experienced care and support that mostly met their needs and protected their rights. One person told us that staff were usually good at offering them pain relief when they needed it and some people's relatives told us they had the opportunity to visit the home before people lived there. Recent records of people's compliments and comments that we saw included, 'Thank you for the person centred care, end of life care and kindness and care of our family to all staff ' a positive experience.'

We last visited Brookholme Croft in May 2013 when we found the provider was failing to meet required standards of quality and safety. At this inspection we found continued failings in how people's consent was being obtained for their care, the prevention and control of infection, the environment and assessing and monitoring the quality and safety of service provision.

At our visit there were 44 people living at the home, including 13 receiving nursing care. We spoke with eight staff and seven people about their care and looked at four people's care records.

People told us they were generally satisfied with their care, support and meals provided. We found people were supported to eat and drink sufficient amounts to meet their needs.

Two people told us, that activities were organised, which they could join in with; another told us about residents meetings that were sometimes held, to consult with them about meals and activities. One person told us, 'I like my own room.' Staff support me and help me when I need them.' Another said 'I usually enjoy my meals.'

We were not able to hold discussions with many people because of their conditions, such as dementia. We observed staff interacting and supporting some of them. With the exception of one person's dementia care needs, we found staff delivered care that was safe and appropriate.

Two people told us the home was not always kept clean, tidy and fresh from odours. We found that risks to people's safety were not always properly managed. We also found people's comments and concerns were not always taken into account to improve the service and that consent was not consistently obtained for people's care

We spoke in depth with three people using the service and/or their families about their experience of the service and had informal conversations with six additional people. We also observed care practice during the lunchtime period. We spoke with the management team, five staff and one visiting professional during the visit. We also spoke with one relative and two visiting professionals by telephone following the visit. We reviewed information received about the service from the Local Authority.

People were generally positive about their experiences using the service. One person told us "Staff work hard" and another told us " I love" the staff. A relative told us "I have no doubt that staff genuinely care".

All the people we spoke with stated the food was good, and although one person said they liked some meals better than others, most told us they enjoyed their meals. One person told us "The food is very good' and confirmed that alternatives were offered to what was on the main menu. They said "There is always a choice". Another person described the portions as plentiful.

Relatives told us they were pleased with the way any concerns were dealt with and that any issues were sorted out satisfactorily.

At our visit people gave us examples of ways the service informed and involved them by way of key written information. These included the home's service guide, information about activities, food menus, arrangements for religious worship and also key procedures. Such as for complaints and what to do in the event of a fire.

All of the above was provided in standard print format, with no alternative provision, such as Braille or audio. People told us there were sometimes inconsistencies in staff approaches to their preferred daily living routines and personal care choices, which were not always upheld.

However, all said that meetings were regularly held with them and also their advocates, providing opportunity to share their experiences about the care and services they received with the manager. They also told us about a satisfaction survey conducted with them by way of a written questionnaire, to ascertain their views.

With the exception of matters referred to above, people we spoke with expressed overall satisfaction with the care and support they received. One person commented, 'Staff are kind, it's a lovely home and the care is usually good.' Another said, 'They made sure from the word go that my meals were done in the right way, which is important because of my condition.'

All confirmed suitable arrangements for their health care needs, including for their medicines. They advised that the home was usually well maintained and clean and that they were satisfied with their own rooms, which they were able to personalise.

Three people told us that staff, were mostly available when they needed them. One person said, 'Staff are kind and helpful,' ' They seem to know what they are doing.'

The same three people said they were confident in raising any concerns or complaints they may have and felt these would be properly dealt with. One person had commented in their satisfaction questionnaire return to the home, 'On occasion that I have raised something ' always listened to and acted on.'

These older reports are from our old approaches to inspection, including those from before CQC was created.

Archived: Brookholme Croft Nursing Home

All Inspections

22 July 2015

During a routine inspection

13 March 2014

During an inspection looking at part of the service

8 November 2013

During a routine inspection

3 May 2013

During a routine inspection

6, 7 November 2012

During a routine inspection

2 April 2012

During a routine inspection

Reports under our old system of regulation