Brockenhurst

Brockenhurst is a care home registered to provide accommodation for up to 38 people with various health conditions, including dementia and sensory impairment. There were 35 people living at the service on the day of our inspection. Brockenhurst is a converted care home located in Littlehampton, West Sussex.

People’s experience of using this service:

People were happy with the care they received, felt relaxed with staff and told us they were treated with kindness. They said they felt safe, were well supported and there were sufficient staff to care for them.

Our own observations supported this, and we saw friendly relationships had developed between people and staff. A relative told us, “Many of the staff have worked there a long time, they know [my relative] very well. I couldn’t say a bad word about them.”

People told us their choices and needs were met. They enjoyed the food, drink and activities that took place daily. People thought the service was well managed and they enjoyed living there. A relative told us, “I think the home is very well managed. [My relative] has been nothing but happy there.”

Staff had received training considered essential by the provider. It was clear from observing the care delivered and the feedback people and staff gave us, that they knew the best way to care for people in line with their needs and preferences. A member of staff told us, “We’re always having training, it’s always available.”

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.

The provider had systems of quality assurance to measure and monitor the standard of the service and drive improvement. These systems also supported people to stay safe by assessing and mitigating risks, ensuring that people were cared for in a person-centred way and that the provider learned from any mistakes. Our own observations and the feedback we received supported this. People received high quality care that met their needs and improved their wellbeing from dedicated and enthusiastic staff. A member of staff said, “It’s like we’re one big family, I enjoy coming to work.”

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

Rating at last inspection: Requires Improvement (report published 30 September 2019).

Why we inspected: This was a planned inspection based on the previous rating.

Follow up: We will continue to monitor the intelligence we receive about this home and plan to inspect in line with our re-inspection schedule for those services rated Good. If we receive any concerning information we may inspect sooner.

Brockenhurst is a care home. Brockenhurst accommodates up to 38 people in one adapted building. Brockenhurst provides accommodation, personal care and support to older people, some of whom may be living with dementia. At the time of our visit 38 people were living at the service.

Accommodation was provided over three floors. There were communal areas, including an activity lounge and quiet lounge and two dining rooms. Ten people shared double occupancy rooms. People had access to gardens at the rear of the home.

People’s experience of using this service:

People’s dignity was not always upheld. We observed that staff were not consistent in treating people with patience and compassion. Staff used disrespectful terms to describe people’s needs. We told the provider about this and they started to make changes after the inspection. Further time was required to ensure that the improvements could be implemented and sustained. This is to ensure that people were consistently cared for with patience, dignity and respect.

People were not supported by premises that were adapted to meet their needs, we told the provider and they made some improvements to the environment for people.

Staff rotas showed that there were enough staff to meet people’s needs, but we observed that there were not enough staff to support people to receive their meals at lunchtime. The provider agreed to investigate and address this.

People told us they felt safe and relatives agreed with this. Risks to people were assessed, but risks were not always managed in accordance with the person’s care plan.

The provider did not have a clear process of recording incidents and records showed that staff were not clear about when an accident or incident needs to be recorded. Despite this we did not find that people were unsafe due to this. We told the provider about this and they implemented a falls recording system and booked reporting and recording training.

People and relatives gave mixed feedback about staff. Ensuring that staff practice was consistent was an area of improvement. Despite this, records showed that staff received mandatory training and were supported to gain qualifications in health and social care. Staff knew how to keep people safe in an emergency, such as a fire.

The provider did not maintain records for people’s Deprivation of Liberty Safeguards (DoLS). We told the provider about this and they took immediate action to improve this area.

People told us they receive their medicines on time and medicines were managed and stored safely.

Records showed people had input from a range of health and social care professionals. External health professionals gave us positive feedback about how the home was run.

Relatives told us they were made welcome to visit when they wished.

People were supported at the end of their life to have a comfortable and pain free death. Health professionals and relatives gave us positive feedback about how staff had supported people at the end of their lives.

The service met the characteristics of Requires Improvement in all areas.

More information is in the ‘Detailed Findings’ below.

Rating at last inspection and update: The last rating was Requires Improvement (published 24 May 2018). The service remains Requires Improvement, this is the third time in succession we have given this rating.

Why we inspected: This was a planned inspection based on the previous rating.

Follow up: We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

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

Brockenhurst is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home provides accommodation, for up to 38 older people, who are living with dementia and who require support with their personal care needs. On the day of our inspection there were 37 people living at the home. The home is a large property situated in Littlehampton, West Sussex. There are five dual occupancy rooms, where two people share a room and the remaining bedrooms are single occupancy. It has three communal lounges, two dining rooms and a garden. There is a passenger lift so people can access the first and second floors.

The home was the only home owned by the provider, who was also the registered manager. The management team consisted of a registered manager and team leaders as well as an administrative person with a management role. A registered manager is a '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 home is run.

At the last inspection of 17 October 2016 we rated the service as Requires Improvement and served six requirement notices. We asked the provider to complete an improvement plan to show how these requirements would be addressed. The provider submitted an action plan detailing how the requirement notices would be met. We have summarised the requirement notices served following the previous inspection along with of our findings at this inspection:

• The provider had not ensured the risks to service users were adequately assessed and action taken to mitigate the risks. At this inspection we found action had been taken to address this and care records showed risks to people were assessed and details recorded of action staff needed to take to mitigate the risks. At this inspection we found improvements had been made in this area and this regulation was now met.

• The provider had not ensured medicines were safely managed. At this inspection we found the provider had taken action to meet this and medicines were safely managed although we noted there was a lack of clear guidance recorded for one person who had pain relief on an ‘as required’ basis. At this inspection we found improvements had been made in this area and this regulation was now met.

• The provider had not ensured staff were trained and supervised in their work including a lack of proper induction. At this inspection we found improvements had been made in this area and staff had access to a range of training and an induction for newly appointed staff as well as supervision. At this inspection we found improvements had been made in this area and this regulation was now met.

• The provider had not ensured people were supported to have a positive dining experience and that action was not always taken to monitor those at risk of losing weight. At this inspection we found improvements had been made in this area. People’s weight was monitored and nutritional assessments carried out. People were supported to eat and drink and said they liked the food. We did identify one person who had been assessed as having difficulty chewing and had their meals pureed to assist but this had not been referred for specialist assessment regarding this. At this inspection we found improvements had been made in this area and this regulation was now met.

• The provider had not ensured the requirements of the Mental Capacity Act 2005 (MCA) were being followed. This included a lack of a ‘best interests’ meeting where one person had medicines covertly administered and a lack of documentation where people had a Power of Attorney appointed to make decisions on their behalf. At this inspection we found improvements had been made in this area and this regulation was now met.

• The provider had not ensured people’s care needs were reviewed and updated on a regular basis. At this inspection we found action had been taken to address this and people’s care needs were reviewed and updated. We also found at the last inspection that people did not access to meaningful activities and were sometimes socially isolated. At this inspection we found improvements had been made in this area and this regulation was now met.

• The provider had not ensured there was an effective system for assessing, monitoring and improving the quality and safety of the services provided, as well as, the maintenance of records. Whilst we found improvement had been made in this area we found sufficient action had not been taken to ensure adequate health and safety of the premises and people. The provider remains in breach of this regulation.

The inspection team were concerned about the registered manager’s way of talking to people which did not acknowledge people’s privacy or dignity. Toilets did not have privacy locks on them which people could use and which would allow staff access them in an emergency.

We noted areas of health and safety in the home needed attention. Whilst we noted people had risk assessments these did not include risks to people hitting their head on a beam in two top floor bedrooms. There was also a lack of a risk assessment for people who had access to stairs from the top floor. The provider was not following guidance on checking equipment as set out in the Health and Safety Executive (HSE) publications Health and Safety in Care Homes and Maintaining Portable Electrical Equipment. We also found the provider was not following HSE guidance regarding the management of risks of legionella. We have made a recommendation about this.

The inspection team found the premises were easy to get disorientated in and there was a lack of signage so people living with dementia could orient themselves and find their way around. We have made a recommendation regarding making the environment more suitable for those people living with dementia.

We have rated the service as Requires Improvement and this is the second time in succession we have given this rating.

People and their relatives said the staff ensured people were safe. Staff had a good awareness of safeguarding procedures and were committed to protecting people in their care.

Sufficient numbers of staff were provided. Health care professionals Checks were carried out when new staff were recruited but we noted Disclosure and Barring Service (DBS) were not always carried out prior to staff starting work; this was rectified during the course of the inspection.

The home was clean and hygienic as well as being free from any offensive odours.

People’s health care needs were assessed and met. Health care professionals said staff worked well with them to meet needs such as diabetes and those whose mental health needs were considered to be challenging. Community mental health care professionals said the staff team had been successful in meeting the needs of people with complex needs which had positive results for people’s mental well-being.

Staff were kind and compassionate and responded to reassure people who were distressed. Staff demonstrated they were positive in their attitude to people with mental health needs including those living with dementia. Care plans were personalised and staff knew the importance of treating people as individuals. People and their relatives said they were treated well by the staff.

People and their relatives said they knew what to do if they needed to raise a complaint and said any issues or concerns were promptly dealt with.

Health care professionals and relatives described the service as well led. Staff described an open culture where they could discuss issues and concerns. People, relatives and health and social care professionals were able to give their views on the service as part of a quality assurance system. The staff and registered manager worked well with other agencies to meet people’s needs. There was a system of audit checks on a number of areas of the service provision so that any trends or need for changes could be identified.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

Brockenhurst is a residential care home providing accommodation, for up to 38 older people, who are living with dementia and who require support with their personal care needs. On the day of our inspection there were 38 people living at the home. The home is a large property situated in Littlehampton, West Sussex, there are five dual occupancy rooms, where two people share a room, other rooms are single occupancy. It has three communal lounges, two dining rooms and a garden.

The home was the only home owned by the provider, who was also the registered manager. The management team consisted of a registered manager and team leaders. A registered manager is a ‘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 home is run.

Risk assessments related to some people’s needs were in place to ensure that people were provided with safe care. However, not all risks, specific to people’s needs had been considered. For example, people were unable to use call bells due to their cognitive abilities, this had not been identified or assessed as a risk and consideration had not been taken to ensure that people could call for assistance if needed.

People had access to medicines and records showed that these were administered on time. However, there were concerns regarding the administering of medicines. For example, medicines were not dispensed using a non-touch method and this increased the potential risk of cross contamination. The administration and recording of medicines and the management of risk to people’s safety were areas of concern.

People were supported by staff that had the relevant experience to meet their needs. However, there were concerns regarding the lack of formal training and support that staff received. Observations of staff’s practice and of records raised further concerns about the amount of training and support staff had been provided with. The lack of formal training and support provided to staff were areas of concern.

People were asked their consent before being assisted and there were measures in place to ensure that people’s relatives' had been involved in decisions about people’s care needs. However, practice and the lack of records confirmed that here was a lack of understanding in relation to the practical application of mental capacity assessments (MCA) and the deprivation of liberty safeguards (DoLS) and some decisions were made by people who were legally unable to make decisions on people’s behalves. The lack of understanding and practical implementation of the MCA and DoLS were areas of concern.

People appeared to enjoy the food that was provided. One relative told us, “X seems happy with the food here. They enjoy it.” However, there were concerns regarding some people’s dining experience and some people’s access, particularly those that spent time in their rooms, to food and drink. Appropriate measures for a person that had lost weight had not always been taken. The experience of people when having their meals and the lack of action taken in relation to a person whose weight had decreased were areas of concern.

Care records provided details about the person’s care needs, however these did not always contain sufficient information to provide staff with appropriate guidance to suitably meet people’s individual needs. Some people, who spent time in their rooms, were at risk of social isolation and there was not sufficient stimulation or meaningful activities to engage people and occupy their time. The lack of information in people’s care reviews and the lack of meaningful activities were areas of concern.

People, relatives’, staff and visiting healthcare professionals’ were complimentary about the leadership, management and culture of the home, they found the manager professional, caring and approachable. Comments within a feedback leaflet completed by a relative stated, ‘The home has a homely feel’. However, there was a lack of effective record keeping and robust quality assurance processes to enable the registered manager to have appropriate oversight of the systems and processes used within the home and to ensure people were receiving the care they had a right to expect. These were areas of concern.

People were treated with dignity and respect and their privacy was maintained. There were sufficient numbers of staff to ensure that people’s care needs were met. Staff had an understanding of safeguarding and people told us that they felt safe. People had access to external healthcare professionals when they were unwell and relatives’ confirmed that they felt confident that people would receive the support if needed. Comments from a relative, on an online care home survey stated, ‘My relative’s care is always excellent and I know the staff will contact me when needed’. People were cared for by staff that were kind and caring and who knew them well. One person told us, “They’re so lovely, so kind to me”. Minor complaints that had been received had been dealt with according to the provider’s policy.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the registered manager to take at the back of the full version of the report.

Is the service Safe? Effective? Caring? Responsive? and Well-led?

Below is a summary of what we found. The summary describes what relatives of people using the service and members of staff told us, what we observed and what we learnt from the records we looked at. We talked with three of the staff, a deputy manager, the registered manager (provider) and a consultant who works with the service. Records we looked at included three care records, staff training records, management audits and the service's quality assurance documentation.

If you want to see the evidence that supports our summary, please read the full report.

Is the service safe?

All staff were up to date with training about safeguarding vulnerable people. They were given a handbook specifically about their safeguarding responsibilities. Staff we spoke with had a clear understanding of what constituted abuse and how to refer any concerns as safeguarding or whistle blowing issues.

Care plans included strategies for identifying and minimising behaviours that could cause people distress or difficulty to themselves or others.

Is the service effective?

Care plans included a standard range of assessments giving baseline scores. They were reviewed periodically, which enabled planning to meet people's care needs and reduce identified risks. Staff we spoke with said the care plans guided the care and support people received. Staff knew how to access information. They received a handover of updating information each time they started work, with additional information if they had been away from the home for a significant period, such as a holiday.

Records showed staff were observant of changes in health and wellbeing. Health professionals were contacted in a timely way, as necessary. The home used body maps to show clearly where any mark or injury was observed but these were not being used to track progress of treatment.

A person with a relative who lived in the home told us they were informed about care plan reviews, invited to take part and informed of outcomes. They were informed about, and asked their opinions on, any health changes. Review records showed changed needs were identified and responded to. For example, a person's declining mobility had been addressed by provision of additional equipment and staff training.

Is the service caring?

We observed attentive, meaningful and friendly interactions between staff and people in the home. Staff explained care intentions to people and allowed time for responses. Staff told us there were always enough staff to meet people's needs. A person who lived in the home told us 'They like to know we are happy.' Another said 'The staff are very kind, they spend time with us.' A visitor told us they always saw staff smiling, talking and using non-verbal communication with people.

People we spoke with, who lived in the home, said they got up when they pleased in the mornings and went to bed at times that suited them. One said 'There's nothing you have to do, you do what you like.' We saw people were invited and encouraged to join in activities, but there was no pressure to do so if they declined. We saw a person being supported to eat their lunch. The staff member continually checked the amount of direct assistance the person wanted, whilst allowing independence of action.

Is the service responsive?

Staff were supported in delivering care by an organised training programme, which included dementia awareness. All but one of the staff had achieved or were working towards diploma qualifications.

The provider spent considerable time in the home. They had close working relationships with staff and engaged routinely with visiting relatives. This meant they were available to observe or be alerted to any shortfalls and to address them. An annual survey of people's relatives, staff and visiting professionals provided extra feedback to the provider on people's views of the quality of the service. A staff member told us 'The manager is very open and welcomes observations.' Complaints were recorded and addressed.

Management and staff told us of changes they had made to staffing at lunch times, following our observation at our previous inspection that some people were insufficiently supported.

Is the service well-led?

The provider is also the manager of the home. They used a consultant to assist with monitoring the quality of service and maintaining up to date knowledge of developments in the care industry. We met the consultant and found they had a detailed knowledge of the service. The two deputy managers were also involved in developmental work. The provider had arrangements in place for business continuity in the event of a contingency situation arising.

Staff meetings covered care and operational issues. Staff we spoke with said they felt management listened to their views and kept them well informed of developments and plans. They expressed a strong identity as a team working together to meet the needs of people who lived in the home.

We gathered information from a variety of sources. These included talking with five people who lived at the home and four relatives. We also spoke with the manager and four members of staff. We left comment cards for people to complete if they wished to inform us of their views on the home, 15 were returned. These were from relatives, friends and visiting healthcare professionals.

Everyone told us that they were happy with the care and support they received. One person said, 'I think it is wonderful here, they look after me so well and the food is very good'. Another told us, 'The girls are kind to me'. Relatives were very positive about the home. One said, 'I can sum it up in one word; fantastic!' Some of the feedback on comment cards that we received included, 'The care given to my wife is first class' and, 'I cannot fault the care, I felt there was a real compassionate attitude here'.

Staff were enthusiastic about working in the home. One told us, 'I love it here'. Another said, 'If it was my Mum or Dad I could sleep in peace if they were here'. One relative told us, 'Mrs Matthews and her staff are the best you can get'.

People told us that they were happy with the support they received from the home to access healthcare professionals.

The provider had a system to assess and monitor the quality of dementia care that people received. This included seeking the views of people who used the service or their representatives and acting upon their wishes.

We spent 30 minutes watching care and support provided to five people just before lunch. We found that people had positive experiences. The care staff readily engaged with people talking about their families and visitors. They also explained to people what they were going to do after lunch. The care staff on duty knew what support each person needed and they respected their wishes if people wanted to be left on their own.

We spoke with three members of staff who were on duty. We were informed that people had been treated with respect and dignity. We were also informed that people had been encouraged to make choices as far as they were able.

We also spoke with two relatives who were visiting. They confirmed they were very satisfied with the care and support provided. One relative told us, 'This is first class, as far as care homes go.' The other one said, 'There is a massive sense of humanity about the provider and her staff; they really care. There is a clear sense of personal engagement with people.'