Brockenhurst

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question Inadequate. At this assessment the rating has changed to requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed. The provider was previously in breach of the legal regulation in relation to safe care and treatment. Improvements were found at this assessment, and the provider was no longer in breach of this regulation.

This service scored 56 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The management team had made improvements to the culture of safety and learning.

Records of incidents and accidents were being recorded appropriately. A process of reviewing these incidents to identify trends and patterns had been recently introduced. However, full consistency of practice had not yet been demonstrated. For example, falls had previously not been consistently recorded or reviewed. Staff had now been asked to record all falls, and although leadership had reviewed these and identified some patterns, they required subsequent monthly analysis to confirm those trends or causes. The manager was not currently involved with the monitoring and reviewing which meant that leadership oversight had not yet been established. These processes, together with audit practices, were new, and evidence of consistent application had not yet been established.

The manager, supported by quality assurance professionals, had understood the issues identified at the previous inspection and was acting upon these to drive improvement. Action plans were being followed. Staff understood reporting practices and felt confident about raising safety concerns.

Staff worked with people and healthcare partners to establish and maintain safe systems of care. Since the last inspection, leaders had engaged proactively with external professionals to refer and review people’s needs. For example, Action plans showed a comprehensive engagement with external professionals to review and support continuity of care in relation to falls (falls referrals) and skin integrity (Tissue Viability Nurses).

Leaders and staff worked to implement any guidance resulting from these. One professional said, “Brockenhurst management and senior care staff have always been very engaged with the team and the whole process. The importance of the reviews had been clearly understood. Any recommendations we make have been valued and acted on and suggested actions are followed through.”

Staff worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that.

The management and oversight of incidents had improved and, where appropriate, these had been escalated and referred appropriately to the relevant authorities, in line with safeguarding requirements. People told us they felt safe living at the service. One person said, “Yes, they look after you well.” One relative told us about their loved one, “Yes, she’s safe. There’s no reason to be concerned. They look after her, she’s always OK.

Staff demonstrated an improved understanding of safeguarding and what was needed to ensure people were protected. One staff member said, “Safeguarding is to protect people from harm, whether it’s physical harm or mental harm or abuse, neglect, and obviously knowing how to report it.” Another staff member told us, “If I’m walking around, I always try to see everyone is safe and nothing untoward is happening both to staff and residents. I have not had any incidents.”

People were safeguarded as staff and management worked within the principles of the Mental Capacity Act 2005 (MCA). People were protected when issues around capacity had been identified. Mental capacity assessments had been conducted and recorded to determine whether they had capacity to make specific decisions about their care. Deprivation of Liberty Safeguards (DoLS) applications were completed appropriately and in people’s best interests with minimal restrictions. Where people had a DoLS in place, conditions to their authorisations were being met.

Leadership had prioritised improvements in risk management since the last inspection. Although significant progress had been made, some practices, processes and tools needed to be embedded to ensure that risks were mitigated and monitored safely. These included areas staff recording, use of best practice tools and the escalation of people’s care when their condition deteriorated.

For example, some people required monitoring and support with wound management. One person’s daily notes did not consistently evidence that vulnerable areas were checked and documented each day. Entries often appeared to relate primarily to personal care provided rather than specific skin assessments. People’s assessments of their skin integrity used Waterlow tools to identify whether they were at risk of developing pressure ulcers, although there were no records to show that these were reviewed when for example, changes happen or when a person is readmitted from hospital. Leaders had developed a pressure care and skin integrity tool that included weekly skin check guidance and pictorial examples of skin changes. However, this document remained a work in progress and is not yet been fully embedded into practice.

As part of the inspection, we looked at staff response to, and recognition of, deterioration in people’s health and identifying these to mitigate risks. Improved risk assessments and guidance had improved practice in this area, and leaders had started to introduce NEWS (National Early Warning Score) scoring to identify, track, and respond to physical deterioration in residents. One professional said, “Further progress is still needed, particularly around the earlier recognition of deterioration and the need for escalation. Before (manager) began her managerial role, most concerns about changes in a resident’s condition were escalated directly to the home’s proprietor, who was also the Manager at the time, who would then decide whether further escalation or external support was required. Since taking up her post, I am advised that (the manager) has worked hard to build the team’s confidence in recognising deterioration and in taking appropriate, timely action. This includes encouraging staff to escalate concerns to senior team members or directly to external services such as the GP surgery, community teams, 111, or 999 when necessary. Although I understand that some improvements have been made in both confidence and escalation practices, some staff members continue to rely on previous ways of working.”

Leaders had strengthened the management of risks associated with people’s health conditions by providing clearer guidance and information for staff on how to mitigate these risks. Improvements were implemented in the monitoring and oversight of people at risk of falls, those requiring repositioning to prevent pressure damage, and individuals at risk of choking. These changes enhanced the consistency and safety of care delivered.

The management team had made significant improvements to ensure that facilities and the environment supported the delivery of safe care.

People’s use of the stairs had been reassessed and changes to safety rails had been made, while safety restrictions had been implemented to prevent those at risk of falls from accessing the stairs independently. The maintenance team and management team ensured that necessary checks were regularly completed. For example, fire drills and safety checks were being completed by staff, while gas, and electrical equipment were up to date. Personal evacuation plans had been reviewed and updated following actions from a fire drill. These informed staff of how to support people to evacuate the building in the event of an emergency.

Improvements were still needed to ensure that the environment remained safe. For example, people with dementia were able to safely access the environment of the service. Dementia friendly signage was lacking to support people to orientate around the service. Dementia-friendly signage and environments in care homes are critical for reducing confusion, anxiety, and agitation, enabling residents to maintain independence and dignity.

We identified that locks had not always been installed on communal toilet doors and a shower door was loose and unsecured. These had not been identified by the management teams quality assurance maintenance systems. We brought these to the attention of the leadership and changes had been made when we returned for the second day of the inspection.

Staffing levels did not always ensure people received safe, consistent care.

Staff told us there were occasions when there were not enough care staff on duty, which meant they were required to prioritise tasks and had less time to spend with people. Some staff said they felt rushed and that short‑notice sickness or unfilled shifts placed additional pressure on the team. One staff member said, “Sometimes there is enough staff but there could be more. Sometimes I feel a bit rushed and you don’t always have as much time as you’d like to spend with people.” Another staff member commented, “No, not enough staff. The majority of the time we are short-staffed. When staff call in sick, we don’t always have an extra person on the floor and still have to do what we need to do in a certain amount of time and make sure residents are looked after.” One family member said staffing had been ok, “Up to now, but now they do more and more paperwork. It’s pointless. It should be about the care, not paperwork. It’s taking over.” Leaders had begun using agency staff to improve consistency, and regular agency staff were now in place to reduce disruption to people’s care.

The management team had taken steps with the arrangement of the environment to consolidate staffing, although the deployment of staff remained inconsistent. Observations of care on the first floor showed limited staff presence outside of task‑based care, leaving some people without stimulation or meaningful engagement. Staff reported that support was sometimes harder to access as leaders were balancing multiple operational demands. Leaders informed us they were taking steps to support people on the first floor access the communal areas to improve this.

Training provision had improved, with staff receiving further training on supporting people living with dementia. Observations showed that this learning was not yet consistently embedded in practice. Staff did not always demonstrate an understanding of how dementia can affect people’s communication, behaviour and decision‑making, and some interactions reflected a task‑focused rather than person‑centred approach.

Staff did not always receive consistent supervisions to carry out their roles safely and effectively. While many staff said they received supervision, some staff could not recall having recent supervisions, and one member of staff had not received any supervision since returning from leave. Records continued to show an inconsistency in staff receipt of formal support. This limited opportunities for reflective practice and oversight of staff competence.

The management team had begun planning improvements and changes to the induction and competency processes. Leaders had recognised existing induction documents were limited and had started developing more detailed processes for agency staff. A competency tool for moving and handling was also being introduced, although these systems were still at an early stage and not yet embedded.

Despite pressures, many staff described positive teamwork and support from colleagues and told us they valued recent leadership changes. However, staffing arrangements and skill mix were not yet sufficiently robust to ensure consistently safe and effective care.

Staff were consistently recruited through an effective recruitment process that ensured they were safe to work with people. Appropriate checks had been completed prior to staff starting work which included checks through the Disclosure and Barring Service (DBS). DBS checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions.

The management team had not always assessed and managed the risk of infection.

During the assessment we observed the condition of one communal toilet to be poor, with rust and leakage stains. We also observed that nylon net shower sponges were being used communally. These are generally considered poor for Infection Prevention and Control (IPC) due to their high susceptibility to bacteria. These issues had not been identified by the management team’s quality assurance processes for infection control or actioned. We brought this to the attention of the leadership who acted to address these risks.

Staff understood the importance of good infection control practices and were observed following guidance on hand hygiene, personal protective equipment (PPE), and safe food handling. Staff had access to PPE. One staff member said, “We sanitise, clean, the night staff do a lot of the cleaning whilst residents are in bed, door handles. Throughout the day, if we’re doing someone’s bedroom, once their washed and dressed, we clean the room and we have cleaning equipment outside.” People reported that they felt the service was clean.

The management team did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. The management team had made improvements in the management and administration of people’s medicines since the last inspection.

Processes to ensure appropriate medicines were in place were not always robust. For example, we identified creams and solution within the first aid boxes that were out of date, while not all creams had been labelled with an opening date. Although risk to people was low, there was a potential that these would lose their potency, potentially become contaminated. There was an inconsistency in staffs understanding of the process to dispose of unused medicines. We brought this to the attention of the leadership and effective changes were made to make the process consistent.

We observed a series of medicines being administered which was completed safely and effectively. People spoke positively about the administration of their medicines. Medicines were stored correctly. Medication administration records showed that people received their medicines as prescribed, and these records were completed accurately. PRN protocols were in place for medicines which were prescribed on a ‘when required’ basis. Staff had received training to administer medicines and their competencies assessed. One medicines professional said, “The importance of optimising the medications has always been appreciated, right from our first visit. Brockenhurst staff embraced and adopted that approach going forwards, and I have found they have been confident to query medication on their weekly GP ward.”