Archived: Brookfield Nursing Home

Brookfield Nursing Home is located in a residential area of Urmston, close to local amenities and transport links. It provides accommodation and nursing care for up to 21 people in a detached property with a garden area to the rear. There were two lounges, a dining room and a mix of single and shared bedrooms over three floors connected by a passenger lift.

There was a registered manager in post on the day of our inspection. 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.

We found there was a lack of organised activity in the home for people to engage with, and saw people had given this feedback to the provider at a recent residents meeting. The provider acknowledged this was an area in which they needed to improve, and we saw this had been included in the 2016-2017 service plan. .

People felt safe living in the home, and we saw evidence the provider had care plans which identified risks associated with people’s care and support and had put measures in place to ensure people’s safety. People lived in an environment which was safe. There was a programme in place for rolling improvements to the décor of the home, and all maintenance was kept up to date.

The provider ensured people who used the service were cared for by staff whose employment backgrounds had been appropriately checked. Staff files contained copies of employment references and confirmation they were not barred from working with vulnerable people. There were enough staff on duty to meet people’s needs.

We found there was a good understanding of the principles of safeguarding people from abuse. Staff had regular training in this area and knew when and how to report any concerns.

We saw medicines were managed safely. Records were up to date and contained no gaps, and the stocks of medicines matched these records. Some blood glucose monitoring records had not always been kept up to date, and the registered manager took action to rectify this during the inspection.

Staff were supported to be effective in their roles. There was a thorough induction and on-going refresher training in place, and staff had regular opportunities to discuss their performance and any training needs in supervision and appraisal meetings.

The service was working within the principles of the Mental Capacity Act 2005 (MCA). People were offered choices which were respected, and their capacity to make decisions was appropriately recorded. When people lacked capacity to make certain decisions, best interests decisions had been made on their behalf. Where people’s liberty had been restricted to ensure they remained safe, we saw applications for the appropriate Deprivation of Liberty Safeguards had been made to the local authority.

People had access to fresh food which looked appetising, as well as snacks and drinks during the day. Where people needed assistance or a specialised diet this was provided. We found the meal time lacked a sociable atmosphere .

We received good feedback about people’s relationships with staff, and observed good practice throughout the inspection. We saw staff engaged with people in a friendly and appropriately familiar way, and staff were able to tell us ways in which they ensured people’s privacy and dignity were respected.

The provider carried out an assessment of people’s care and support needs before they started using the service, and this information was used to prepare a series of care plans which showed how the care and support was to be delivered. Care plans were kept under regular review to ensure they always reflected people’s up to date care and support needs.

We saw there were systems and process in place to ensure concerns and complaints were addressed, and people said they would know how to raise these. We saw the provider received a large volume of written compliments which expressed people’s appreciation for the good standard of care they or their relatives received.

There was good feedback about the registered manager and provider’s leadership in the home. We saw they were a visible presence who were known to people who used the service, and worked alongside staff in delivering care and support.

There were appropriate systems in place to measure, monitor and improve quality in the service. Staff, people who used the service and relatives had opportunities to attend meetings to discuss the service, and we saw this feedback had been used in preparing the 2016-2017 plan for the service. In addition the registered manager undertook planned audits to further monitor and improve the service.

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-

Is the service safe?

We were given a tour of the building we saw bedrooms and communal areas were clean and tidy and there were no unpleasant odours present. Bedrooms were personalised with photographs and ornaments and the rooms were clean.

There were housekeeping staff on duty each day to maintain cleanliness and hygiene in the home. We saw stocks of personal protective equipment (PPE) such as gloves and aprons were available throughout the building in wall mounted dispensers.

Care plans contained risk assessments in relation to personal emergency evacuation procedures (PEEP) in the event of a fire. Risk assessments were in place in relation to; nutrition, falls and moving and handling.

There was evidence to demonstrate equipment was regularly maintained and serviced to minimise risks.

There were safeguarding and whistleblowing procedures in place. The staff we spoke with were aware of their responsibilities to report poor practice.

Is the service effective?

We saw staff demonstrated a good awareness of people's care and support needs.

We spoke with four people who lived at the home who told us staff were kind and caring. Comments included: 'They look after me well.' 'They are kind.' 'They are all lovely.'

There were forums in place to gain people's views and opinions about the care and support they received. Regular resident meetings were held where topics such as; menus were discussed. In addition people we spoke with told us they saw the manager or provider daily and felt able to voice any concerns views and opinions about the service they received. From our observations it was evident the provider knew people well and had a good rapport with the people they cared for.

Is the service caring?

We looked at a sample of care plans and saw they recorded people's preferences for how their care and support needs should be met. We spent time over the lunch service observing interactions between staff and the people they supported. We saw staff offering people a choice of meal and what they would like to drink.

We saw staff approached people with respect and were patient. Where people needed assistance staff offered support in a sensitive manner. Some people were cared for in bed and although we did not go into people's bedrooms whilst they were eating we could hear the conversations from one bedroom. We heard staff speaking in soft tones explaining what the meal was and encouraging the person to try and eat more.

Staff took time to chat with people whilst they were assisting with care needs. The people we spoke with told us: 'They are wonderful.' 'The girls are lovely.' 'It is nice here.' 'They are kind.' 'I am very happy here.'

Is the service responsive?

There was a questionnaire sent to relatives on an annual basis and any comments were considered and acted upon. Residents meetings were held to gain people's views in addition residents questionnaires were sent out quarterly.

We looked at the most recently completed questionnaires and saw people were complimentary about the care and support they received. Comments included: 'Homely feel.' 'Staff are very kind.' 'Staff turnover does not seem very high.' 'The girls look after me well.' 'Wonderful magnificent women.'

The people we spoke with knew who to speak to if they had any concerns and people felt their concerns would be listened to.

Is the service well led?

The manager was on leave on the day of our inspection. The provider who is a registered nurse (RGN) was working in the home.

There was a system of audits in place that included; infection control; medication, mattresses, accidents and incidents.

Staff were offered support in the form of training, supervision and annual appraisals. In addition the staff we spoke with told us the manager or provider was always available to discuss any concerns or issues.

We looked at the medication records for all 21 people living at Brookfield Nursing Home. We found that improvements had been made since the last inspection. Appropriate arrangements were in place in relation to the recording, handling, storage, disposal and safe administration of medicines. We looked at records for December 2013 and January 2014, the medication administration records (MAR) were in place detailing the medication, dosage and times medication needed to be administered.

We were shown copies of the monthly audit the manager had implemented since our last inspection. We saw the audits looked at supply of medication, storage, administration, records, controlled drugs and disposal. We looked at the last audit carried out and saw detailed notes of action required.

We reviewed the care files held for four people who used the service. We found care plans clearly identified the needs of the person and included information on their wishes and preferences in relation to the support they required.

People we spoke with told us they received appropriate support with their medication. However we found improvements needed to be made to help ensure medicines were always administered safely.

We saw evidence there were appropriate recruitment procedures in place to ensure people who used the service were protected from inappropriate staff.

We found there were effective systems in place for the completion and storage of records relating to the care of people who used the service and the maintenance of the premises.

One person told us 'it's just excellent; food is good, menu excellent, nurses very friendly and very good. They involve me in decisions; if I want to go out they take me. I've nothing in the world to complain about.'

A staff member told us, "I always ask them what they would like, and make sure I give them a choice.'

We observed people being assisted with hoists. Staff worked with people, reassuring them at all times and explaining what they were doing and why.

One relative told us about the importance staff place on ensuring people were eating enough. 'For a couple of days when X first arrived they didn't want to eat, they fancied chips so staff went out to get chips.'

A relative also told us that, 'all staff top to bottom are always willing to help, they are kind, I have seen them treat people with respect and have kind caring conversations with people.'

People were made aware of the complaints system. The owner told us that relatives were provided with a copy of the procedure at the point of admission.

One relative told us 'we got a booklet with the complaints procedure in, can't fault anything, never had cause to complain. Beds are kept spotlessly clean.'