Archived: Brooklodge

Brooklodge is a residential care home providing personal care to one person aged 65 and over at the time of the inspection. The service can support up to three people. Accommodation is within the provider and registered manager’s own home and is over a single storey with several communal areas as well as private bedrooms. The provider had decided not to admit further people into the home at the time of inspection.

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

The one person who used the service received an exceptionally person-centred service that met their needs. They were supported by a small staff team resulting in consistent and individualised care that was flexible and dedicated. Staff knew them and their needs, extraordinarily well.

The person’s needs had been assessed and recorded and these were regularly reassessed for any changing needs and care adapted as appropriate. The person had their health needs met and received their medicines as prescribed. The service took time to meet their complex nutritional needs and this was dedicated in ensuring the best results were achieved.

The individual risks to the person had been identified and managed and actions taken had reduced the likelihood of harm. Risks associated with the premises had also been managed however, the service could not always demonstrate this through documentation. For example, there was no certificate in place to demonstrate the electrical wiring had been tested as required.

The provider employed only two staff who worked infrequently. They had received training and the one staff member we spoke with told us they felt supported and part of a small and close-knit staff team. There were no concerns with staff performance, as confirmed by the relatives we spoke with, however the provider could not fully demonstrate that they had completed all checks on their suitability for their roles as required.

There were no formal processes in place for such aspects as meetings with stakeholders and staff and gaining people’s feedback on the service provided. However, due to the small and personal nature of the service, this was not required as communication was continual and individual. Records were not always in place to document what care was provided and the outcomes achieved however, as only the provider and registered manager delivered care, the risks associated with this were significantly low and communication was constant amongst the care givers.

People told us the service was caring and would recommend it. One relative said, “I would recommend Brooklodge to anyone who wants a more personal and friendly type of care for their relative, the sort big homes are just not able to provide.” Relatives told us staff ensured their relative’s dignity was maintained and that they had a kind and devoted approach. The one person who used the service was supported to have maximum choice and control of their life and staff supported them in the least restrictive way possible and in their best interests.

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 (report published 3 July 2017).

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.

Brooklodge provides residential care for up to 3 older people. The provider’s representative and registered manager live on site. At the time of this inspection there were 3 people living in the home. Accommodation is over a single story and all those that use the service have their own rooms. A number of communal areas and gardens are available to those living at Brooklodge.

At our last inspection carried out in December 2014, the service was rated as good. At this inspection, carried out in June 2017, the service is again rated as good. However, in order to further improve the service delivered and in order to sustain those improvements, we have made recommendations. These recommendations relate to the management of medicines, adherence to the MCA and care planning.

There was a registered manager 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.

The staff members that the provider employed had all undergone checks to reduce the risk of employing people not suitable to work with those who used the service. Staff had received training, told us they felt supported and there were enough of them to meet people’s needs in a prompt and person centred manner.

Staff worked well together and, as there were so few of them, communicated effectively to achieve a shared aim. The culture of the home was based on building relationships and meeting people’s needs in a person centred and individualistic manner. Staff demonstrated respect, compassion and humour when engaging with those that used the service. People’s dignity and privacy was maintained and they received support to make choices.

The risks to those that used the service had been identified and managed although not consistently or robustly recorded. However, staff knew those that used the service exceptionally well and mitigated the risks in the support they provided. Staff had received training in safeguarding vulnerable adults.

The CQC is required to monitor the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS) and report on what we find. The service understood how to support people to make choices and involved others in making best interests decisions. However, the service lacked records in relation to MCA assessments and best interests decisions.

People received dedicated and individual care that met their personal preferences, likes and dislikes. Staff knew people exceptionally well and delivered care and support that was based on relationship development and getting to know people as individuals. People, and their relatives, were involved in the planning of their care.

Nutritional needs were met and people received enough to eat and drink. The service referred people to healthcare professionals as required.

There were little planned activities going on in the service however those that used it, and their relatives, told us the stimulation they received and family orientated environment met their needs.

The provider and registered manager had a good oversight of the service as they delivered the majority of the care and support. Formal feedback was not sought and no audits took place on the service. However, due to the continuity of care and regular interventions, they were both in a position to identify issues and rectify them. Those we spoke with talked of a responsive approach to issues or concerns.

All those we spoke with told us they would recommend the service due to its small size, dedicated care and support and family feel.

Following the July 2013 inspection we required that the provider produce an improvement action plan, which we received. This inspection showed us that improvements had been made.

We found information was available to show how people needed to be supported. Daily records were now being kept to record people's nutritional intake where they were at risk of malnutrition.

Various improvements had been made in relation to the management of medicines. However a stock accounting record needed to be devised, which we discussed with the manager.

Records kept in respect of people's health were now accurate. People's weights were now being recorded which enabled the correct application of MUST (Malnutrition Universal Screening Tool) and the Waterlow Pressure Ulcer Risk Assessment Tool. Handwritten Medication Administration Records (MAR) were fully completed.

On reviewing care records we found that plans of care were not devised from needs or risk assessments. We had particular concerns that risk tools to identify malnutrition were not being utilised properly. Staff had identified that some people's appetites had diminished and some action had been taken but no plans were in place to address these concerns.

We found omissions in relation to the management of medicines. Medication Administration Records (MAR) did not contain sufficient information and one person's recent prescription had not been added to their record. Controlled drugs had not been stored or recorded in accordance with legal requirements. We also had concerns about disposal of unused medicines and the effectiveness of the annual audit process.

Because of the size of the home there was considerable scope for people to choose what they wanted to eat and when. People we spoke with said the food was good. People were encouraged to eat as necessary.

The home had a complaints and concerns procedure which was available to people living at the home and any visitors.