Brookfield

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

The service was able to show how they met the principles of Right support, right care, right culture.

Right support:

The model of care and setting maximised people’s choice, control and independence.

People were encouraged and empowered to make their own decisions. Care staff ensured that people were supported and gave people daily choices which were appropriate to their needs and level of understanding and ability. People lived in an ordinary, semi-detached family home which integrated well within the community.

Right care:

Care was person-centred and promoted people’s dignity, privacy and human rights.

Staff knew people well and established positive relationships with them. People’s dignity, privacy and human rights were maintained. People were treated and supported as an individual, and we saw that the service had made improvements around providing individual stimulating activities.

Right culture:

The ethos, values, attitudes and behaviour of leaders and care staff ensure people using the service lead confident, inclusive and empowered lives.

People were involved in the community and taking part in a wide range of community-based activities. People were put first, and the service had made good progress with building activities and facilities around people, following lockdown.

The new leadership team were open, honest and easy to talk to. They listened to people, staff and visitors to discuss concerns and improve the service for people.

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.¿

• People’s care and support was provided in a safe, clean, well equipped, well-furnished and well-maintained environment which met people's sensory and physical needs. People told us they loved their home. A lot of resources had been put into making sure the decoration reflected people’s tastes and was comfortable and safe.

• People were protected from abuse and poor care. The service had enough appropriately skilled staff to meet people’s needs and keep them safe.

• People were supported to be independent and had control over their own lives. Their human rights were upheld.

• People received kind and compassionate care from staff who protected and respected their privacy and dignity and understood each person’s individual needs. People had their communication needs met and information was shared in a way that enabled them to understand and engage.

• People’s risks were assessed regularly in a person-centred way; people had opportunities for positive risk taking. People were involved in managing their own risks whenever possible.

• People who expressed distress in ways that could challenge others had proactive plans in place to reduce the need for restrictive practices. Systems were in place to report and learn from any incidents where restrictive practices were used.

• People made choices and took part in meaningful activities which were part of their planned care and support. Staff supported them to achieve their aspirations and goals. The service had started to design and build a sensory garden together with people and sought activities which were of specific interest for them.

• People’s care, treatment and support plans, reflected their sensory, cognitive and functioning needs.

• People received support that met their needs and aspirations. Support focused on people’s quality of life and followed best practice. Staff regularly evaluated the quality of support given involving the person, their families, and other professionals as appropriate.

• People received care, support and treatment from trained staff and specialists able to meet their needs and wishes. Managers ensured that staff had relevant training, regular supervision and appraisal.

• People and those important to them, including advocates, were actively involved in planning their care. Where needed a multidisciplinary team worked well together to provide the planned care.

• Staff understood their roles and responsibilities under the Human Rights Act 1998, Equality Act 2010, Mental Health Act 1983 and the Mental Capacity Act 2005.

• People were supported by staff who understood best practice in relation to learning disability and/or autism. Governance systems ensured people were kept safe and received a high quality of care and support in line with their personal needs. People and those important to them worked with leaders to develop and improve the service.

Why we inspected

This was a planned inspection based on the previous rating.

We undertook this inspection to provide assurance that the service is applying the principles of Right support ,right care, right culture.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

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

Brookfield provides care and accommodation for up to three people who have learning disabilities. At the time of inspection there were two people using the service.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice and independence. People using the service received planned and co-ordinated person-centred support that is appropriate and inclusive for them.

People’s experience of using this service:

The outcomes for people using the service reflected the principles and values of Registering the Right Support in the following ways. The service promoted choice, control and independence. The service was person centred. People had maximum control over all aspects of daily life. This included their routines, activities and meals. People's support focused on increasing their opportunities and providing them with skills to become more independent.

People's feedback was regularly sought through surveys, monthly 'keyworker discussions' and house meetings. A newsletter had been introduced to show people and their relatives the activities and significant information regarding the service. Relatives told us the service had improved. One relative said, “It has definitely improved.” One relative commented, “They are [activities] definitely much better. The activities are moving in the right direction. There are also now evening activities.” Staff told us they felt listened to and supported by the management team. One member of staff commented, “The management style has changed. It’s like a brand-new service.”

People had risk assessments in place which met their needs. Systems were in place to safeguard people from the risk of abuse. Medicines were managed safely, and people received their medicines as prescribed. The home was clean and tidy. A cleaning schedule was in place and regular infection control audits took place.

The water temperature in the staff toilet was above 51 degrees. However, an assessment of risk and appropriate control measures had not been put in place regarding this. This was immediately rectified during inspection with a new sink and mixer tap being installed. During inspection we found cleaning products in the staff toilet. Although they were on a high shelf these were within reach. The manager immediately placed the two items in a locked cupboard.

Staff recruitment records demonstrated the service was ensuring staff were subject to the appropriate scrutiny. References were obtained and Disclosure and Barring Service (DBS) checks completed. Staff received appropriate induction, training and supervision. Staff responded to people’s needs. We saw one staff member taking the time to clearly explain why they were counting money. Another staff member encouraged one person to show the inspection team their activity book. The person enjoyed showing their pictures and talking about what they had been doing.

The provider had a complaints policy and procedure in place. The manager had a system in place to keep an overview of complaints to identify any patterns and trends.

At the last inspection, we were told a quarterly audit and a master action plan, giving a clear overview of all the actions required, would be introduced by the regional support manager. This had not been completed. The audits did not pick up the issues we identified at inspection. For example, the poor recording of food amounts and the undated hospital passports.

We found systems and processes were not established and operated effectively. They provider did not adequately assess, monitor and improve the quality and safety of the services. They did not effectively assess, monitor and mitigate the risks relating to the health, safety and welfare of service users and others. The manager and regional support manager’s audits had identified the water temperature in the staff toilet was above 50 degrees as it was used as a sentinel tap (a tap which needs to be kept above 50 degrees for legionella risk management), yet no control measures to manage this risk had been put in place. We concluded this was a breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, good governance.

Rating at last inspection:

At the last inspection the service was rated Requires Improvement (report published 1 March 2019).

Why we inspected:

This inspection was planned based on concerns found at the previous inspections and the service rating.

Enforcement:

Full information about CQC’s regulatory response to the more serious concerns found in inspections and appeals is added to reports after any representations and appeals have been concluded.

Follow up:

We will continue to monitor this service. We will check improvements have been made by completing a further inspection in line with our re-inspection schedule for those services rated requires improvement.

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

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements had been made and were ongoing. This service is no longer rated as inadequate overall, or in any of the key questions. Therefore, this service is now out of Special Measures.

Brookfield provides care for up to three people who have learning disabilities. At the time of inspection there were two people using the service. People in care homes receive accommodation and personal care as a single care package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection.

The service had a manager in place who had started working at the service six weeks prior to the inspection but they had not registered to manage this service yet. They told us they were planning to submit their application by the end of January 2019. It is a legal requirement that this service has 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.

We found the manager, regional support manager and staff had worked hard to make improvements in the areas of concern found at the last inspection. At this inspection, we found improvements in all areas. However, we discussed with the manager and regional support manager more work was needed to ensure a robust and sustained service moving forward. The management team agreed with this and told us they had been focusing on ensuring the home was safe and people received the right support.

Regular health and safety meetings took place between the staff responsible for maintenance and the manager. Action plans were created following the meetings and it was clear when actions were to be completed by and by whom. However, we noted the temperature of the kitchen tap was extremely hot. Although this had been identified on maintenance checks no action had been taken and it had not been picked up at the health and safety meetings. The manager and regional support manager immediately took steps to make the temperature safe and ensured a thermostatic mixing valve was fitted. We made a recommendation that the maintenance checks were reviewed at the health and safety meetings to ensure action is taken where necessary.

Robust procedures were in place to protect people from financial abuse. Staff knew who to report any concerns to both within the organisation and to external agencies, such as the CQC. We found medicines were managed safely and in a person-centred way. People received their medicines as prescribed. There were PRN protocols in place and clear guidelines what to do if a person refused their medicines.

Improvements had been made to risk management. Personal Emergency Evacuation Plans and the Herbert protocol were fully completed. The Herbert Protocol is a national scheme introduced by the police in partnership with other agencies to compile useful information which could be used in the event of a vulnerable person going missing.

There were appropriate staffing levels to meet people’s needs. Lone working arrangements were followed and staff knew who to contact if they needed additional advice or support. Staff recruitment records demonstrated the service was ensuring staff were subject to the appropriate scrutiny. References were obtained and Disclosure and Barring Service (DBS) checks completed. The DBS helps employers make safer recruitment decisions and reduces the risk of unsuitable people from working with vulnerable groups.

Improvements had been made to staff induction which was more robust. Staff had begun to receive appropriate support and supervision. The management team had oversight of all staff training via a database to ensure it was kept up to date. This showed all staff had completed mandatory training and received refresher training.

People's nutritional needs were being met. People’s needs and choices were assessed and care, treatment and support was delivered. A planned transition took place when new people moved into the home. Hospital passports were in place and were detailed and bespoke to each individual. People had access to healthcare professionals including, GPs, dentist, dietician and hospital consultants.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Capacity assessments were in place for specific decisions with accompanying best interest decisions. The new care documentation being introduced highlighted a person’s capacity, assessments and decisions more clearly.

We observed and staff told us how they respected people’s privacy, dignity and independence. Staff were aware of people’s needs and knew what was important to them. People were involved in making decisions about their care, support and treatment as far as possible. People chose where to spend their time, this was either in their room, the lounge, the garden or out of the home. One person changed their mind about the activity they wished to do. This was accommodated. The details of people’s advocates were recorded in their care documentation and staff were aware of this.

New care records were being introduced. These were more streamlined, person-centred and reflected people’s needs. The new documentation and reviews were focussed on goals, aspirations and outcomes for people. We made a recommendation that all care and support plans were completed and fully implemented in the service by the end of February 2019. People took part in activities that they chose to do. We saw complaints were investigated and dealt with appropriately.

Improvements had been made to the oversight and leadership of the home. However, further work was required to continue to improve the home and ensure the new systems and processes were embedded into practice. The new paperwork being introduced was clearer and the focus was moving towards outcomes for people who used the service. Staff and relatives were supportive of the new management team. Staff had begun to be involved in developing the service through supervisions and team meetings.

Brookfield provides care for up to three people who have learning disabilities. At the time of this inspection two people were using the service. People in care homes receive accommodation and personal care under a contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection.

The service did not have a registered manager. 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. A manager had been appointed to manage Brookfield and two of the provider’s sister services; they had been in post six weeks.

The service was not safe because risks were not assessed or well managed. We identified issues around fire safety and infection control. Accidents and incidents were not investigated. The service did not learn from incidents and prevent events from reoccurring. Medicines were not managed safely. People were not safeguarded from abuse. Staff were not appropriately supported and supervised. Only one member of staff was on duty for most of the time which resulted in people having limited opportunities to engage in person centred activities; one person was funded for one to one staffing but they did not receive this.

Support plans were not always accurate and did not reflect people’s current needs. People had not been involved in the support planning process. People’s health needs were not met because they did not always receive health checks and support from health professionals. People’s nutritional needs were not met. Food records showed meals were not varied or balanced. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible.

We observed friendly interactions during the inspection. A member of the night staff was finishing their shift when we arrived and one member of staff was on shift during the day. People were comfortable with the staff who supported them.

There were widespread and significant shortfalls in the way the service was led. Some important records could not be located. Staff and resident meetings had not been held so people did not have opportunities to share their views. The provider did not have effective systems to assess, monitor and manage the service. They did not have processes to learn lessons and drive improvement. The provider did not respond to external reports.

We found eight breaches of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014, which related to person centred care, meeting people’s nutritional needs, management of risk including medicines and infection control, staffing, safeguarding people from abuse, consent to care, maintaining premises and governance arrangements. We also found a breach of the Health and Social Care Act 2008 (Registration) regulations 2014 because the provider had not notified CQC about some significant events.

The overall rating for this service is ‘Inadequate’ and the service therefore has been placed in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The service has a registered manager. 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.

Premises were appropriately maintained to ensure people’s safety.

The provider ensured appropriate recruitment checks were completed. The provider’s recruitment policy stated satisfactory references must be obtained before staff start work. This was not adhered to for one member of staff, although they shadowed until references were received. We made a recommendation that the provider ensures they follow their own policies.

We observed there were sufficient staff to meet people’s needs. We made a recommendation the provider ensured a named member of staff was allocated on the rota to provide 1:1 hours.

Staff were provided with appropriate support to ensure the safe administration of medicines. They had undertaken training in medicines management and their competency was assessed.

The home was clean and tidy although some areas did require maintenance and updating. Staff used appropriate Personal Protective Equipment (PPE). A cleaning schedule was being introduced which including tasks for night staff.

Although staff received an induction they did not receive appropriate training as is necessary to enable them to carry out the duties they are employed to perform. We concluded this demonstrated a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were supported to plan their meals and buy their food. People had access to other healthcare professionals.

People’s care records were up to date and recorded what support people required. People’s activity planners were detailed and provided a good picture about each individual.

People were involved in the running of their home through resident meetings.

Staff told us how they respected people’s privacy and dignity. For example, by listening to people, knocking on doors and asking permission if they wanted to enter their room. We observed one incident which impacted on a person’s dignity when they left their home with large stains on the front of their top.

Staff were passionate about encouraging people to be as independent as possible. For example, ensuring they were involved in cleaning, preparing meals and choosing activities.

The provider had a complaints policy and procedure in place. The home had not received any complaints.

Audits were completed in areas such as, medicines, finances, and infection control. The registered manager or deputy completed a monthly report log looking at incident records. The report logs did not analysis patterns and trends and what action could be taken to prevent behaviour escalating.

The CQC had been notified of a number of safeguarding incidents between two service users. We also liaised with other health and social care professionals regarding this. The provider had not analysed the information to ensure patterns and trends were picked up at the earliest opportunity.

A policy and procedures file provided on inspection contained out of date policies without review dates. Some of the policies were not relevant to the service for example, prevention and early detection of depression in older people and the safe use of bedrails.

We concluded the issues identified collectively constituted a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Staff told us on the whole they felt supported and listened to. Team meetings took place which included feedback from inspections at the provider’s other care homes to share learning.

You can see what action we told the provider to take at the back of the full version of the report.