Brookside Residential Home

Brookside is a residential care home providing personal care to up to 29 people. The service provides support to older and younger adults, people with mental health concerns and people living with dementia. At the time of our inspection, there were 28 people living in the home. Care was provided in 1 adapted building, there were communal rooms available for people to enjoy.

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

Risks to people were not always effectively monitored or assessed. Environmental risks were not always safely managed. Potentially harmful substances were not always stored away safely. Quality audits were taking place; however, these had not identified some of the discrepancies found during this inspection. Some care plans contained conflicting or out of date information and auditing systems required improvement to monitor potential risk.

The provider acted on all areas of feedback during this inspection. The manager was new to the service and shared plans to improve the quality auditing processes, including the introduction of a new electronic monitoring system. We will review the success of these new systems in our next inspection.

People told us they felt safe living in the home and with the staff who supported them. There were enough staff on duty to support people safely and staff were recruited safely. Staff received safeguarding training and were confident to report their concerns.

People and relatives told us the culture in the home was positive and they felt included in the service. The manager worked in partnership with other professionals and health care services, and a visiting professional told us the manager actively communicated any changes or concerns.

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.

Rating at last inspection

The last rating for this service was good (published 3 March 2022).

Why we inspected

We received concerns regarding incident and risk management. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this report.

The provider responded to all of our feedback and introduced new quality monitoring systems. We will review the success of these systems in the next inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘All inspection reports and timeline’ link for Brookside Residential Home on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to risk management, storing harmful products safely and overall governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

All visitors were checked in via an electronic screening system to ensure they were symptom free and had received a vaccination.

The registered manager had undertaken extra training, so they were able to train the staff in the safe use of PPE and the home had an infection control champion.

People were supported to stay in contact with their families and the provider had built a visiting pod. The registered manager told us that essential care givers had been able to visit at all the appropriate times.

People that used the service and staff all had an individual risk assessment in relation to COVID 19 which identified and mitigated risks around identified needs.

Brookside residential home is a 'care home'. Brookside accommodates up to 25 older people that may live with Dementia in one adapted building. At the time of this inspection 23 people were using the service.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

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

Some care files did not always appropriately identify risk prevention, to allow staff to ensure people’s risk of pressure ulceration was managed in a safe way and repositioned in a timely manner. However, care files demonstrated that people’s identified risks had been assessed,

We observed that adjustable tables in the lounge had been moved in front of people restricting their movement and walking aids were not always available. The registered manager recognised this and put immediate action into place to ensure that people were not restricted.

We made a recommendation about how to appropriately meet people’s needs and reflect their preferences.

People had their medicines managed safely. There were nightly medicines count completed by night staff as well as monthly medicine audits undertaken by the registered manager.

Daily handovers, were completed that recorded any outstanding concerns related to people and the environment, ensuring staff remained up to date with all important information related to safety.

We used the Short Observational Framework for Inspection (SOFI) during meal times that looked at peoples dining experience. We observed that there was limited interaction between staff and people.

We made a recommendation regarding peoples dining experiences.

Care files and care plans were written as a fluid document and used information from the initial assessment and full assessment, and through consultation with people and / or their relatives.

People and their relatives or advocates, where appropriate, were actively involved in decisions related to care and support. Where people were unable to make important decisions related to their care, the service ensured evidence was retained of any best interest decisions made.

All complaints were managed robustly and in a timely way. The registered manager used the learning from concerns and complaints as an opportunity for improvement.

The registered manager had introduced a number of monthly quality audits to assist with the governance of the service and drive improvements were shortfalls had been identified.

We made a recommendation regarding the audit systems used by the registered manager.

People’s human rights were protected by staff who demonstrated a clear understanding of consent, mental capacity and Deprivation of Liberty Safeguards legislation and guidance

People were involved in decisions about the décor of their rooms, which met their personal and cultural needs and preferences. People brought furnishings of their choosing that allowed personalisation of their rooms.

We observed staff supporting people in a caring and compassionate manner. Peoples care plans clearly evidenced the support they required and their personal preferences.

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.

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 requires improvement (published 23 November 2018)

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.

Brookside residential home 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. Brookside accommodates up to 25 older people that may live with Dementia in one adapted building. At the time of this inspection 23 people were using the service.

A manager was at the service and they had submitted their application to register with us. 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.

Although some improvements had been made since our last inspection, further improvements were required to ensure staff administered people’s medicines safely. Staff were aware of the risks to people and how to manage those risks such as ensuring people had enough to drink. Staff knew how to escalate any concerns they had about people in order to safeguard them from harm. People told us there was enough staff to meet their needs. People were protected from the spread of infection and where incidents and accidents took place, lessons were learnt and action was taken

Since our last inspection 18 staff had left the service. A training programme was in place to ensure all of the new staff recruited had the skills and knowledge for their role. People’s needs were assessed before they moved into the home and provided staff with the required information to meet their needs. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible. Further training was required to ensure staff fully understood the Mental Capacity Act.

People and their relatives described the staff as caring and kind. People’s choices about how they spent their day were routinely respected and people were encouraged where possible, to retain a level of independence. People were treated with dignity and respect.

Improvements had been made to ensure care records reflected people’s preferences to enable staff to be aware of what was important to them and their wishes. The provider was in the process of recruiting designated staff to improve the activities provided to people. Systems were in place to ensure any complaints received were responded to.

The new manager and provider had an action plan in place which was being followed to embed the changes they had made, and to continue to drive improvement in the home.

Brookside Residential Home 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.

Brookside Residential Home accommodates up to 25 people in one adapted building. At the time of this inspection there were 23 people using the service.

At the last inspection the service was rated as requires improvement. At this inspection the service was rated requires improvement again. This is the third consecutive time the service has been rated Requires Improvement. You can see what action we told the provider to take at the back of the full version of the report.

There was a registered manager in post at the time of the 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.

People’s risks were not always suitably managed in order to keep them safe.

People told us they received their medicines as prescribed however we found some issues which showed that medicines were not always managed safely.

People’s care plans were not always up to date with current information, important personal information and professional advice.

Systems and processes in place to monitor the quality and safety of the service needed some improvement, as the issues we identified during the inspection had not been identified through these processes.

People received support to be pain free and comfortable at the end of their lives however their wishes in relation to end of life care were not always recorded.

Staff knew how to protect people from avoidable harm and abuse. Staffing levels were sufficient to meet people's needs and staff had their suitability to work in a care setting checked before they began working with people. Premises were kept clean and tidy and people were protected from the risk of infection.

People’s needs and choices were assessed prior to them moving into the home. 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 support this practice. People were supported by trained staff however some staff needed more support to check they had understood the training they received. Staff received regular supervision and felt supported in their roles.

The environment was suitably adapted to meet people’s needs. There was a good choice of food, which people enjoyed and they received support to meet their nutrition and hydration needs. Healthcare professionals were consulted as needed and people had access to a range of healthcare services.

Staff were kind, caring and compassionate with people. People were supported to express their views and encouraged and supported to make their own choices. People were treated with dignity and respect and their independence was respected and promoted.

People knew how to complain and concerns were acted upon.

The registered manager was also the provider and was freely available to people, relatives and staff. People, their relatives and staff were involved in the development of the service and they were given opportunities to provide feedback that was acted upon.

Brookside Residential Home provides support and care for up to 25 people, some of whom may be living with dementia. At the time of this inspection 25 people used the service.

The service had 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.

The Mental Capacity Act 2005 (MCA) is designed to protect people who cannot make decisions for themselves or lack the mental capacity to do so. The Deprivation of Liberty Safeguards (DoLS) are part of the MCA. They aim to make sure that people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom. The provider did not consistently follow the principles of the MCA by ensuring that people consented to their care and support.

People were safeguarded from abuse and the risk of abuse as staff knew what constituted abuse and who to report it to. The registered manager had previously made referrals for further investigation when they had suspected abuse had taken place.

Risks to people's health and wellbeing were identified, assessed and reviewed. People were provided with personalised care to meet their needs and preferences. Care plans included life history information and staff knew people's preferences.

There were enough suitably qualified staff, who had been recruited using safe recruitment procedures, available to maintain people’s safety and meet their individual needs. People’s medicines were stored and administered by medication trained staff.

Staff were supported to fulfil their role effectively. There was a regular programme of training that was relevant to the needs of people at the home. Care was personalised and met people’s individual needs and preferences.

People’s nutritional needs were met and they were supported to access a range of health care services. When people became unwell staff responded and sought the appropriate support.

People's privacy and dignity was respected. Staff were observed to be kind and caring and they told us they were well supported by the registered manager.

The provider had a complaints procedure and people knew how to use it.

Systems were in place to monitor the quality and safety of the service. When improvements were required these were made in a timely manner.

We spoke with six people that used the service, two relatives, four members of staff and the provider. We spoke with a visiting district nurse and the regular visiting district nurse on the telephone. People told us that they liked living in the home and were very settled. One of the relatives we spoke with told us that they were pleased with the care and attention provided. One person living in the home told us, "I am settled and quite content with my lot. The staff treat me very well'.

We saw that people were supported to make decisions and were involved in the planning of their care. We saw that people were treated with care and respect. We saw that people were supported to remain as independent as possible and that appropriate risk assessments were in place.

The staff we spoke with had a good knowledge and the skills to provide the care that people required. We were told and saw evidence that people using the service were protected from harm, abuse and neglect. There were arrangements for the management of people's finances in place.

The home had a complaints procedure which people living in the home were aware of.