The Care Quality Commission
  • Care Home
  • Care home

Archived: Brookfield Residential Home

Overall: Inadequate read more about inspection ratings

7-9 Hayes Road, Clacton On Sea, Essex, CO15 1TX (01255) 427993

Provided and run by:
Mr & Mrs J Dorval

All Inspections

13 November 2014

During a routine inspection

This unannounced inspection took place on 13 November 2014. Brookfield Residential Home provides accommodation and personal care for up to eleven people. Two people had been admitted to hospital for care and treatment following serious concerns raised by healthcare professionals about how their needs were being met by the service. The majority of people living at Brookfield Residential Home were living with dementia and had varying levels of dementia related needs, some more advanced.

There was a registered manager in post at the service. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. In this instance the registered manager is also one of the partners in the partnership providing the service and is therefore also the registered provider.

At our last inspection on 5 September 2014 we found the provider was failing to plan and deliver safe and appropriate care to people to meet their needs. We served a Warning Notice on the provider telling them where they were failing and requiring them to address the issues before 28 October 2014. We also asked the provider to make improvements to cleanliness and hygiene in the service, staffing levels and staff training, medication management, how the human rights of people who may lack capacity to take particular decisions are protected and how the quality of the service was monitored.

They sent us an action plan telling us the improvements they were making. During this inspection we looked to see if these improvements had been made. We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and that the provider had not responded effectively and promptly to our concerns; very little improvement had been made to ensure people received care that was safe, effective and protected them from harm.

People’s safety was being compromised and they were at serious risk of harm because care was not being assessed and delivered which met their changing needs. There was no system to assess staffing levels and make changes when people’s needs deteriorated, so that staff could care and support people safely. There were insufficient numbers of staff to meet people’s needs at all times, particularly at night. There was poor medicine management and people were not always receiving their medication as prescribed.

Staff did not have the knowledge and skills they need to carry out their role and responsibilities effectively. They did not recognise poor practice which might put people at risk of injury, for example when supporting people to move and transfer. Risks, including nutritional needs were not identified, monitored or managed. People were not supported to have sufficient quantities to eat and drink and maintain a balanced and nutritious diet.

Care was based on routines rather than individual choice, for example the time people went to bed and the time they got up. People’s interests or past hobbies were not explored; they were socially isolated and some were withdrawn. Staff were not provided with guidance on how to deliver the best possible care to people at the end stage of their life in a way that maintained their dignity and comfort.

Care was not personalised but delivered by a task led approach and people’s choices and preferences were not respected. People had not been protected from the risks of receiving care that was unsafe or inappropriate. People had not been referred to healthcare professionals for treatment, support or advice to maintain their health and wellbeing.

Quality assurance systems had not been implemented and the provider was unable to recognise or independently identify where improvements were needed. There was a lack of proactive managerial oversight to ensure that risks to people’s safety and welfare were being identified and managed. The culture of the service was not open and transparent with professionals who were trying to support and the service was not being run in the best interests of the residents.

5 September 2014

During an inspection in response to concerns

Prior to our inspection we had received concerns from the local authority about the care and support provided to the people who used the service. We undertook this inspection to check that people were being provided with safe and effective care.

We spoke with five of the 11 people who used the service. We also spoke with the registered manager and three staff members. We observed the care and support provided to people to check that staff interactions were effective and caring. We looked at four people's care records. Other records viewed included staff training and supervision records, the staff rota and records associated with the quality assurance in the service. We considered our inspection findings to answer questions we always ask; 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?

When we arrived at the service a staff member looked at our identification and asked us to sign in the visitor's book. This meant that the appropriate actions were taken to ensure that the people who used the service were protected from others who did not have the right to access their home.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Not all staff had been provided with training in DoLS and Mental Capacity Act (MCA) 2005. The registered manager and a staff member were not aware of the changes relating to DoLS following a Supreme Court judgement in March 2014. We could not be assured that the registered manager and staff had the knowledge that they needed to ensure that people who used the service were not unlawfully deprived of their liberty. This was because we saw staff use restraint without the appropriate assessments to ensure people's rights were protected.

The staff training plan did not provide a robust system to allow the provider to check that all staff had been provided with the training that they needed to meet people's needs safely and effectively. A compliance action has been set and the provider must tell us how they plan to improve.

There were shortfalls in the service's medication procedures and processes. We were not assured that the systems in place were robust enough to ensure that people were provided with their prescribed medication safely. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

The service was not clean and hygienic. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Is the service effective?

People told us that they were happy living in the service. One person said, "I can't complain, I get everything done for me." Another person said, "I get everything I need, food is good, I don't mind it at all, I am quite happy."

During our inspection there were enough staff to meet the needs of the people we saw being cared for. However when we looked at the staff rota, this did not reflect what we had been told and saw during our inspection. We were not assured that there were always sufficient staff numbers to meet people's needs in a safe and consistent. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Is the service caring?

People told us that the staff treated them with respect and kindness. One person said, "They (staff) are very good, they are very professional and know what is what." Another person said, "They (staff) are kind."

Staff interacted with people in a caring, respectful and professional manner.

Is the service responsive?

We were concerned that the ways that people's care records were maintained did not reflect people's needs accurately, how these needs were met and any changes in people's needs and preferences. Therefore we could not be assured that staff were provided with information to meet people's needs and that people were provided with the care and support that they required in a consistent way. We are taking enforcement action and have told the provider when they need to improve.

We saw that the staff were responsive to people's needs and responded to requests for assistance, including call bells, in a timely manner.

Is the service well-led?

The shortfalls which we identified in the care provided to people, infection control, staff training and the medication processes identified concerns about how the service was led. We were not assured that people were provided with safe and effective care.

The provider's quality assurance systems were not robust enough to ensure that people were provided with safe and effective care and to ensure that they could identify shortfalls, address them and improve the service.

5 April 2013

During a routine inspection

The people we spoke with told us they were happy living at Brookfield and that the staff were kind. We spoke with two relatives during our visit. We were told by one relative: 'The staff are very caring and I feel they are safe with them looking after them'. Another told us: 'They are very good at keeping me informed of any changes in their health, and they can recognise when they need any medical treatment'.

We saw people being spoken with and cared for with respect and dignity at all times during our visit.

20 September 2012

During an inspection looking at part of the service

During our visit to Brookfield Residential Home we talked with people living there to obtain their views of the service. People told us that they were happy with the service they received and that the staff were polite and treated them well. Some of the people we met living in the home were not always able to communicate with us verbally. Therefore we used observational skills and relied on staff to speak on their behalf.

People we spoke with, as well as our observations, confirmed that staff treated people with dignity and respect. People told us that staff always knocked before entering their room and that they were able to make decisions about what they wanted to do during the day, including when they wished to get up and go to bed.

People told us they were satisfied with the level of care and support they received at Brookfield and felt well looked after. One person told us "It is not home but it's ok." Another person told us "The staff are kind and look after us."

People told us that they were receiving good care, treatment and support and that they had access to the GP and district nurses and other health professionals, as and when required, to attend to their health needs.

People told us that they felt comfortable talking with the staff about any issues that they had and that the manager was also always available for them to talk to. They also

told us that they had not been asked to complete a satisfaction questionnaire recently, although they told us that they were satisfied with the service they received.

4 May 2012

During an inspection in response to concerns

During our visit to Brookfield Residential Home we talked with most of the people living there to obtain their views of the service. People told us that they were happy with the service they received and that the staff were polite and treated them well. Some of the people we met living in the home were not always able to verbally communicate. Therefore we used observational skills and relied on staff to speak on behalf of these people.

People spoken with, as well as our observations throughout the day, confirmed that staff treated people with dignity and respect. People told us that staff always knocked before entering their room and that they were able to make decisions about what they wanted to do during the day, including when they wished to get up and go to bed.

We spoke with three people in more depth about their views of the care, treatment and support they received. One person told us that the staff, 'Look after me very well, they respond promptly day and night'. One person commented,' I am very happy with staff and service I receive'. People told us that the food is good and that they can have what they like to eat. One person described the staff as, 'Good as gold'. They told us that staff, 'Get on and do the job, but are always available to have a chat, when I feel like it'.

1 February 2012

During an inspection looking at part of the service

The people with whom we spoke told us that 'I am happy today.', 'I like living here and we all get on.' In addition to this one person said 'They help me and tell me what to do.'

Those people with whom we spoke said they could choose whether or not to join in activities and could spend time alone in their room pursuing their own interests if they preferred.

People with whom we spoke were not able to tell us what was in their care plans or whether they had been involved in planning or consenting to their care.

People using the service told us that staff helped them with their medication when they needed it.

People told us when we visited that they liked the home and that they liked living there and that they liked their rooms and found them comfortable.

People told us that they feel well looked after by the staff at Brookfield. One person with whom we spoke said "The staff are very good. They are friendly and I get on with them all."

People told us that they would feel confident in raising any issues that they were not happy about. They told us that the manager and staff encourage them to raise any concerns.

24 August 2011

During an inspection in response to concerns

People with whom we spoke told us that their privacy, dignity and independence are respected and that their views on the support and care they receive are taken into

account.

They also told us that generally they were able to make choices about aspects of their

care. For example, we spoke with two people about how they are supported to choose what to eat each day. They told us that staff offer them a choice of meals each

day and they can choose where they have these. They are also able to make a decision as to whether or not they participate in social activities or go out.

One relative with whom we spoke confirmed they were happy with their relative's care and support and found staff to be kind and caring.

One person said, in relation to personal care, "I can do most things myself but if I need help I can ask for it. There are not many activities here but I am ok with what I do"

One person with whom we spoke told us they were not aware of what a care plan was but was looked after well.

The people with whom we spoke made the following comments 'I am happy today', 'I like living here and we all get on.' and 'They help me and tell me what to do.'

Those people with whom we spoke said they could choose whether or not to join in activities and could spend time alone in their room pursuing their own interests if they preferred.

People told us that they feel well looked after by the staff at Brookfield. One person with whom we spoke said "The staff are very good. They are friendly and I get on with them all."

People told us that they would feel confident in raising any issues that they were not happy about. They told us that the manager and staff encourage them to raise any concerns.