The Brooklands Residential Home

We found the following examples of good practice.

Staff understood and followed good infection prevention control (IPC) procedures which helped protect people from the risk of infection. Supplies of personal protection equipment, (PPE) was available throughout the home. Staff and visitors were able to dispose of used PPE in suitable bins throughout the home.

People living in the home were supported to isolate in their rooms during the outbreak to help minimise the risk of further infections. Where people were at risk, for example, from falls staff supported them in separate communal areas.

The home was clean and tidy. Regular cleaning routines and procedures helped minimise the risks of contamination and infection. People living in the home who had COVID-19 had their laundry placed in alginate bags in their rooms before being washed. The home had an ozone machine to sanitise rooms on a regular basis.

Managers had supported staff to refresh their IPC knowledge with elearning.

The Brooklands Residential Care Home is registered to provide personal care for up to 24 older people, people with a physical disability, sensory impairments, younger adults and people living with dementia. 24 people were living in the service at the time of the inspection.

People’s experience of using this service

The provider had systems that ensured allegations of abuse were acted upon. Records relating to incidents and accidents and lessons learned were noted. Sufficient staff were employed to support people’s needs and a safe recruitment programme was seen. Medicines were managed safely.

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. The registered manager had submitted applications to the supervisory body when restrictions were placed on people’s liberty. People told us meals were good and we noted a positive lunch time experience. People and professionals told us, and records confirmed, relevant health professionals were involved in assessments of people’s individual health needs. Staff had assessed individual and environmental risks to help keep people safe. The service had a number of communal areas and all bedrooms were of single occupancy with ensuite facilities. Pictorial signage was used to help people find their way around. The service was clean and tidy and free from clutter.

People gave positive feedback about the care provided. People were treated with dignity and respect and were involved in decisions about their care. Care files had been developed with people’s involvement. The provider had a system to deal with complaints. Activities were offered to people regularly. People’s hopes and wishes were discussed with them and the service supported people to achieve them.

All people we spoke with were complimentary about the registered manager. People’s views were considered and team meetings were taking place. Senior staff carried out audits and monitoring to assess quality and ensure the service was safe for people to live in.

Rating at last inspection: At the last inspection the service was rated good (Published 09 October 2016).

Why we inspected: The inspection was scheduled based on the ratings from the last inspection.

Follow up: The service will be re-inspected as per our inspection programme. We will continue to monitor any information we receive about the service. The inspection may be brought forward if any risks are identified.

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

The Brooklands Residential Care Home provides personal care for up to 24 older people, some of whom are living with dementia. Accommodation is provided in single rooms, all with en-suite facilities. There are two communal lounges, a visitor’s lounge, a hairdressing room and a separate dining room. There is a small garden, patio and space for parking. At the time of the inspection there were 22 people living at the home.

The service did not have a registered manager in post on the day of the inspection. The previous registered manager had resigned their post shortly before the inspection. The registered providers were already in the process of trying to recruit a suitable replacement. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 and associated Regulations about how the service is run.

People living in the home told us that they felt safe living there and relatives we spoke with told us they were “very satisfied” with the care being provided. We saw that the people who lived there were being well cared for and were relaxed and comfortable in the home and with the staff that were supporting them. The atmosphere was informal and inclusive. Everyone we spoke with praised the staff that supported them.

The environment of the home was welcoming and the communal areas had been arranged to make them homely and relaxing. We found that all areas of the home used by the people living there were clean and tidy. People told us they had a choice of meals, snacks and drinks. The people who lived there told us that the food was “very good” and “first class” and that they enjoyed their meals.

People were able to see their friends and families as they wanted and go out into the community with support. There were no restrictions on when people could visit the home. People were able to follow their own interests, practice their religious beliefs and see their friends and families as they wanted.

The staff on duty we spoke to knew the people they were supporting very well and about their lives and personal preferences. Staff were aware of the choices people had made about their care and daily lives. The staff we spoke with were aware of their responsibility to protect people from harm or abuse. They knew the action to take if they were concerned about the safety or welfare of a person.

Systems were in place for the recruitment of staff and for their induction and on going training and development. Staff training relevant to the needs of the people living in the home was provided and staff said they were well supported by the management team. There was an on call system for staff to access management support at night.

We looked at the risk assessments in place for people and these included risk assessments for skin and pressure area care, falls, moving and handling, mobility and nutrition and for the management of a different conditions or specific medication. We looked at the risk assessments in place and how people would be moved in the event of fire. These had been kept under review.

During this inspection we looked at the way medicines were managed and handled in the home. We found that medicines were being administered and records were being kept of the medicines kept in the home. We have made a recommendation to the nominated individual that the service reviewed the storage of the controlled drugs against the current guidance and legislation and amend practices accordingly. We also made a recommendation that they looked at current National Institute for Health and Care Excellence (NICE) medicines guidance. This was regarding variable doses of medicines and handwritten prescriptions and that they take appropriate action to update practice.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

Is the service safe?

People were comfortable and relaxed during our inspection. We observed care being provided in a dignified and supportive manner. People told us they felt safe and respected. One person said, 'It feels like my home. My bedroom is mine and the staff respect my privacy'.

People consistently stated staffing levels were adequate to meet their needs. One person said, 'They have plenty of staff on'. This meant staffing levels deployed by the service were adequate to ensure the safety of people in their care.

The Brooklands had effective infection control measures in place to ensure people were safe from acquired infections. We found the home to be hygienic, clutter-free and well-maintained. A relative told us, 'It's always clean and smells very nice'. This showed the home protected people against infection because appropriate prevention systems were in place.

Our discussions with staff confirmed they understood the needs of the people in their care. This matched the information we found in people's care records. This meant the provider had protected people from unsafe care by ensuring care planning and risk assessment was appropriate.

Is the service effective?

People told us they felt the home was effective in meeting their needs. One person said, 'They ask me about my care and whether it or the home could improve'. This showed staff involved people in giving feedback about their care.

We observed improvements had been made by the Brooklands in relation to how the home ensured consent was sought, recorded and reviewed. One staff member told us, "Even when residents are ill or not themselves you still have to offer choice and help people make decisions. I cannot assume somebody will decide one way or the other just because I think I know them". This meant people were safeguarded against inappropriate care because the service gained people's consent prior to giving support.

Documents we reviewed showed support plans and risk assessments were individualised and regularly updated. Support planning matched people's assessed needs. This meant people were protected against ineffective care provision because people's needs were adequately assessed.

Is the service caring?

People consistently stated that the home delivered a caring and supportive service. A relative told us, 'I'm confident the staff know my mum and help her in a kind and supportive way'.

People were comfortable and relaxed during our inspection. Staff engaged with people in their care in a friendly, supportive and appropriate manner. People told us they were happy with the care provided. One person said, 'It's my home and the other residents and staff are like my family and friends'.

Is the service responsive?

One person told us, "I have a keyworker who checks on my care and if anything could be done better'. This demonstrated the home checked and responded to people's changing needs.

People's needs were assessed before they accessed the service. This meant the Brooklands was able to confirm that they could meet the individual's support needs.

Is the service well-led?

The Brooklands had a range of quality audits in place. Other regular processes underpinned this, such as resident and team meetings. This meant people were protected against inappropriate support because the manager had systems to check the quality of care. A relative told us, 'If I had any concerns I know I could go to the manager and she would sort it out. There's nothing I would change about the home. They couldn't do anything better as far as I am concerned'.

Care delivery was well-led and there were clear lines of responsibility. Care planning was in-depth and personalised. This was reflected in our observations during our inspection. This meant the Brooklands delivered appropriate and safe care because the home was well-led.

Another person told us; "They look after us well. Very well."

People told us they enjoyed the food. One said; "The food is good, the menu is good. It's fresh, it's lovely".

We spoke to a visiting professional who confirmed that the staff were helpful and approachable. They told us that a few months ago they had reported to the manager an incident where a member of staff spoke inappropriately to someone. They believed that action had been taken and were not aware of any recurrence.

We looked at the 'residents quality assurance questionnaire' from July 2013. This covered areas such as; 'privacy', 'activities' and 'mealtimes'. There were 11 responses from people and their relatives. People were asked to rate various things under a five point scale. Under the heading for 'staff', eight ratings were 'excellent' and three were 'good'.

We found that the procedure for assessing mental capacity had not been followed in practice, monitored, or reviewed. Therefore, the provider may not have acted in accordance with legal requirements. The registered person did not have suitable arrangements in place for obtaining, and acting in accordance with, the consent of service users in relation to the care and treatment provided for them.

People who lived at the home told us they were involved in planning and reviewing their care and said they felt confident they would be listened to. Up to date care plans were in place.

Staff told us they were trained to do their job properly and said they felt supported by their manager. Staff were observed to be respectful of people's privacy and dignity during the visit. A district nurse told us the staff were professional and co-operative and always followed their care instructions.

There were systems in place to monitor the quality and suitability of the service. The home was clean, bright and comfortable throughout.

We recieved feedback from the local authority before our visit. They told us they had made some minor recommendations for improvements at their last visit in July 2012. The service had been co-operative and had implemented all of the requirements.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.