Brockholes Brow - Preston

Updated 21 September 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

Two inspectors, a member of the CQC medicines team and a specialist professional advisor who specialised in learning disabilities carried out the inspection.

Service and service type

Brockholes Brow - Preston (Brockholes Brow) is a combination of a 'care home' and domiciliary care service. People in care homes receive accommodation and nursing or personal care as single package under one

contractual agreement. Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a manager registered with CQC. This means that they and the registered provider was legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service, including information from the provider about important events that had taken place at the service, which they are required to send us. We sought feedback from the local authority. The provider was asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.

During the inspection

We spoke with seven people who lived at the home about their experiences of the care provided. We spoke with eight members of staff including the registered manager, the service manager, the care consultant, the deputy manager, the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the registered provider. We reviewed a range of records. This included eight people’s care records, multiple medication records, accident and incident records and three staff recruitment records. We looked at a variety of records relating to the management of the service. We walked around the home and observed the environment and interactions between staff and people.

We are improving how we hear people's experience and views on services, when they have limited or no verbal communication. We had an inspector who could communicate using British Sign Language (BSL) and a BSL interpreter to support the team. We used them to communicate with staff and people to tell us their experiences.

We used the Short Observational Framework for Inspection (SOFI) spent time observing people. SOFI is a way of observing care to help us understand the experience of people who could not talk with us

After the inspection

We continued to seek clarification from the registered manager to validate evidence found. We spoke with three relatives over the phone and met with member of the board of trustees. We looked at training data and quality assurance records.

Updated 21 September 2022

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability or autistic people.

About the service

Brockholes Brow - Preston (Brockholes Brow) is a small community for adults who live with deafness, learning disabilities and mental health needs. The service is registered to provide a combination of accommodation and personal care for up to 34 people. The service comprises of four linked houses with some single occupancy bedrooms and a self-contained flat which can be used as shared accommodation. The service is also registered to provide personal care to people in their own homes. There were 28 people using the residential service and 11 people using the domiciliary care service at the time of our inspection.

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

This service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right Support

People and their relatives told us they felt safe and protected from the risk of abuse and avoidable harm by staff who understood how to recognise, respond and report concerns. The registered manager had improved safeguarding processes. However, improvements were required to ensure staff were encouraged and supported to share concerns about poor practices within and outside the service. While we noted improvements in risk management, people were not adequately protected from the potential risk of avoidable harm such as skin damage and fire risk. People’s medicines were not safely managed. People were supported by staff who had been safely recruited. Staff had received training and guidance in the prevention and control of infections including COVID-19 however infection prevention practices exposed people to infections.

Right Care

People did not receive care that supported their needs and aspirations was focused on their quality of life, and followed best practice. Care records were not always complete or written in a way that promoted outcome focused care. People told us they were supported people to access the local community however there was limited opportunities to take part in meaningful day time activities. People's individual communication needs had been assessed and staff had tools to assist their interactions with people. However, people shared concerns that some staff were not able to communicate with them. The registered manager had made improvements in the way they dealt with people's concerns and complaints.

The provider had made improvements to the governance arrangements, leadership structure and the quality monitoring system. This had contributed to some of the improvements we observed at the service. However, the changes were in their infancy and had not been adequately imbedded. We found shortfalls linked to the implementation of changes. Changes required had not been sufficiently expediated to improve shortfalls identified at the last inspection in April 2021. This included person centred care planning and practices, rectifying shortfalls timely and medicines management. There was a lack of monitoring on the care delivered to people living in their own homes. Staff shared mixed responses regarding the leadership, support and the culture in the service.

Right culture

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 and in their best interests; the policies and systems in the service did not support this practice. While people's care and support had been planned in partnership with them where possible and some improvements had been made in relation to mental capacity, practices in the service did not always maximise choice and control. The provider had supported staff to acquire training in various areas. This was a significant improvement. Further improvements had been made to support people in line with national and best practice guidance.

The provider had started to review the way care was provided and their care model. However, we found little improvements had been made since our last inspection. The campus style model of service delivery offered to people at this setting does not meet current best practice. It is known that in large campus style environments that truly person-centred care which promotes people having meaningful lives where they have control, choice and independence is difficult to achieve. Care practices were not person centred to reduce the impact.

People and their relatives shared mixed comments regarding the caring nature of the staff team. Some people told us staff were kind and considerate and treated them with dignity. However, some people said staff did not support them to be as independent as they could be to fully exercise their choices.

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

Rating at last inspection and update:

The last rating for this service was inadequate (published 11 June 2021) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made in some areas of care delivery however the provider was in continued breach of regulations.

At our last inspection we also recommended that the provider seek guidance on end of life care practices. At this inspection we found the provider had not sufficiently acted on the recommendations or made improvements needed.

This service has been in Special Measures since 11 June 2021. The overall rating for this service is ‘Requires improvement’. The service remains in 'special measures'. We do this when services have been rated as 'Inadequate' in any Key Question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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

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 coronavirus and other infection outbreaks effectively.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold register providers to account where it is necessary for us to do so.

We have identified breaches of regulation in relation to keeping people safe from preventable harm such as skin damage, medicines management, infection prevention and control. The provider was also not supporting the delivery of person-centred care and maintaining good governance at this inspection.

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.