Brockwell Court Care Home

Brockwell Court is a care home which provides nursing and residential care for up to 75 people. The service provides support to older people living with dementia, mental health conditions and physical disabilities. At the time of our inspection 74 people using the service.

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

People were extremely satisfied with the service and felt staff always went above and beyond in delivering the care. They described the little extras staff just did as a part of their job. Staff were passionate about providing good care outcomes and took ownership for their practice.

The management team ensured there was always enough staff to support people. The provider had redesigned the dependency tool and staff found this gave a more accurate reflection of how many staff were needed to safely support people. People told us the staff were always readily available, extremely supportive and caring. Recruitment practices met legal requirements and the registered manager used a variety of effective strategies to encourage people to apply to work at the service.

Medicines management was effective and closely monitored. Staff who administered medicines had the appropriate training.

Risk assessments were clear and readily identified how to mitigate them. Staff were familiar with these documents and the actions they needed to take. Visiting healthcare professionals reported how knowledgeable, competent and skilled the nurses were and found they had a good working relationship with staff.

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. Staff had received training around the Mental Capacity Act 2005 and associated code of practice and felt confident applying this in their practice. Staff took steps to safeguard people and promote their human rights.

The management team had created a robust governance system, which rapidly identified any issues, which were then quickly addressed. The registered manager critically reviewed the service and proactively looked at how improvements could be made. Staff told us that the registered manager was approachable and listened to their views. People felt the registered manager was running a good service.

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 8 June 2021).

At the time we found the service was in breach of regulation regarding medicine management. 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 and the provider was no longer in breach of regulations.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

This report only covers our findings in relation to the key questions safe and well-led. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Brockwell Court on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Brockwell Court Care Home is a residential care home providing nursing and personal care to older people and people living with dementia. The home accommodates up to 75 people across four separate wings, each of which has separate adapted facilities. One of these wings specialises in providing care to people living with dementia. 61 people were living at the service when we inspected.

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

Medicines were not managed safely. Audits were carried out but these had not identified or addressed the issues we found with medicines management.

Risks were assessed and addressed. People were safeguarded from abuse. Effective infection prevention and control measures were in place. Accidents and incidents were monitored.

Feedback was sought and acted on. People and staff spoke positively about the management of the service. Staff said they were supported in their roles.

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 good (published 15 October 2019).

Why we inspected

The inspection was prompted in part due to concerns received about staff use of personal protective equipment (PPE), medicines management, pressure care and staff knowledge of people’s support needs.

As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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

We have found evidence that the provider needs to make improvements. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Brockwell Court Care Home on our website at www.cqc.org.uk.

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 providers to account where it is necessary for us to do so.

We have identified breaches in relation to medicines management at this inspection.

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

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.

Brockwell Court is a residential care home which provides people with nursing and personal care. The home can accommodate up to 75 people. The home has four areas of accommodation – Allensford, Blanchland, Corbridge and Dewentside. At the time of our inspection Allensford was closed for refurbishment. This meant temporarily the home could accommodate 55 people and there were 52 people using the service.

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

People were consulted about ongoing environmental changes at the service which was having an impact on people moving rooms short term.

Medicines were managed safely, there were enough staff on duty and staff were recruited safely. People were protected from abuse by staff who understood how to identify and report any concerns. The risks to people’s health, safety and welfare had been assessed, recorded and plans put in place to reduce these.

People were supported to access healthcare services if needed. People were supported to have enough to eat and drink and staff were trained to support people who had different dietary needs.

Interactions we saw between people and the staff team were very positive and relatives also said they were made very welcome at the home. People were treated with kindness, dignity and respect.

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 were supported to engage in activities they enjoyed and we saw the service promoted people accessing local community facilities and supporting them to go on trips. People and their relatives told us they knew how to make a complaint.

There was a clear management structure and staff were supported by the registered manager. Quality assurance systems were completed.

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 requires improvement (published 3 April 2019) 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 and the provider was no longer in breach of regulations.

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.

People’s experience of using this service: Records held in the service to describe people’s care needs and provide guidance to staff were not always accurate and up to date.

Information was provided to kitchen staff about people’s dietary needs. This was not always accurate and information used by kitchen staff to serve people’s meals in one area of the home contained errors.

Checks had been carried out to ensure people lived in a safe environment. There were however gaps, in some of these checks. Actions were agreed with the regional manager and the registered manager with the fire service to reduce potential risks in the home.

The service had failed to assure themselves agency staff who worked in the service had the necessary background to deliver people’s care needs. Pre-employment checks were carried out on permanent staff to ensure they were suitable to work in the home. People told us they had experienced insufficient staff being on duty.

People who used the service were not always treated with dignity and respect. We made a recommendation about the provider finding ways to improve this area of practice.

People’s personal risks were not identified or actions put in place to reduce the risks of harm to people. Where accidents and incidents had occurred, the registered manager had monitored them to see if they could have been prevented.

Staff had access to gloves and aprons to support them in their duties. Cleaning was ongoing in the home to reduce the risk of cross infection. However, there were areas of the home which required further cleaning.

The care provided fluctuated in different parts of the home. Whilst people and their relatives spoke positively about staff, people who lived in the Allensford area of the home lived in poor conditions. The fabric of their part of the home required attention. Following our site visits the registered manager told us the flooring problems had further deteriorated and the provider had taken the decision to close the unit.

Induction, training and supervision was provided to educate and support staff carry out their roles. Staff felt supported by the registered manager and were complimentary about their management skills.

People were supported with their health by staff who had regular contact with other healthcare professionals to discuss people’s conditions and seek advice. Information from other professionals had not always been incorporated into people’s care plans.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. People were given choices and their decisions were respected.

Staff spoke to people with kindness. People felt staff acted in a kind manner. There were examples of staff supporting people to be more independent.

People had the opportunity to give their views about the service and a complaints procedure was available. Complaints had been thoroughly investigated. Relatives were invited to meetings to give their views and hear news about the service.

Activities were provided in the service. An activities co-ordinator was supported by staff to engage people in meaningful activities during our inspection.

People’s preferences for their end of life care had been discussed with them and their wishes were noted. Arrangements were in place for people who did not wish to be resuscitated.

More information is in the 'Detailed Findings' section below. For more details, please see the full report which is on the Care Quality Commission’s (CQC) website at www.cqc.org.uk

Rating at last inspection: At our last inspection in January 2018 this service was rated as requires improvement. (Report published 13 March 2018)

Why we inspected: This was a scheduled inspection based on the previous rating.

Improvement Action: Please see the ‘action we have told the provider to take’ section towards the end of the report.

Follow up: We will continue to monitor the service through the information we receive and discussions with partner agencies. We will be speaking to the provider about their next steps to improve the service to an overall rating of Good. We have rated the well-led key question inadequate. This means we will inspect the service within the next six months.

During this inspection we found breaches of Regulations 10, 12, 15, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because staff were not aware of people’s needs and how to keep them safe. The provider had not done all that was reasonably practicable to mitigate risks to people including the safe administration of people’s topical medicines and the cleanliness in the home. The premises in certain parts of the home were unsafe. The audits carried out to monitor the service had failed to identify these issues and records were not always up to date and accurate.

Brockwell Court 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. The home can accommodate up to 75 people. At the time of our inspection there were 70 people using the service. The home was divided into four areas – Allensford, Blanchland, Corbridge and Derwentside. Each area had a different emphasis on meeting people’s care needs.. For example Allensford focussed on people with dementia whilst the Derwentside focussed on people with nursing care needs. People can transfer between the areas.

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

The local infection and prevention control team had visited the home and carried out an audit in August 2017. They returned in January 2018 and found not all of the actions had been carried out. We found the Allensford area of the home was odorous and lacking in cleanliness.

We found the administration of people’s medicines varied in the home. There were arrangements in place for the ordering, receipt, administration and disposal in the home. However we found in Allensford some topical medicines (creams applied to the skin) in people’s bedrooms which were out of date. These were removed by staff during our inspection.

Relatives told us there were not enough staff on duty. We looked at people’s needs and the demands place upon staff and found more staff were required to provide the necessary support to people. The deputy manager told us new staff were being employed in the home.

Regular maintenance checks were being carried out to ensure people were protected from fire and water hazards. However we found areas of the home to be unsafe. For example we found some emergency pull cords were tied up and out of reach of people who may have fallen to the floor.

We saw that the physical environment in Allensford did not reflect best practice in dementia care. Adaptations were not in place to support people to remain independent. We also found some care practices did not always promote the dignity of people living with dementia. The regional manager brought a dementia care specialist into the home who agreed to support the home make improvements.

Checks were carried out on staff before they started working in the service to ensure they were suitable to provide care to vulnerable people. After being appointed, staff underwent an induction process and were supported through supervision and appraisal. However we found not all staff had received the four supervision meetings with their supervisor in 2017 and annual appraisals.

Other professionals had been consulted regarding people’s health care needs and advice sought. We found the guidance and advice provided by other healthcare professionals was not always acted upon by the care staff.

Audits carried out in the home failed to identify the deficits we found during the inspection.

People were protected from the risk of abuse because the staff in the home understood their responsibility to keep people safe and the actions to take if they were concerned a person may be at risk of harm.

We saw some staff knocking before entering people’s rooms, and closing bedroom and bathroom doors before delivering personal care. However we found not all staff knocked on people’s doors before entering.

Staff recorded incidents and accidents on the provider’s electronic system. The registered manager reviewed the accidents as they occurred. However, we found some accidents in people’s files which had not been recorded on the system for the registered manager to review.

The registered manager and staff were aware of the deprivation of liberty safeguards and they knew the processes to follow if they considered a person's normal freedoms and rights were being significantly restricted.

Staff provided support and encouragement to people to eat. Food supplements had been sourced for people who were at risk of weight loss. Menu boards were available but not in use to enable people to make meal choices.

People’s care plans contained person centred information and described people’s needs in detail. We found people’s care plans who had been discharged from hospital for intermediate care prior to making decisions about their future care needs were documented on the NHS documentation. had familiarised themselves with their discharge plans.

Complaints had been investigated by the registered manager and appropriate responses were provided to the complainants.

Lessons had been learnt by the management team. We saw there was a ‘You said, We did’ board where the management team had listened to people’s comments and taken action.

The provider had an electronic system in place for gathering feedback about the quality of the service. People who used the service, their relatives and professionals had given positive feedback about the home and the way it was run.

Following the inspection the registered manager sent us an action plan to tell us what actions they had taken and intended to take to improve the service.

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

The concerns were raised with CQC on the 29 June 2014.

The inspection team involved two inspectors and a member of Durham County Councils Safeguarding Team.

We arrived at the home at 10.am on 18 July. A single inspector re-visited the home on 21 July 2014.

We looked at the information sent to us by the provider and additional information provided by the Police and Durham County Councils Safeguarding Team. We also looked at the information we held about the service. As part of our inspection we spoke with the regional manager, deputy manager, another registered manager from a sister home, two senior carer's one RGN and five care staff.

The focus of this inspection was to check that people were safe and to ensure people experienced effective and appropriate care, treatment support that met their needs and protected their rights.

Are services safe?

People told us they felt safe. We observed that people were treated with dignity and respect by the staff.

We saw that the safeguarding procedures were robust and staff we spoke with understood how to safeguard the people they supported.

Systems were in place to make sure that the manager and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations.

The home had policies and procedures in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). We saw four applications had been completed and were about to be submitted to the supervisory body (local authority) to request to deprive someone of their liberty. Relevant staff had been trained to understand when an application should be made.

The registered manager has overall responsibility of the staff rotas. They take people's care needs into account when making decisions about the numbers, qualifications, skills and experience required. This helped to ensure that people's needs could be met.

On examination of staff records we found that the staff received regular supervision and an annual appraisal. There were policies and procedures in place to make sure that unsafe practice is identified so that people were protected.

Are services effective?

People's health and care needs were assessed with them and with their relatives or representatives where appropriate. People were involved in writing their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required. People and relatives we spoke with said that they had been involved in writing them and they reflected people's current needs.

We found that people, where possible were involved in most decisions about their care and support. Staff made appropriate referrals to other professionals and community services, such as the dietician, mental health team, CPN's, GP's, care manager's and other health care professional's We saw that the care staff team understood people's care and support needs, and the staff we observed were kind and thoughtful towards them and treated them with respect.

People's needs were taken into account with signs around the home that made it easier for people to see where toilets, bathrooms and bedrooms were located. Doors of these rooms were colour coordinated to help with this. The layout of the building enabled people to move around freely and safely. The premises had been sensitively built to meet the needs of people with dementia and physical impairments.

Visitors confirmed that they were able to see people in private and that visiting times were flexible.

Are services caring?

People were supported by kind and attentive staff. We saw that staff showed patience and gave encouragement when they supported people. For example we saw one person with poor mobility who was standing in the corridor looking 'lost' and was anxious. A staff member offered them reassurance, engaged them in conversation and tried to find out where they wished to go and what they wanted to do.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

We saw that people were well cared for. They told us that they spoke to staff about their preferences, and that this was undertaken in an informal way. Every one commented on the kindness and gentleness of the staff at the home. People told us that their dignity and privacy were respected when staff were supporting them, and particularly with personal care. We saw that staff addressed people by their preferred name and we heard staff explaining what they were about to do and ask people if it was alright before carrying out any intervention.

On the day of our inspection, we spoke with two professional involved with people's care and support needs. A care manager said 'I believe that the staff provided good support and the interventions used support people to make informed decisions where they are unable to do this by themselves'.

A doctor said 'I visit the home at least three times a week. The staff are very caring and they quickly identify when a person becomes ill, physically/or mentally, and requires treatment, and they immediately respond to meet their needs.

In addition, we contacted a number of other health and social care professionals involved with people's care and support needs. All said that the staff were professional and responded well to people's needs.

Are services responsive to people's needs?

People regularly took part in a range of activities in and outside the home.

People knew how to make a complaint if they were unhappy. People said they did not have any concerns or complaints. We looked at how complaints would be dealt with, and found that on one recent complaint the responses had been thorough and timely. People can therefore be assured that complaints are investigated and action is taken as necessary.

Are services well-led?

We spoke with sixteen people who lived at the home and six visitors about the staffing levels and the management team. They said 'The staff are lovely and very kind'. 'There have been positive changes made by the manager.'

One relative said 'I am completely satisfied with the care my relative receives'.

Other comments included;

'The care is 100%'.

'I visit every day. This is the third home my relative has been in and I have no concerns at all. I did once raise a concern and the manager dealt with this immediately'.

'I was able to accompany my relative on an outing in the provider's mini bus to Seaton Sluice earlier today and we had a lovely day out. My relative receives very good care here'.

'My friend has only been here for two weeks and I can see a massive difference in their health and wellbeing'.

"I have travelled up today from down south. This is my first visit to the home and I am very impressed with the overall care my relative is receiving. It is my wish that they can stay here on a permanent basis'.

People who lived at the home and their relatives or representatives completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed.

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service has a quality assurance system to monitor the service provided. Records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service continued to be monitored to ensure standards are maintained.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and the quality assurance processes in place. This helped to ensure that people received a good quality service at all times.

During our inspection we asked the provider, staff and people who used the service specific questions; is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

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

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us they were treated with respect and dignity by the staff. They said they felt safe. We found safeguarding procedures to be robust and staff understood how to safeguard the people they supported.

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

The home had proper policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. The manager told us about an application that had been submitted. We also found relevant staff had been trained to understand when an application should be made, and how to submit one. This meant people were safeguarded as required.

The service was safe, clean and hygienic. Equipment was well maintained and serviced regularly therefore not putting people at unnecessary risk.

The registered manager set the staff rotas, they told us they took people's care needs into account when making decisions about the staffing numbers, qualifications, skills and experience required. This helped to ensure that people's needs were met.

Is the service effective?

There was an advocacy service available if people needed it, this meant people could access additional support when required.

People's health and care needs were not fully assessed with them, and they or their representatives were not fully involved in writing their plans of care. We made a compliance action to make sure this issue was addressed by the provider.

Specialist dietary, social, mobility, equipment and dementia care needs had been identified in care plans where required.

People's needs were taken into account with signage and the layout of the service enabling people to move around freely and safely. The premises had been sensitively adapted to meet the needs of people with physical, memory and mental health impairments. We saw improvements had commenced to extend the dementia care unit and a landscaped sensory garden was almost completed for people to use.

People who used the service confirmed they were able to see people in private and that visiting times were flexible.

Is the service caring?

People told us they were supported by kind and attentive staff. We saw care workers showed patience and gave encouragement when supporting people. People commented, 'The staff are very good. They put me at my ease,' 'This is a good place to live. They look after me very well, there is wonderful food. It's nice here. We all have a nice time,' 'I have a bell in my room. When I pull it the staff come quickly' and 'They are good the staff. They would get the doctor quickly if I was unwell.'

People using the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. Where shortfalls or concerns were raised, we saw these had generally been addressed by the provider.

People's preferences, interests, aspirations and diverse needs were recorded and care and support was provided in accordance with people's wishes.

Is the service responsive?

People completed a range of activities in and outside the service regularly.

People we spoke with knew how to make a complaint if they were unhappy.

Is the service well-led?

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and the quality assurance systems in place. This helped to ensure that people received a good quality service.

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service had a quality assurance system. The records we looked at showed any shortfalls were addressed promptly. As a result the quality of the service was continuingly improving.

All of the people we spoke with were full of their praise for the care and attention they were receiving.

One lady said 'I have no complaints. The staff show me a lot of respect and are very kind." Other comments included: 'If you want something you only need to ask and they will get it for you.' Another person said "I was a Cook prior to my retirement and the food is like how I made it at home."

One relative told us 'My husband was in two homes before he came here and this is the best. I could not fault the care for my husband who spends a lot of time in bed. I have nothing but praise for the staff. They are very kind and patient. It is like a family here.'

Several relatives commented on the great improvements since there had been a change of management in the home. One relative said "The staff are really working as a team now. There is a change in the atmosphere and everyone seems to be keen to help each other even more than before.'

Another relative said 'My grandfather is very happy here. The staff are fantastic and always on the go. They thought they might be slightly understaffed sometimes. She said her grandfather was always very smartly dressed every time she came in to see him. He likes his food and he is well fed here."