Brook House

Brook House is a care home with nursing registered for a maximum of 47 people. People living in the home may have health and mobility issues associated with old age, physical disabilities or sensory impairment. At the time of our visit, there were 47 people living in the home.

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

Medicines were not always managed safely.

People were safeguarded from the risk of harm or abuse. Staff were recruited safely. People had risk assessments to reduce the risk of harm they may face.

Care workers we spoke with told us that there was a lack of staff on the 2nd floor. We raised this with management who said that they would review this.

People and their family members told us they were happy with the care provided and living at the home. People were supported by a team of consistent staff who knew them well and who had the right skills, experience and knowledge to look after them.

People’s needs were assessed including risks to people’s health and the environment they lived in which was monitored to ensure safety. The service was well maintained, clean and homely. People were protected from the risks associated from the spread of infection.

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.

We observed caring interactions between staff and people using the service. People's cultural and religious needs were met. Staff understood how to form positive relationships with the people they supported. Staff promoted people's privacy, dignity and independence.

There was a variety of activities available for people to get involved with. Care plans contained information about people's preferences and needs.

Staff spoke highly of the registered manager and said they felt well supported. Staff were able to approach the management team and felt valued and happy in their role.

There were systems in place for communicating with people, their family members, and staff to collect their views and feedback regarding people's care and support.

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

Rating at last inspection

The last rating for this service was good (published 07 June 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service. 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 COVID-19 and other infection outbreaks effectively.

Enforcement and recommendations

We have identified 1 breach of regulation 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 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.

The home is owned and operated by Barchester Healthcare Homes Limited. Brook House is registered to provide care and accommodation for up to 47 people. At the time of the inspection there were 45 people living in the home.

At our last inspection on 4 April 2016 the home met regulations inspected and was rated good. The home remained good at this inspection.

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 (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 2008 and associated Regulations about how the service is run.

People who lived in the home and their relatives told us they were satisfied with the care provided in the home and spoke positively about care staff and management at the home. Some people in the home had complex needs and were therefore unable to provide us with feedback. We therefore spent time observing interaction between people and staff. During the inspection we observed people were well cared for and appeared relaxed and comfortable in the presence of care staff. We observed positive engagement between staff and people. Staff were respectful of people and showed a good understanding of each person’s needs and abilities.

Risks to people had been assessed, updated and regularly reviewed to ensure people were safe and risks to people in relation to treatment or care were minimised.

People we spoke with told us they felt safe in the home and around staff and this was confirmed by relatives we spoke with. Staff had received training on how to identify abuse and understood their responsibilities in relation to safeguarding people, including reporting concerns relating to people’s safety and well-being.

Skin integrity was effectively managed by the home. We saw good evidence of diligent skincare and clear guidance was detailed in care plans. Pressure sore repositioning charts were well maintained for people at high risk of developing pressure ulcers.

Medicines were managed safely and staff were appropriately trained. We however found that there was no provision to dispose of unwanted cytotoxic medicines [medicines that have a toxic effect on cells] at the home and made a recommendation in respect of this.

We discussed staffing levels with management and they advised that staffing levels were assessed depending on people's needs and occupancy levels. The home used their own dependency tool to monitor this. The majority of staff we spoke with told us there were sufficient numbers of staff to safely meet people’s individual care needs. During the inspection, we observed staff did not appear to be rushed and were able to complete their tasks.

The home had appropriate fire and emergency systems in place. There was a record of essential maintenance carried out and this was monitored and maintained by the home's maintenance manager.

Staff received on-going training and spoke positively about the training they received. Regular supervisions and appraisals ensured staff performance was monitored.

All staff we spoke with told us they were well supported by management at the home and said that morale in the home was positive.

People received a comprehensive initial assessment of their needs with their families’ involvement before moving into the home. The pre-admission assessment included information about people’s health and care needs. Individualised care support plans were then prepared using the detail from pre-admission assessments and plans identified people’s preferences, needs, and included details of how staff were to provide them with the care they needed.

The home worked well with external health and social care agencies to ensure people received the care, treatment and support they needed. We saw evidence that people’s healthcare needs were closely monitored by 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 supported this practice. The home operated within the principles of the Mental Capacity Act 2005 (MCA).

Where people were unable to leave the home because they would not be safe leaving on their own, the home had made applications for the relevant authorisations called Deprivation of Liberty Safeguards (DoLS).

People spoke positively about the food available in the home. There was a four weekly food menu which changed every three months according to the season of the year. We looked at how people were protected from poor nutrition and supported with eating and drinking. Care records demonstrated that the home monitored the nutritional needs of people. We observed some people had low weight and a low body mass index and saw that there was clear information about how to support the person with the nutritional needs, preferences and clear guidance for staff detailing how to encourage the person to eat.

The home had held a nutrition and hydration week from 12 to 18 March 2018. To celebrate this event they had organised some form of food or drink activity every day for that week. The purpose of this week was to raise awareness in the home about the importance of eating healthily and drinking fluids.

The home had a varied activities programme which was devised based on people’s interests. Different activities were held weekly so that people experienced a variety of activities. During the week of the inspection, we noted that the following activities were available; art and crafts, culinary craft, movies with popcorn and hotdogs, flower arranging and music from an entertainer. We noted that a 50’s and 60’s themed party was scheduled for 12 April 2018.

Procedures were in place for receiving, handling and responding to comments and complaints. We saw evidence that complaints had been dealt with appropriately in accordance with the policy.

The home had carried out a formal satisfaction survey in January 2018 to obtain feedback from people and relatives. The feedback obtained was positive.

The home had a system in place to obtain feedback about the level of care provided to people. This included an extensive range of comprehensive checks and audits carried out by management in various areas relating to care people received, maintenance and the management of the home. Management carried out a range of monthly and quarterly audits in respect of care documentation, health and safety, safeguarding, medicines, complaints/compliments, infection control, activities, staff files and training.

Management carried out “daily walkabouts” where observations around the home were carried out. This looked at checking care plans, MARs, clinical issues, dining experience, pressure sore care, the call bell, accidents and incidents.

We observed care documentation was well maintained, up to date and comprehensive. The home had a range of policies and procedures to ensure that staff were provided with appropriate guidance to meet the needs of people. These addressed topics such as infection control, safeguarding and health and safety.

People’s care records and staff personal records were stored securely which meant people could be assured that their personal information remained confidential.

There was a clear management structure in place and staff told us morale within the home was positive and staff worked well with one another. Staff told us management were approachable and there was an open and transparent culture. They said communication in the home was good and they were informed of changes.

At our last inspection on 6 August 2014 the service met the regulations inspected.

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 (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 2008 and associated Regulations about how the service is run.

People and their relatives informed us that they were satisfied with the care and services provided. On the day of our inspection we observed that people were well cared for and appropriately dressed. People who used the service said that they felt safe in the home and around staff. Relatives of people who used the service and care professionals we spoke with told us that they were confident that people were safe in the home.

Systems and processes were in place to help protect people from the risk of harm and staff demonstrated that they were aware of these. Staff had received training in safeguarding adults and knew how to recognise and report any concerns or allegations of abuse. Comprehensive risk assessments had been carried out and staff were aware of potential risks to people and how to protect people from harm.

People’s care needs and potential risks to them were assessed. Staff prepared appropriate care plans to ensure that that people received safe and appropriate care. Their healthcare needs were closely monitored and attended to. Staff were caring and knowledgeable regarding the individual choices and preferences of people.

On the day of the inspection we observed that there were sufficient numbers of staff to meet people’s individual care needs. Staff did not appear to be rushed and were able to complete their tasks. However some staff we spoke with told us that the staffing levels were inadequate and extra staff were needed as they were sometimes very busy. We raised this with management and they informed us that staffing levels were regularly reviewed depending on people's needs and occupancy levels.

Systems were in place to make sure people received their medicines safely. Arrangements were in place for the recording of medicines received into the home and for their storage, administration and disposal.

We found the premises were clean and tidy and there were no unpleasant odours. There was a record of essential inspections and maintenance carried out. The service had an Infection control policy and measures were in place for infection control.

Staff had been carefully recruited and provided with induction and training to enable them to care effectively for people. They had the necessary support, supervision and appraisals from management.

People’s health and social care needs had been appropriately assessed. Care plans were person-centred, detailed and specific to each person and their needs. Care preferences were documented and staff we spoke with were aware of people’s likes and dislikes. Identified risks associated with people’s care had been assessed and plans were in place to minimise the potential risks to people. People told us that they received care, support and treatment when they required it. Care plans were reviewed monthly and were updated when people’s needs changed.

Staff we spoke with had an understanding of the principles of the Mental Capacity Act (MCA 2005). Capacity to make specific decisions was recorded in people’s care plans.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS ensure that an individual being deprived of their liberty is monitored and the reasons why they are being restricted is regularly reviewed to make sure it is still in the person’s best interests. The home had made necessary applications for DoLS and we saw evidence that authorisations had been granted and some were awaiting approval.

There were suitable arrangements for the provision of food to ensure that people’s dietary needs were met. People were mostly satisfied with the meals provided. Food looked appetising and was freshly prepared and presented well. Details of special diets people required either as a result of a clinical need or a cultural preference were clearly documented.

People and relatives spoke positively about the atmosphere in the home. Bedrooms had been personalised with people’s belongings to assist people to feel at home.

People and relatives told us that there were sufficient activities available. On the day of the inspection we saw people taking part in “morning chats” discussing the news and board games. Activities for the week included bingo, manicures, a quiz and a jazz performer was scheduled to perform at the home.

Staff were informed of changes occurring within the home through daily staff meetings as well as quarterly staff meetings. Staff told us that they received up to date information and had an opportunity to share good practice and any concerns they had at these meetings.

The home had carried out an annual relatives and resident’s satisfaction survey in 2015 and the results from the survey was positive.

There was a management structure in place with a team of nurses, care workers, kitchen and domestic staff, deputy manager and the registered manager. Staff told us that the morale within the home was good and that staff worked well with one another. Staff spoke positively about working at the home. They told us management was approachable and the service had an open and transparent culture. They said that they did not hesitate about bringing any concerns to the registered manager.

There was a comprehensive quality assurance policy which provided detailed information on the systems in place for the provider to obtain feedback about the care provided at the home. The service undertook a range of checks and audits of the quality of the service and took action to improve the service as a result. Relatives spoke positively about management in the home and staff. They said that the registered manager was approachable and willing to listen. Complaints had been appropriately responded to in accordance with the service policy.

The focus of the inspection was to gather evidence to answer the five key questions : is the service safe, effective, caring, responsive and well-led?

Is the service safe?

The service was safe because risks were identified and managed effectively. There was adequate monitoring in place to ensure people's needs were fully met, for example in relation to hydration and nutrition. There was a strong focus on meeting the individual needs of people who used the service and this helped to reduce any particular risks to which they might be exposed.

The premises were well maintained and efforts had been made to reduce any environmental risks as far as reasonably possible.

Equipment was regularly maintained and serviced so that people were not at risk from using faulty, unsafe or unsuitable equipment. The environment was suitably clean and arrangements were in place to minimise potential infections arising.

The service had thought about planning for foreseeable emergencies and this had resulted in comprehensive plans and actions to cover any such occurrences.

The service had effective measures and procedures in place to ensure infections were controlled.

Is the service effective?

The service had sought people's consent before providing their care and support.

We were told by people who used the service and their relatives the registered manager and staff worked hard to provide a high standard of care and support at all times.

We were told the registered manager engaged very well with relatives and responded effectively to any concerns raised. We observed people had in place the equipment to ensure they received the care and support they required.

Is the service caring?

The service was caring because people who used the service and relatives told us the registered manager spent lots of time with people who used the service and demonstrated a very caring approach towards ensuring people were well cared for and happy.

We observed staff interacting with people and saw people were treated with respect which ensured their dignity was maintained. The service worked hard to ensure people's holistic needs were met, for example by ensuring people were supported to attend local churches of their choice. Reasonable adjustments were made to ensure people's dietary choices were respected and action had been taken with regard to the provision and quality of food available following a person's relative raising an issue about this.

Is the service responsive?

The service was responsive because we were told complaints made were listened to and we saw action was taken to resolve them as fully as possible. The service worked well with local hospitals to ensure people who were returning home were well supported to adjust to the change of environment.

The service focused on meeting people's needs as they changed over time. For example, people whose mobility had decreased were provided with appropriate equipment to ensure they could be safely supported by staff to move and transfer.

Is the service well-led?

The registered manager had ensured there were systems in place to assess and monitor the quality of service being provided. They showed us evidence of the fact they used such systems carefully to continually assess quality and they acted upon issues which the regular audits they had undertaken highlighted as needing action.

The registered manager had made sure there were robust systems in place to ensure all necessary checks were undertaken prior to staff being employed at the service and they monitored these systems to ensure this remained the case.

At this inspection we were satisfied that the service had arrangements to ensure that there were sufficient qualified, skilled and experienced staff in order to safeguard the health, safety and welfare of people who used the service.

People who used the service and their relatives informed us that they were satisfied with the care provided and there were sufficient staff on duty. Staff informed us that the staffing arrangements had improved and on the whole there were enough staff on duty. We observed that people appeared well cared for and those who spent time in the lounges were being supervised by staff.

People who used the service and their relatives informed us that overall, the care needs of people had been attended to and they had access to healthcare services. This was reiterated by two visiting professionals. Assessments, including risk assessments had been carried out. Care plans had been prepared and these were reviewed regularly. There were suitable arrangements for the administration of medication. The home had a varied programme of activities. However, four people who used the service and two relatives stated that there were insufficient staff on duty. They explained that there were insufficient activities and some people who used the service did not get the opportunity to be as mobile and as active as possible.

We spoke with nine staff. We found that staff were knowledgeable regarding the care needs of people. Staff records indicated that they had been provided with essential training. However, with one exception, they informed us that the staffing levels were inadequate and they had difficulty attending to the needs of people. They explained that a large number of people required a high level of care because of the their medical conditions and frailty. We noted that some people were not adequately supervised by staff and we witnessed an incident where people were put at risk of harm.

The home had a complaints procedure. Complaints made had been responded to. A record of compliments and cards from relatives expressing gratitude for the care provided was available in the reception area.