Brockshill Woodlands

Brockshill Woodlands is a care home service, it provides personal care to older people, people with physical disability and people living with dementia. At the time of the inspection there were 23 people using the service. The service can support up to 30 people.

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

People felt safe because they had confidence in the staff and could speak with them if they had any concerns. Staff understood their responsibilities to keep people safe and to take action if abuse was suspected. Risks were assessed and management plans were in place to reduce the risk of avoidable harm.

There were enough staff to meet people’s needs. Staff were recruited in a safe way because checks were carried out before employment was offered. Staff had training about managing people’s medicines and did this in a safe way.

People had their needs assessed before moving in. Staff had the training and support they required to meet people’s needs.

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 had access to healthcare professionals such as GP’s and community nurses.

Staff had developed positive relationships with people and treated people with respect, kindness and compassion. People had autonomy about how they lived their lives.

Care and support was person centred, staff knew people well and understood their needs. People were able to follow their interests and hobbies and were supported to maintain relationships with their friends and family.

The culture of the service was open and inclusive. People and staff felt supported by the registered manager. Audits were carried out and the provider had oversight of the service through reporting systems and audits. Action was taken where shortfalls were identified, and improvements were made.

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 8 November 2019) and there were 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.

Why we inspected

The inspection was prompted in part by notification of an incident following which a person using the service died. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk. This inspection examined those risks.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe 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 COVID-19 and other infection outbreaks effectively.

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

Follow up

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

Brockshill Woodlands is a care home service, it provides personal care to older people, people with physical disability and people with dementia. At the time of the inspection there were 23 people using the service. The service can support up to 30 people.

Brockshill Woodlands provides accommodation across two floors, with a lift to the second floor. People with higher dependency needs are accommodated on the ground floor. There is an enclosed communal garden. There are a range of bungalows in the homes grounds that currently accommodate people living independently.

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

People told us they felt safe. However, we identified concerns with the management of risks to people, risks in the environment and infection control. Systems and processes to monitor the safety and quality of the service had not identified concerns that we found prior to our inspection.

Improvements were needed around people’s mealtime experience to ensure people enjoyed their food and were well supported.

Information was not consistently provided in a way that people could understand, we have made a recommendation around this. The provider had plans in place to make the home dementia friendly, this had started at the time of the inspection and would need to be continued and embedded.

Staff were trained to ensure they had the skills they needed to meet people’s needs. They received regular supervisions and appraisals. We observed that staff did not always use their knowledge from training and we saw some examples of poor practice around infection control and support for people.

People were protected from abuse with whistle blower support available for people and staff. People told us that staff were kind and caring and we saw examples of this during our inspection.

Medicines were managed, stored and disposed of safely and people received their medicines when they needed them. The service worked in partnership with other professionals to ensure people had access to health care when they needed it.

People were involved in the planning and delivery of their care or where appropriate their family member or advocate were involved to ensure people had choice and control. Regular questionnaires and meetings ensured that people were listened to.

People knew how to make a complaint if they needed to and complaints were managed in line with the providers policy.

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.

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 17 February 2017).

Enforcement

We have identified breaches in relation to the safety of people living in the home and the providers oversight of the safety of the environment and quality of the service.

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

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Brockshill Woodlands is a residential care home providing accommodation for up to 30 older people who live with dementia, physical disability and mental health needs and who require personal or nursing care. The home has 23 bedrooms, 10 of which have ensuite facilities. There are toilets and bathrooms on each of the two floors. There are two communal lounges and a dining room. At the time of our inspection 19 people were using the service.

The service did not have a registered manager 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. At the time of our inspection the service was managed by a manager who was in the process of applying to be registered manager.

People who used the service were safe. They were supported and cared for by staff that had been recruited under recruitment procedures designed to ensure that people suited to work at the service were employed. Staff understood their responsibilities for protecting people from abuse and avoidable harm.

People’s care plans included risk assessments of activities associated with their care routines. The risk assessments provided information for care workers that enabled them to support people safely but without restricting their independence.

There were sufficient numbers of suitably skilled and knowledgeable staff deployed to meet the needs of the people using the service. Staffing levels were decided according to the needs of people using the service. Care workers duties included kitchen duties which meant a care worker was diverted from directly supporting people for up to three hours a day.

People were supported to receive the medicines by staff that were trained in medicines management.

Care workers were supported through supervision and training.

The manager understood their responsibilities under the Mental Capacity Act (MCA) 2015. Staff had awareness of the MCA and understood they could provide care and support only if a person consented to it and if the proper safeguards were put in place to protect their rights. There were people at Brockshill Woodlands who were being cared for under the Deprivation of Liberty Safeguards of the MCA.

People’s lunchtime meals were delivered ready made from the provider’s ‘central kitchens’ service based at another residential home service run by the provider. Some people told us they enjoyed their meals, others told us they did not. People who required support with eating were supported.

People using the service were supported people to access health services when they needed them.

Where they were able to be, people were involved in decisions about their care and support. They and their relatives received the information they needed about the service and about their care and support. However, on the day of our inspection people were not provided with enough information to make an informed choice about their lunch-time meal.

We observed staff treating people with dignity and respect when they supported them apart from on two occasions.

People and their relatives contributed to the assessment of their needs and to reviews of their care plans. Their care plans were centred on their individual needs. People knew how to raise concerns if they felt they had to and they were confident they would be taken seriously by the provider.

People were supported to participate in activities. These included social and individual activities. We have made a recommendation about activities for people living with dementia.

The provider had arrangements for monitoring the quality of the service. These arrangements included asking for people’s feedback about the service and a range of checks and audits. The quality assurance procedures were used to identify and implement improvements to people’s experience of the service. A check that had been delegated to care workers had not always been correctly carried out. The provider had not acted, by the day of our inspection, on a requirement from a local authority food hygiene inspection in March 2016 but they were reviewing the situation.

Brockshill Woodlands is a residential care home that provides care and support for up to 30 older people living with dementia, physical disability and mental health needs. The home has 23 bedrooms, 10 of which have ensuite facilities. There are toilets and bathrooms on each of the two floors. There are two communal lounges and a dining room. At the time of our inspection 15 people were using the service.

The service has a registered manager. 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.

People using the service were protected from abuse and avoidable harm. Staff understood and practised their responsibilities for keeping people safe. People’s care plans included risk assessments which included information for staff about how to support people safely.

There were enough care workers to meet the needs of people using the service. However, care workers were particularly busy in the period from 11.45am to 1.30pm. During that period they served lunches, supported people to have their meals then cleaned the dining room, kitchen and washed cutlery and china. They had much less time to attend to people’s needs during that time.

People were supported to have their medicines at the right times. The arrangements for the storage of medicines were safe.

People were supported by staff with the right skills and knowledge. Staff were supported through training and supervision. Staff were aware of their responsibilities under the Mental Capacity Act 2005.

Lunchtime meals are delivered from another home run by the provider. Choice of meals was limited and people were not given an accurate description of the meals that were available. Meals were not served in a way that made them look appetising. A food hygiene inspection by the local authority two weeks before out inspection downgraded the food hygiene rating from `5’ to `3’.

People were supported to access health services when they needed those services.

Staff were kind and caring. We saw staff being attentive to people’s needs and ensuring their comfort. Staff supported people with their privacy and dignity. We also saw examples of staff being well intentioned but not as skilful as other staff. We brought this to the attention of the registered manager who supported the staff to understand how they could improve.

People were involved in decisions about their care and were provided with information about the service and independent advocacy.

People received care that was personalised because the staff understood people’s needs and preferences. People were provided with social activities at the home and outside. The registered manager was introducing new and fresh activities for people, including for those living with dementia.

People knew how to make a complaint and raise a concern. They had opportunities to contribute suggestions and ideas at residents meetings. If people wanted to they participated in reviews of their care plans.

The registered manager had a clear aim about what they wanted to achieve for the people using the service. Their aims were supported by staff. People using the service and their relatives expressed confidence in the registered manager.

The registered manager regularly monitored the quality of the service and sought the views of people using the service to identify improvements. Their monitoring activity was verified by the regional director who carried out their own checks and reported findings to the provider’s board of directors.

A refurbishment of the premises was expected to take place after an audit of the premises by the provider’s estates department. The registered manager had expectations that the refurbished premises would be more `dementia friendly’. We made a recommendation about guidance the provider could refer to about this.

When we returned to inspect the service in January 2014 to review the improvements made we found two walk in shower facilities 'wet rooms' had been installed and additional equipment had been provided to an existing bathroom to increase is accessibility for people with mobility difficulties. We found repairs had been undertaken to areas within the service which had been identified as requiring improvement.

The senior carer in charge of the service on the day of our visit told us that people who used the service had benefited from the installation of the shower facilities. They told us staff were now able to provide a choice to people as to whether they wanted a bath or shower as the facilities were now accessible to those with mobility difficulties.

During our visit we observed staff encourage people to take part in individual or group activities which included throwing a ball and a game or skittles. We noted some people were actively watching the television whilst two people sat reading the daily newspaper. One member of staff sat with one person and looked at a book with them. The television was turned on in one lounge whilst in the other lounge music was being played. In the afternoon a number of people went out on the mini-bus for a drive into the countryside and stopped for a drink.

We looked at four people's care plans with regards to eating and drinking and their involvement in care planning including their consent to care. We found people's care plans in these areas had been regularly reviewed and either the person themselves and / or their relative had signed their care plan. We found where people did not have capacity to make an informed choice the registered manager had liaised with health and social care professionals and people's relatives to ensure people's rights were promoted and protected. We found care plans had been regularly reviewed and showed where necessary appropriate health care referrals had been made to ensure people's health and welfare was monitored and supported.

Records showed that gas systems had been checked by external contractors as to their safety. We toured the premises and found that the services communal sitting and dining facilities were well maintained and met people's individual and collective needs. We found the service required improvement in some aspects of maintenance, which included the number of accessible bathing and showering facilities to meet people's individual and collective needs. Improvements were also identified as requiring attention in individual bedrooms. The provider has provided us with information as to what action they will be taking to address the issues identified.

The provider had a procedure for people to raise concerns or make a complaint. We noted a recent complaint had been recorded and the action taken, including the response to the complainant.