Archived: Brookdale Care Home

We found the following examples of good practice:

Robust procedures were in place for staff and authorised visitors to follow when entering and leaving the premises. This included temperature checks via a ‘no touch’ digital temperate scanner, clear instructions for donning, doffing and disposal of personal protective equipment (PPE) and recording of contact details.

Effective systems were in place to support isolation, cohorting and zoning (as and when applicable). Staff provided people shielding or in isolation with activity packs to keep them occupied. Additional staff hours were also dedicated to the welfare of people in their rooms.

The layout of the premises supported good IPC practice. Communal areas were spacious with good ventilation.

In the event of a person developing a sudden onset of signs and symptoms of coronavirus, staff used emergency 'breakout boxes' filled with essential PPE and temporary signage that warned a person was isolating.

A bespoke outdoor visiting pod had been built in the grounds of the home. This was of high quality and designed in consultation with residents and their families. For example, a choice of colours and fabrics had been created into mood boards which people then chose via social media channels.

Despite the challenges posed by the pandemic, the registered manager had maintained a focus on continuous service improvement. This included reviews and improvements on documentation, the level of engagement with staff and families, enhanced level of activities, new risk assessments and updated hygiene care plans and associated guidance.

The registered manager had developed a 'human rights charter' which sought to uphold the human rights of residents and their relatives throughout the pandemic. The home had embedded this into everyday practice.

Further information is in the detailed findings below.

A new manager had recently been employed at the service. They were in the process of registering with us.

People, their relatives and the staff all told us they felt confident in the leadership and management of the service.

We found the registered provider demonstrated a commitment to continuing to drive forward improvements in the service. The registered provider was always looking for ways to develop and improve the support provided to people who lived with dementia. This helped people receive good quality care in line with current and developing best practice.

Staff morale was good and the team were committed to ensuring people received care and support based on their preferences and choices. The staff team had recently won a national award for staff team of the year.

Staff had received training in safeguarding adults and knew what action they should take if they witness poor care or they thought a person was at risk. They were confident that the registered provider and manager would act to ensure people were kept safe.

People said they were always treated with respect and felt well cared for. Staff were safely recruited and good staffing levels afforded people responsive and dignified support.

People lived in a clean and comfortable environment and systems were in place to ensure the safe handling of medicines.

People’s care records showed that individual risk assessments were in place to help ensure they received safe care and support.

The manager ensured authorisation for any restrictive practices, carried out in people’s best interest, had been applied for from the relevant local authority.

People were supported by staff who had received training and support to provide effective care, with further developments planned.

The Cherry Blossom suite had been specifically designed to help people who lived with dementia find their way around, with wide corridors for those who wanted to walk without purpose.

People’s records showed their personal wishes and preferences had been considered. The records were kept under review to ensure people’s care and support needs had not changed.

People received support to engage in activities at Brookdale and were also able to do so within the local community. There were two activity co-ordinators who were committed and passionate about the role.

More information is in the detailed findings below.

Rating at last inspection: Good (report published January 2016).

About the service: Brookdale Care Home provides personal care for up to 58 mainly older people some who lived with dementia. At the time of the inspection 47 people used the service.

Why we inspected: This was a planned inspection based on the rating at the last inspection. This inspection was unannounced and took place on 12 and 16 November 2018 and completed on 17 December 2018.

Brookdale 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.

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 an application had been made by the manager to register with us. They were approved by CQC shortly after our inspection.

At our last inspection in November 2015 we rated the service as good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Brookdale Care Home provides care and personal support to up to 58 mainly older people, many of whom live with dementia. The service comprised of the main house and a specialist dementia unit. At the time of our inspection visit, 54 people were using the service.

The service had a registered manager in place. 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 we spoke with told us that they felt safe at the service. They said, “The fact is I’m some distance from the front door, and nobody can get in without being official,” and “The windows are secure at night.”

Staff had completed training in safeguarding adults. All the staff we spoke with told us of the correct action to take should they witness or suspect abuse, including the poor practice of colleagues. We saw a robust system of recruitment was in place in the service. This helped to protect people from the risk of unsuitable staff.

Procedures and training were in place for staff in relation to the safe administration of medicines as well as the prevention and control of the spread of infection.

People who used the service that we spoke with said they thought the home was clean and equipment well maintained. One person said, “I can’t fault it.” Relatives said they though the home was clean and well maintained. We saw that the service was clean, bright and welcoming. The decor was neutral, the bedrooms in the dementia unit were painted pastel colours, and this helped to create a calm atmosphere.

We saw tasteful Christmas decorations had started to be put up throughout the home. The grounds were seen to be well-maintained and plans were in place to add a second conservatory area to the front of the home in keeping with the main house.

We saw that staff received the induction, training and supervision necessary to enable them to do their jobs effectively and care for people safely.

Steps to ensure that any restrictions in place for people who used the service were legally authorised under the Deprivation of Liberty Safeguards (DoLS) had been taken.

Systems were in place to help ensure people’s health and nutritional needs were met.

The care records we saw contained good information about how people needed to be cared for and supported safely by staff.

A programme of activities was in place to help improve the well-being of people who used the service. There was also effective use of new technology such as iPad, ‘smart’ televisions, a sound system and a Twitter account to keep relatives and friends in touch with what was happening at the home.

Systems were in place to investigate and respond to any complaints people might make.

All the people who we spoke with told us that the registered manager was approachable and they could talk to them. One person said, “I’m sure I could but I’ve no reason to, I’m quite settled here.” Another said, “Yes, she’s alright, but really busy.” Relatives said they could talk to the manager. One relative said, “Yes, she’s lovely.” Another relative said, “The management team are good and responsive.”

Quality assurance and health and safety systems were in place that mirrored the CQC outcome areas safe, effective, caring, responsive and well led. Members of the staff team were asked to give their views and opinions about how the service was run.

The home was part of the Bury Dementia Action Alliance (BDAA), which aims to make Bury a more dementia friendly place to live.

Brookdale Care Home had won the regional award for the ‘Care Team of the Year 2015’ and were through to the national finals to be held in the near future.

Safe

People were protected from the risk of infection because appropriate guidance had been followed in all areas of the home. The home was seen to be clean and tidy throughout and no malodours were detected.

People we were able to speak with told us they felt safe and could speak to a member of staff if they had any worries or problems.

Caring

People who used the service appeared smartly dressed and well cared for. We saw that the interaction between people who used the service and the staff caring for them was frequent and friendly. The atmosphere was calm and relaxed. We saw members of the staff were able to communicate well with people with good eye contact and a ready smile.

We saw that because staff knew people who had dementia well, they were able to recognise any potential for anxiety, agitation and distress people might experience, and used de-escalation techniques to distract people.

A relative said 'The care my wife receives is good. The food is very good and the carers are very kind and considerate.'

Effective

The home had access to two doctors who were able to respond quickly should there be a change in people's physical and mental health. Both doctors were able to change a person's medication and consult with the GP who the person was registered with.

We saw that the provider had given thought to creating an environment that was dementia friendly, for example bright wide corridors for people to use should they wish to walk safely and a sound system that could stream in sounds of nature and music.

We saw that a new computerised records system had been introduced to the home. The system had had a significant impact on the day to day running of the home. It had reduced the time staff needed to complete paperwork and improved communication across the staff team.

Responsive to people's needs

People were able to participate in activities. We saw people involved in baking biscuits. Relatives were able to join in as well if they wanted to. The biscuits were to be cooked and then eaten with a drink during the afternoon activity. People who were able to speak with us told us they had been on trips out to Bury Market for fish and chips, Queen's Park, a garden centre, watching Irish Dancing at a civic hall and a local jigsaw event.

We saw that were possible people with dementia were supported within their own reality for example some ladies found it comforting to hold a baby doll and other people liked to push a child's trolley.

We saw that when a person returned from a hospital appointment they were immediately offered lunch and something to drink.

The home had completed the Six Steps programme to help staff to support people during the end of their life and work effectively with healthcare professionals such as doctors, district nurses and paramedics.

Well led

The home had a manager who was registered with the Care Quality Commission (CQC). The registered manager was present during our inspection visits.

The registered manager was supported by the operations manager for the organisation, an assistant manager and senior carer team.

We looked at a copy of the registered manager's monthly audit for August 2014 which was sent to the operations manager. The report covered a wide range of areas.

Prior to our visit to the home we contacted the local authority commissioning, quality assurance and safeguarding teams. We were informed there were no new concerns at this time.

At this inspection we found improvements in all areas. On checking people's bedrooms and en suites we found they had soap to use for washing, toothbrushes and hair brushes and combs.

We received a copy of the home's whistle blowing policy and procedure. We saw that staff had completed a questionnaire to confirm they understood what was meant by confidentiality, who to inform if they had any concerns, who dealt with complaints and if they had concerns that could not be raised with the registered manager who they could speak with. The questionnaire was signed by the staff member and their line manager to confirm they understood the procedure.

We found no areas of concern in relation to health and safety. We saw that a quality assurance review had been undertaken to find out the views of relatives. The collated results we saw showed a slight drop in overall satisfaction in some areas, and particularly laundry, with improvements noted in the provision of activities available for people who use the service.

People were supported to be able to eat and drink sufficient amounts to meet their needs. A substantial amount of food was offered to people and it looked and smelt appetising. People's independence was encouraged to eat their meals themselves and then prompt and assistance given where necessary.

People who use the service were not protected from the risk of abuse because the provider had not taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. We had not been informed by the home about a number of safeguarding investigations that had taken place.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

The provider had no effective system in place to identify, assess and manage risks to the health, safety and welfare of people using the service and others. We were concerned about some health and safety practices around the home for example security and fire safety.

People were not protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

We found that the provider had taken action to address this matter.