Brookview Nursing Home

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last inspection we rated this key question as Requires Improvement. The provider was also in breach of regulation as they failed to have systems and processes established which effectively assessed, monitored and improved the quality and safety of the services provided to people. They also failed to effectively assess, monitor and mitigate the risks relating to the health, safety and welfare of the people using the service.

Improvements were found at this inspection, and the overall rating of this section has improved to Good. The provider was no longer in breach of this regulation. This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

This service scored 68 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.
The provider had made improvements in this area since our previous inspection. The manager had a vision for a person-centred care home service which they shared with staff.
Staff told us how problems of consistency had previously been caused by regular changes of manager. For example, a staff member told us, “We had new staff joining while others left, then you had each new manager employed coming with their own way of working. It affected the consistency of how work is to be carried out.”
Another staff member told us, “In my time here, from day one to now, I have seen a massive improvement in the service. This is down to the new manager and clinical deputy manager who are also both new.”
Staff and the manager demonstrated a positive, compassionate, listening culture which promoted trust and understanding between them and people using the service.
Staff at all levels received training to ensure they understood equality, diversity and human rights, and so they understood the need to prioritise safe, high-quality, and compassionate care.

The provider had inclusive leaders who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.
The provider had made improvements in this area since our previous inspection. They had appointed a manager who had the experience, capability, and integrity to ensure the care home service met people’s needs and risks were well managed. The manager, clinical deputy manager, and senior care staff were visible and led by example, modelling inclusive behaviours.
The provider had effective recruitment processes in place to ensure new staff joining the care home were suitable and safe to appoint.
The manager was knowledgeable about issues and priorities essential to ensure the quality of services and was alert to any examples of poor culture which may affect the quality of people’s care and have a detrimental impact on staff. A staff member told us, “The residents are happy. The staff were a little down but, since they have appointed new management, things are all good and everyone is happy to come to work.”

The provider fostered a positive culture where people felt they could speak up and their voice would be heard.
The manager encouraged staff to raise concerns and promoted the value of doing so. When concerns were raised, the manager investigated sensitively and confidentially. Where lessons were learned, they were shared and acted on.
The manager told us when something goes wrong, people received a sincere and timely apology and were told about any actions being taken to prevent the same happening again.

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.
The provider had policies and procedures for inclusion and diversity within the workforce. For example, recognising people’s protected characteristics and ensuring appropriate measures were in place to support these. Protected characteristics are a set of nine characteristics which are protected by law to prevent discrimination. For example, discrimination based on age, disability, race, religion or belief, and sexuality.

The provider did not yet have clear responsibilities, roles, systems of accountability or good governance securely embedded into the service. They did not always act on the best information about risk, performance and outcomes, or share this effectively with others when appropriate.
At our previous inspection we found the provider was in breach of the legal requirement to have established systems or processes in place which operated effectively to assess, monitor and improve the quality of the services provided to people. Their systems and processes also failed to effectively assess, monitor and mitigate the risks relating to the health, safety, and welfare of the people receiving a service.
The provider had made some improvements in this area since our previous inspection and was no longer in breach of regulations.
However, the understanding of people’s health status, and the sharing of health-related information with relevant external healthcare agencies, was not always well managed. For example, an external healthcare professional told us, “Our team have not been made aware who the clinical lead is. The ward round is usually attended by a senior carer or a nurse. The staff rely heavily on one senior carer for both nursing and residential patients. [The senior carer] is aware of their limitations in respect of the nursing patients.”
Further, they told us, “Prior to the ward round, health observations have not always been checked and charts such as bowel charts and as required medication records are not always readily available.”
The manager told us they had already taken action to improve the situation and had implemented a structure to the preparations for the weekly ward round. This was to ensure the necessary information was available to share with the relevant health care professionals. However, these improvements were recent and therefore could not be evidenced as being fully embedded.
People’s daily care notes completion had improved since our last inspection. The manager had explained to staff why accurate and timely notes of the care provided to people were important. For example, recording what people ate and drank, regularly recording people’s weights, and the time at which personal care tasks were carried out. These observed improvements were also recent and therefore could not be evidenced as being fully embedded at the time of the inspection.
The manager ensured necessary notifications to external agencies, such as the Local Authority safeguarding team and the Care Quality Commission were submitted in a timely manner.
The provider had organised and effective arrangements in place for the availability, integrity and confidentiality of data, records and data management systems. The provider used a combination of electronic and paper-based records. The provider used that information to monitor and improve the quality of care people received.

The provider understood their duty to collaborate and work in partnership, but the service was not always effective at doing so at the time of the inspection. They did not always share information and learning with partners or collaborate for improvement.
The manager understood the importance and benefits of working alongside other professionals. The manager collaborated effectively with external safeguarding teams in the investigation of serious accidents or incidents. However, staff worked less effectively in partnership with external health care professionals to ensure people received effective care.
The manager was aware of this issue and was introducing clearer accountabilities and arrangements to ensure more effective partnership working was achieved with the external health care teams.

The provider focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people.
The manager had a good understanding of how to make improvement happen. The manager had a continuous improvement plan in place, which was used appropriately to track improvements which had been identified by the manager and staff as being needed. The approach was consistent and included confirmation when required improvements had been made.
The manager had developed processes to ensure learning happened from feedback received. For example, feedback from a recent relatives’ meeting mentioned issues with delays to answering phone calls and answering the front doorbell in a timely manner when visitors arrived. The manager had acted on those issues to put in place measures to resolve those problems.
The manager also learned from safeguarding incidents. For example, an incident relating to a prescribed medicine recording issue led the provider to learn from the incident and identify improvements which were then shared with the staff team and the provider’s other care home services. This reduced the likelihood of a similar incident recurring.