Archived: Brockhampton Court Care Home with Nursing

Brockhampton Court Care Home with Nursing is a care home providing personal and nursing care to a maximum of 58 older people and younger adults with physical disabilities within a large adapted building. At the time of our inspection, 39 people lived at the home.

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

There were aspects of the home environment that required action to ensure it was safe. For example, windows were not restricted, unsafe areas were unlocked and communal bathrooms had hot water pipes exposed. People's medicines were not managed and stored in a safe way. The provider’s representative recognised the seriousness of our concerns and took action to mitigate immediate risk.

People were safeguarded from the risk of abuse, and lessons were learnt following incidents and accidents. There were sufficient infection prevention and control arrangements in place and the home was clean. People told us staff were caring and kind. There were sufficient staff available to meet people's needs. Staff were recruited safely and had pre-employment checks to determine their suitability for employment.

The provider had systems in place to monitor the quality of the service, however, this was not always effective. People had access to information about how to raise a complaint and felt listened to. Staff worked with external healthcare professionals to follow their guidance and advice about how to support people following best practice. 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 March 2021).

Why we inspected

The inspection was prompted in part due to concerns received about medicines, infection control and staffing and also in part by a notification of an incident following which a person using the service sustained a serious injury. This incident is subject to a criminal investigation and 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 of falls. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

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 monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment of people at this inspection. Following our inspection, the provider took action to mitigate the risks identified and has sent us written and photographic evidence to confirm changes to the environment and management of medicines has been effective.

Follow up

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

Brockhampton Court Care Home with Nursing is care home providing personal and nursing care to a maximum of 58 older people and younger adults with physical disabilities within a large adapted building. At the time of our inspection, 41 people lived at the home.

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

The registered manager had made the necessary improvements since our last inspection to ensure people had their assessed needs met and were safe. Risks to people were now managed safely and systems to ensure people were protected from abuse were now effective.

The provider had implemented effective governance systems since our last inspection to identify shortfalls in the quality and safety of the service. Actions identified were addressed allowing continuous learning and improving the quality of care provided. These improvements meant the provider was no longer in breach of Regulation 17 HSCA RA Regulations 2014 Good governance.

People and staff felt the home was well-led by a supportive registered manager.

People were supported by staff who knew them well and felt safe. People reported there were sufficient staff to meet their needs.

People received their medicines from staff who were trained to administer medicines safely. Staff followed good infection control practices to reduce the risk 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.

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 09 September 2020). At that inspection three breaches in regulation were identified to Regulation 12 Safe Care and treatment of the Health and Social Care Act 2008 (Regulated Activities) Regulations, Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and 2014 and Regulation 18 Staffing of the Health and Social Care Act 2008 (Regulated Activities) Regulations.

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 regulation.

Why we inspected

This was a planned inspection based on the previous rating. This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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 coronavirus and other infection outbreaks effectively.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.

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

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.

We found the following examples of good practice.

¿ Visitors to the home were invited to wash and sanitise their hands, had their temperatures taken and completed a Covid-19 screening questionnaire prior to entering the home. Personal protective equipment were available for visitors to use. There was clear information on display on arrival to the home to ensure visitors followed guidance and procedures to ensure compliance with infection prevention control.

¿ People were supported to maintain contact with relatives and friends who were important to them through video, social media and telephone calls. The management team had maintained regular contact with relatives through emails, social media and telephone calls to keep them informed about the wellbeing of their family member. A ‘visiting pod’ was under construction at the time of our visit to introduce family visits when it was safe to do so.

¿ Arrangements had been introduced for staff to appropriately social distance as much as possible, during breaks and staff used a separate entrance to access the home.

¿ People who had tested positive for Covid-19 self-isolated in line with current guidance; whilst ensuring those people testing negative were kept separate as much as possible for the duration of the isolation period.

¿ Clinical waste and laundry were handled in line with government guidance.

Brockhampton Court Care Home with Nursing is care home providing personal and nursing care to a maximum of 58 older people and younger adults with physical disabilities within a large adapted building. At the time of our visit, 41 people lived at the home.

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

Risks to people's safety were not always managed well which placed people at risk of harm. Some previously demonstrated standards including the monitoring of accidents and incidents had not been maintained. This showed lessons had not been learnt.

People felt safe and liked living at the home but the standards of care they received had declined since our last inspection. Safeguarding procedures were in place to protect people. Staff knew to report any suspected or witnessed abuse to their managers. Staff received training to help them understand the different types of abuse people might experience.

Staff were recruited safely, and enough staff were on duty to meet people's needs during our visit. However, the provider could not demonstrate all staff had received the training they needed to be carry out their roles effectively. Despite our findings people and relatives had confidence in the ability of staff to provide good quality care.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice.

Quality assurance systems required improvement because the management team did not have sufficient oversight of the service provided. Audits and checks had not always taken place as required and the management team had not identified the shortfalls, we identified during our inspection visit.

The management team showed dedication to their role and welcomed our feedback. They began to take reactive action to make improvements during our visit.

People, their relatives and staff spoke positively about the leadership of the service. Staff felt valued by their managers and confirmed they understood their roles and what the provider expected of them. People had opportunities to put forward their ideas and suggestions to improve the service they received. People had opportunities to maintain and develop links with their local community.

People enjoyed the food. Whilst the mealtime experience was positive for people the provider was unable to demonstrate people had consumed sufficient amounts of fluids to maintain their health.

People received their medicines when they needed them. People had access to health professionals when needed. Health professionals confirmed staff had sought and followed their advice when required.

Improvements to the prevention and control of infection had been made since our last inspection. The environment was clean staff followed safe infection control practice. The environment continued to meet people's needs.

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 (24 October 2019).

Why we inspected

The inspection was prompted in part due to concerns received about the quality and safety of the service people received including the use inappropriate restraint and changes in people’s health not being recognised resulting in hospital admission. As a result, a decision was made for us to inspect and examine those risks. We undertook a focused inspection to review the key questions of safe, effective and well-led only.

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

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 monitor the service and 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 the safety, governance and staff training.

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 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.

Brockhampton Court accommodates up to 58 people within a large adapted building and specialises in care for older people and younger adults with physical disabilities. At the time of our inspection, 45 people were living at the nursing home.

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

People at the home told us they felt safe and protected from harm. People were cared for by staff who understood how to protect them from abuse and harm and keep them safe. People had comprehensive assessments, care plans and risk assessments which included information about their care and support needs and preferences. Staff were provided with ongoing training to meet people’s diverse needs and understood people's individual needs. People were supported with their medicines by staff using safe practice. Staff had limited training and awareness of infection control and prevention procedures. Incidents and accidents were investigated, and actions were taken to prevent recurrence.

People’s care and support was planned and delivered in line with current best practice guidance and legislation. Care was delivered by staff who were knowledgeable about people's needs and wishes. 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 received personalised care from staff who knew their needs and wishes. People's concerns were listened to and action was taken to improve the service as a result. Where improvements were identified, there were plans in place to ensure these were made. People could remain at Brockhampton Court to receive end of life care, provided by the management team and staff, which was supported by external professionals.

The management team were open, approachable and focussed on providing person centred care. The management team and staff engaged well with other organisations and had developed positive relationships. The provider did not have formal processes in place to monitor and improve the quality of the service. However, the registered manager promoted a culture of openness and of reflection and learning.

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 20 July 2018) 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.

Brockhampton Court Care Home with Nursing is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Brockhampton Court accommodates up to 58 people within a large adapted building, and specialises in care for older people and younger adults with physical disabilities. At the time of our inspection, 48 people were living at the nursing home.

The provider is also registered to operate a domiciliary care agency at this location. It provides personal care to people living in their own houses in the community and operates from a main office located within a separate building in the home’s grounds. It provides a service to older people who may have physical disabilities . At the time of our inspection visit, 28 people were receiving care and support in their own homes from the agency.

Not everyone using the domiciliary care agency receives regulated activity; CQC only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

A registered manager was in post and present during 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 provider’s systems and procedures designed to ensure people received their medicines safely and as prescribed were not always as robust or effective as they needed to be, and did not always reflect current good practice. The provider had not adequately assessed the broader risks to people’s health and safety and done all that was reasonably practice to mitigate these. The provider did not have formal systems in place for the clinical supervision of nurses or managerial supervision of care staff. People’s care plans did not always fully demonstrate an individualised assessment of their care and support needs or fully support a person-centred approach to people’s care. The provider had failed to notify us of eight serious injuries involving people who used the service, in line with their registration with CQC. The provider's quality assurance systems and processes were not as effective as they needed to be.

Staff received training in, and understood, their individual responsibility to protect people from abuse and discrimination. The staffing levels maintained ensured people’s needs could be met safely at the nursing home, and that people received reliable and consistent care and support in their own homes. The provider completed checks on prospective staff to ensure they were safe to work with people. The provider had taken steps to protect people, staff and visitors from the risk of infection.

Staff completed the provider’s induction and participated in a programme of ongoing training to help them work safely and effectively. Staff helped people to prepare their meals in their own homes, and offered physical assistance to enable people to eat and drink where they needed this. Any risks associated with people’s eating and drinking were assessed and managed. Staff helped people to access healthcare services and played a positive role in ensuring their day-to-day health needs were met. The overall design and adaptation of the nursing home enabled staff to meet people’s individual needs safely and effectively. Staff and management understood and promoted people’s rights under the Mental Capacity Act 2005.

Staff approached their work with a kind and caring attitude and treated people with dignity and respect. People and their relatives were supported to express their opinions and be involved in decisions that affected them.

People had support to participate in a range of stimulating recreational activities. People and their relatives understood how to raise a complaint about the service, and had confidence they would be listened to. The provider had systems and procedures in place enabling them to identify and address people’s preferences and choices for their end-of-life care .

The management team promoted a positive, open and inclusive culture within the service. Staff felt valued and well-supported in their work, and were clear what was expected of them. The management team promoted collaborative working with external health and social care providers to facilitate joined-up care for people, and had forged strong links with the local community.

Brockhampton Court provides personal and nursing care for up to 58 people, some of whom are living with dementia. At this inspection 43 people were living there.

A registered manager was in post and present during 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.

People were safe as staff had been trained and understood how to support people in a way that protected them from danger, harm and abuse. Staff had access to detailed care plans and risk assessments and were aware of how to protect people from harm.

There were enough staff to support people and to meet their needs. The provider had systems in place to adapt to the changing needs of people and to make provision for additional staffing when required. The provider completed appropriate checks on staff before they started work to ensure they were safe to work with people.

People received their medicine from staff who were trained to safely administer these and who made sure they had their medicine when they needed it. Staff followed safe practice when assisting people with their medicines.

People received care from staff who had the skills and knowledge to meet their needs. Staff attended training that was relevant to the people they supported and adapted to meet specific needs. Staff were supported by the provider and the registered manager who promoted an open and transparent culture.

People were involved in decisions about their day to day care. When people could not make decisions for themselves staff understood the steps they needed to follow to ensure their rights were upheld. People’s likes and dislikes were known by staff who supported them in a way which was personal to them. Staff provided care and support which was personalised and respected people’s likes and dislikes. People took part in activities they liked and found stimulating. People felt involved in the day to day running of the home and were kept up to date with changes and developments.

People were supported by staff who knew them well and had good relationships with them. Staff made sure people were involved in their own care and information was given to them in a way they could understand. People’s independence was encouraged and staff respected their privacy and dignity.

People had a choice of food to eat and could choose alternatives if they wished. People had access to healthcare when needed and staff responded to any changes in need promptly and consistently.

People and staff felt able to express their views and felt their opinions mattered. The provider and registered manager undertook regular quality checks in order to drive improvements. The provider engaged people and their families and encouraged feedback. People felt confident they were listened to and their views were valued.

Most people told us that they felt able to raise any issues with the manager or staff should they have any concerns. Staff spoke of their awareness of how to keep people safe from harm. Staff told us about the training that the home had arranged for them to attend so that they would recognise abuse and how to report it.

People told us that staff were usually available when they needed help. They said that the staff were friendly and always acted professionally. One person said, 'It's all very good' and another said, 'Really nice bunch of staff'.

The provider had developed a system whereby they can monitor how well the home was meeting the needs of the people who live there.

We found that people were treated with respect and kindness. People told us, "it's a lovely place and they look after us all really well" and, "the care here is absolutely wonderful". One relative said, "we're very pleased with the way they've looked after her".

People told us that they received a high standard of care and support. There was clear and detailed information for staff about people's needs and how they should be met. Records showed that staff were providing care which met people's needs.

Staff had been provided with training about how to recognise and report concerns about possible abuse or neglect. People told us that they felt safe at the home. They said that they would know who to talk to if they had any concerns. They were confident that they would be listened to and that their concerns would be taken seriously.

People were very positive about the staff, and described them as, "excellent in all respects" and, "always willing to help". One person told us, "the matron sets a very high standard and the staff follow her lead".