Brooklands Nursing Home

Brooklands Nursing Home is a residential care home providing the regulated activity of personal and nursing care for up to 45 people in a purpose built building. The service provides support to older people and people living with dementia. At the time of our inspection there were 39 people using the service.

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

Whilst some improvements were noted since our last inspection in June 2019, not all risks were robustly assessed or recorded in sufficient detail to mitigate the risk or potential harm for people using the service. Not all information relating to people’s fire evacuation arrangements in an emergency were accurate, up to date or easily accessible. Although the premises was odour free, not all areas of the home environment were clean. Governance arrangements at the service continued to require improvement to ensure improvements were sustained in the longer term. Following the inspection the registered manager forwarded an action plan detailing the steps being taken to make the required improvements.

People told us they were safe. Suitable arrangements were in place to protect people from abuse and avoidable harm. Staff demonstrated a basic understanding of safeguarding and how to raise concerns. Whilst comments from people and their relatives relating to staffing levels were variable, the deployment of staff was appropriate. Staff recruitment practices at Brooklands Nursing Home were safe. Medication practices ensured people received their prescribed medication.

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 August 2019].

Why we inspected

We carried out an unannounced comprehensive inspection of this service between 10 and 18 June 2019. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection although improvements were still required, we found improvements had been made and the provider was no longer in breach of Regulations 12 [Safe care and treatment], Regulation 17 [Good governance] and Regulation 18 [Staffing].

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions of Safe and Well-led which contain those requirements.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained Requires Improvement. 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 Brooklands Nursing Home on our website at www.cqc.org.uk.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice:

• Arrangements were in place for relatives to visit their family member and included where people were judged to be at the end of their life. Suitable measures were in place to screen visitors and included a questionnaire, temperature checks, the wearing of Personal Protective Equipment [PPE] and rapid testing to keep infection risks to a minimum.

• People were admitted into the service safely. People’s COVID-19 status was sought prior to admittance and people self-isolated in line with current government guidance.

• Appropriate infection prevention control practices were observed for staff, such as the wearing of masks, gloves, aprons and included good hygiene practices.

• Most staff had received training on infection prevention and the correct use of PPE and specific training relating to COVID-19.

• Cleaning schedules were in place and the environment was visibly clean.

Not all risks to people were mitigated at the earliest opportunity for their safety and wellbeing. There was a lack of understanding of the risks and the impact on people using the service. Staff response times to answer people’s call alarm facilities were not as responsive as they should be. Though this was identified by the registered provider and manager, actions to address this had not been implemented. Improvements were required to the provider’s recruitment practices to ensure this was robust. People were safeguarded from abuse and staff received safeguarding training. People received their medicines as prescribed and appropriate arrangements were in place to ensure the proper and safe use of medicines. People were protected by the service’s prevention and control of infection procedures.

People’s comments about the meals provided were positive. However, people were brought into the dining room to early and some people became distressed. Most interactions at meal times were not person-centred and primarily focused on tasks. Improvements were required for staff to effectively communicate with the people they supported. Staff were appropriately trained and received a robust induction. Staff told us they were supported and valued by the organisation. 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 services and the organisation worked collaboratively with other organisations.

People’s comments about the quality of care they received was variable, with both positive and less favourable comments. People were not always treated with dignity or respect. Most staff were focused on tasks and not all support provided was consistent.

Information recorded within people’s care plans required reviewing to ensure these were sufficiently detailed and provided guidance for staff to follow. Suitable arrangements were required to ensure full compliance with the Accessible Information Standard. Suitable arrangements were in place to enable and support people to participate in social activities. People’s concerns and complaints were listened and responded to. People were supported at the end of their life to have a comfortable death.

Governance arrangements at the service were not always effective to achieve positive outcomes for people using the service.

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

The last rating for this service was good (published July 2017). This was a planned inspection based on the previous rating.

We have made recommendations about recruitment practices, staff interactions with the people they support and care planning and record keeping arrangements.

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.

As a result of our concerns a breach of regulatory requirement relating to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 was made. We undertook a focused inspection on 15 June 2017 to review the above and to ensure that compliance with regulatory requirements had now been achieved. This report only covers our findings in relation to this area. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Brooklands Nursing Home on our website at www.cqc.org.uk

A registered manager was in post. 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.

Medicines were safely and securely stored, recorded and administered in line with current guidance to ensure people received their prescribed medicines to meet their needs. This ensured that people using the service received their prescribed medication as they should and in a safe way. Staff were suitably trained to administer medication and had their competency assessed at regular intervals to ensure they remained competent to undertake this task. Suitable arrangements were in place to assess and monitor the provider’s arrangements for compliance with medication.

A registered manager was in post. 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 arrangements for the management of medicines required improvement relating to staff’s practice and medication records. Minor improvements were needed to ensure that the provider’s recruitment systems were robust.

Although people did not think always feel that there were sufficient numbers of staff available to meet their needs or their relative’s needs, our observations showed that staffing levels were suitable at the time of the inspection. However improvements were needed to ensure that the deployment of staff was suitable to support people safely and to ensure that communal lounge areas were supported.

Staff had a good understanding of safeguarding procedures to enable them to keep people safe and the management team had a consistent approach in place to effectively deal with safeguarding. People confirmed that they felt and were kept safe.

Staff received opportunities for training and this ensured that staff employed at the service had the right skills to meet people’s needs. Staff felt supported and received appropriate formal supervision. Staff demonstrated a good understanding and awareness of how to treat people with respect and dignity.

The dining experience for people was positive and people were complimentary about the quality of the meals provided. Staff were friendly, kind and caring towards the people they supported and care provided met people’s individual care and support needs. Care plans accurately reflected people’s care and support needs. People received appropriate support to have their social care needs met. People told us that their healthcare needs were well managed.

Where people lacked capacity to make day-to-day decisions about their care and support, we saw that decisions had been made in their best interests. The registered manager was up-to-date with changes to the law regarding the Deprivation of Liberty Safeguards (DoLS) and at the time of the inspection they were working with the Local Authority to make sure people’s legal rights were being protected. People who used the service and their relatives were involved in making decisions about their care and support.

People and their relatives told us that if they had any concern they would discuss these with the management team or staff on duty. People were confident that their complaints or concerns were listened to, taken seriously and acted upon.

There was an effective system in place to regularly assess and monitor the quality of the service provided. The registered manager was able to demonstrate how they measured and analysed the care provided to people, and how this ensured that the service was continually improving to meet people’s needs.