Archived: Brookes House

Updated 9 February 2019

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

Inspection team

The inspection was carried out by one inspector, an assistant inspector and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service. This person had expertise in dementia care.

Service and service type Brookes House 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.

The service did not have a manager registered with the Care Quality Commission, at the time of the inspection. This means that the registered provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

Inspection site visit activity started on 8 January 2019. We did not give the provider notice of our inspection.

What we did

We reviewed the information we had received about the service since the last inspection. This included details about incidents the provider must notify us about, such as abuse. We sought feedback from the local authority and spoke with other professionals who worked with the service. We assessed the information providers send to us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. We used all this information to plan our inspection.

During the inspection, we spoke with eight people, four relatives and nine members of staff, to ask about their experience of the care provided. We observed the care people received, to help us understand the experience of people who could not talk with us. We also spoke the deputy manager, and three senior managers. They are referred to in the report as the registered provider.

We reviewed a range of records. This included six people's care records and medication records. We also looked at five staff files around staff recruitment and various training and supervision records. We looked at audits and quality assurance procedures relating to the management of the home.

After the inspection, we asked the registered provider to confirm how they propose to manage the current safety levels, when admissions to the service restart. We also asked the registered provider to specify how the current staffing levels will be sustained and how they planned to improve the quality of the service moving forward.

Updated 9 February 2019

About the service: Brookes House is a ‘care home’ that was providing personal and nursing care to 30 people aged 65 and over at the time of the inspection.

People’s experience of using this service:

The service was not always safe. At the last inspection, we imposed restrictions on the registered provider, to not allow them to admit anyone new to the service. They had adhered to this instruction. Following the last inspection, a number of safeguarding incidents had occurred and some were being investigated by the local authority. The registered provider did not always deliver a safe service to people, that was supported by consistent, competent and responsive staff. After the last inspection, people had experienced a change in staffing, because occupancy had decreased and staffing levels had stayed the same. Staff competency when delivering care had improved. At the last inspection, people's medicines had not been administered correctly. At this inspection, people were receiving their medicine in the right way.

The service was not always effective. For a prolonged period of time, the registered provider found it difficult to ensure that people consistently achieved good outcomes and received good care. At this inspection, people did not always receive good oral health care. The service did not always involve people in the design and decoration of the service. Assessments were in place but these could be developed further to consider a wider range of needs of the whole community, such as LGBTQ. People’s meal experiences had improved.

The service was caring. Whilst people had not always experienced a caring service, people told us they were being treated with dignity and respect. Staff treated people in a kind and caring way and had been involved in reviews of their care.

The service was not always responsive. Complaints were not dealt with by people who had the right level of knowledge and skill, to resolve them in an appropriate way. We have made a recommendation about the way the registered provider handles complaints. At the last inspection, established routines of care were in place. Previously, Staff did not always allow people to have control over their day to day lives and make choices as they would like. For example, people did not always have the choice over when they had a bath, when they got up or went to bed, or where they sat. This had improved. Care plans had been reviewed and were more reflective of people’s needs, they included people's choices about end of life care.

The service was not always well led. The management of the service continued to be inconsistent, and this will be the third time this service has been rated requires improvement. Quality assurance frameworks had not always been used in an effective way, and people had not always been given person-centred or good quality care. However, these systems were being used more effectively and this was beginning to have an impact on the service. People were experiencing a service that had improved from being inadequate.

More information is in the detailed report below.

Rating at last inspection: Inadequate (28/9/18) This is the third time the service has been rated requires improvement.

Why we inspected:

At the last inspection, multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were found, and the service was placed in special measures. Services that are in special measures are kept under review and inspected again within six months. This was a planned inspection based on the previous rating. The service had been placed in special measures because there was not enough competent staff to ensure people were safe. Staff had been using manual handling techniques incorrectly and people did not receive personal care in a responsive, dignified and respectful way. Care delivered to people was routine and did not support people to have control over their day to day lives. People did not always receive their medicines at the right time or in the right way, and people often had to wait a long time to get their meals. The quality assurance framework had failed to address the concerns and had not considered people’s feedback about the service. At this inspection, some areas had improved, but further improvements to the service were needed.

Follow up: We will continue to monitor this service and inspect in line with our inspection schedule for those services rated requires improvement.