Archived: Brooklands Care Home

We found the following examples of good practice.

¿ Dedicated changing rooms were available for staff to use at the start and end of their shift to prevent cross contamination.

¿ Agency staffs’ COVID 19 test results were requested from the agency they worked for and they also took part in the homes testing schedule.

¿ A new external door was in the process of being fitted to support visitors to undertake indoor visits safely.

¿ A designated washing machine was used exclusively for the clothing of residents who have tested positive for COVID 19.

¿ The registered manager completed a protection and prevention plan daily to identify any risks and the actions taken to mitigate risks.

Brooklands Care Home is a care home providing personal and nursing care for up to 63 older or younger adults some of whom may have a physical disability or are living with dementia. There were 36 people residing at the service on the day of the inspection.

Brooklands Care Home is purpose built with lift and stair access to the first floor. Accommodation consists of single occupancy rooms situated in three units over two floors.

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

We found improvements had generally been made to people’s care records, which were extensive. Care records relating to catheter care and restricting oral fluids were updated during the inspection. Minor infection control issues were rectified immediately during our visit.

People were protected from the risk of harm and abuse. Safeguarding procedures guided staff about the action they must take if they suspected abuse was occurring. Risks to people’s wellbeing were assessed and monitored this included accidents and incidents to prevent re-occurrence. Medicine management and recruitment was robust.

Staff undertook training to maintain and develop their skills, areas for further development included diabetes. Supervision and appraisal were undertaken to support staff performance and development.

People had their capacity assessed and were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People’s nutritional needs were met. Mealtimes had been reviewed and changes made to ensure people were well supported. People were supported and encouraged to maintain their independence.

People were looked after by caring staff. People we spoke with confirmed this. Staff provided comfort and support if people became anxious or upset. Information was provided to people in a format that met their needs in line with the Accessible Information Standards.

People had their needs assessed before being admitted to the service to ensure their needs were known and could be met. Health care professionals were contacted for help and advice to maintain people’s wellbeing. People’s care was reviewed and monitored by staff to ensure they received the support they required. Complaints received were acted upon. A programme of activities was provided in line with people’s interests. End of life care was provided at the service.

A full range of quality checks and audits were undertaken to monitor the service. This information was shared with the higher management team. Audits in areas where we found minor shortfalls were reviewed to help prevent any re-occurrence of the issues found.

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

Rating at last inspection and update

The last rating for this service was requires improvement (31 October 2018) when there was one breach 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.

Why we inspected

This was a planned inspection based on the previous rating.

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.

Providers should be aiming to achieve and sustain a rating of 'Good' or 'Outstanding'. Good care is the minimum that people receiving services should expect and deserve to receive and we found systems in place to ensure improvements were made and sustained were not fully effective. As this is the third time in a row the service has been rated Requires Improvement, we will meet with the provider to discuss their action plan for improvements.

Brooklands Care Home accommodates up to 63 people. The building is purpose built with lift and stair access to the first floor. Accommodation consists of single occupancy rooms situated in three units over two floors. At the time of our inspection there were 57 people using the service.

Brooklands Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a registered manager in post. A registered manager is a person who has registered with the CQC 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.

There were inconsistencies with people’s care plans. Some people had care plans, which contained good information and guidance for staff in how to meet their needs; these had improved since the last inspection. However, other people’s care plans lacked important information which meant there was the possibility of care being overlooked. This was a continued regulatory breach in relation to person-centred care. You can see what action we told the provider to take regarding the above areas at the back of the full version of the report.

The provider's systems to assess, monitor and improve the quality of the service provided had been effective in driving improvements in relation to risk management and consent, but required strengthening to sustain the improvements with care plan records. A new deputy manager had been recruited to support the registered manager to sustain the required improvements.

Staff were recruited safely. Improvements had been made to the number and deployment of staff. The registered manager used a tool to calculate staffing numbers and monitored this to ensure the levels remained safe. They had recently requested from the senior management team additional staffing hours during the day to provide a ‘staff float’, who would work across the units to provide additional support and cover for staff breaks.

Medicines were managed safely and people who used the service received them as prescribed. There were safe systems in place to manage risks to people’s health and safety. Staff had received training in how to safeguard people from the risk of abuse. Staff knew what to do if they had concerns.

The environment was clean and tidy and staff had access to personal protective equipment to help prevent the spread of infection.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff received appropriate induction, training, supervision and support, which enabled them to feel skilled and confident when supporting people who used the service.

People’s nutritional needs were met. Menus provided people with a choice of nutritious meals and people liked the meals. We saw people were provided with regular hot and cold drinks and nutritious snacks during the day.

People who used the service and their relatives had positive comments about the staff team and their approach when supporting people. People’s privacy and dignity was respected.

Staff supported people to access health professionals when required and they could remain in the service for end of life care if this was their choice. Some health care professionals considered aspects of communication and clinical care had been affected by the high use of agency staff. The management team were confident that the positive recruitment of nursing staff and the appointment of a new clinical lead would ensure consistency of care and communication.

People were encouraged to participate in a range of activities within the service and local community, although trips out had been more limited recently due to hot weather.

Staff, people who used the service and their relatives, told us the registered manager was accessible and approachable. There was a complaints procedure on display in the service and it was included in information given to people. Staff knew how to manage complaints and people spoken with felt able to raise concerns. There were systems in place to enable people to share their opinion of the service provided and the general facilities at the home.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

We undertook this unannounced inspection on the 1 and 2 August 2017. The last full inspection took place on 20 and 21 June 2016 and although no breaches in regulations were identified we rated the service ‘Requires Improvement’ for two of the five key questions and rated the service ‘Requires Improvement’ overall.

During this inspection, we found some concerns regarding quality monitoring which had resulted in shortfalls not identified through the audit programme or when shortfalls were identified, timely action had not been taken to address these. Examples included gaps in care plans, supplementary charts for recording food and fluid intake and records to support consent to care.

There was some inconsistency with the application of mental capacity legislation. Some people had assessments of capacity and records about the restrictions they had in place, but this was not consistent throughout the service. One person was subject to low level physical interventions which had not been agreed or assessed as being in their best interest.

People had care plans in place, however, we found these were not always person-centred and missed important information regarding how staff were to care for them. This meant that important care could be missed.

You can see what action we told the provider to take regarding the above three areas at the back of the full version of the report.

The CQC had not received a notification of an incident which affected the welfare of a person who used the service. On this occasion we are writing to the provider to address this shortfall.

We received a mixed response from people who used the service, staff and visiting relatives with regards to staffing levels at the home. There were occasions when people were not supervised appropriately and staff reported being over stretched at times during shifts and unable to spend time with people. Some relatives considered staff were not visible enough and some people felt they had to wait at times for care. We have made a recommendation that the provider reviews the number and deployment of staff on shifts.

Staff were recruited safely which ensured employment checks were in place prior to new staff starting work. Staff had received training in how to protect people from the risk of harm and abuse. There were also policies and procedures for additional guidance. Staff knew what to do if they had concerns but some staff were not aware of the external agencies they could raise these with.

Generally, there were safe systems in place to manage risks to people’s health and safety although the area director took action during the inspection to ensure one person’s risk of falling was reviewed and action was taken to better protect their safety.

People had access to community health professionals for advice and treatment. Staff knew when to consult these professionals although the guidance provided was not always followed consistently.

Staff completed assessments of people’s nutritional needs and monitored their weight. They referred people to dieticians when required. We saw the menus provided people with a choice of nutritious meals. People told us they liked the meals provided for them and staff were flexible if they wanted an alternative to the main menu choices each day. During the day, we observed people were served drinks and snacks between meals. We found improvements could be made with some people’s accessibility to drinks on the nursing unit.

People told us staff had a kind and caring approach. We saw people’s privacy and dignity was respected and observed many positive interactions between staff and the people they cared for. Staff knew how to promote people’s independence and need to make their own decisions.

We saw people were encouraged to participate in a range of activities at Brooklands and in the community. Relatives told us they could visit at any time and we saw staff supported people who used the service to maintain relationships with their family.

Medicines were managed safely and people who used the service received them as prescribed. People told us their medicines were administered to them in a timely way.

Records evidenced that staff received appropriate induction, training, supervision and support, which enabled them to feel skilled and confident when supporting people who used the service.

Staff, people who used the service and their relatives, told us the manager had an open-door policy and was available to speak with them when required. There was a complaints procedure on display in the service and it was included in information given to people. Staff knew how to manage complaints and people spoken with felt able to raise concerns. There were systems in place to enable people to share their opinion of the service provided and the general facilities at the home.

We found the environment was clean and safe, and equipment used was serviced regularly and maintained on a day to day basis.

This inspection was carried out by an adult social care inspector on 20 and 21 June 2016. The service was last inspected in January 2014 and was found to be compliant with all of the regulations that we assessed at that time.

There was no registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

A manager had recently been recruited but had not commenced working within the service at the time of our inspection. A registered manager from another of the registered provider’s services had worked in the service three days a week since January 2016. We have called them the 'supporting manager' throughout this report.

During the inspection people who used the service and staff raised concerns regarding staffing levels and we recorded periods were people were not supervised by staff. The assistant operations director confirmed that staffing levels would be assessed and changes made as required. Internal auditing highlighted amongst other things, issues with the recording of when medication had been administered. However, this had been monitored internally and improvements had been made.

People who used the service were protected from abuse and avoidable harm by staff who had been trained to recognise the signs of potential abuse and knew what actions to take if they suspected abuse had occurred. Accidents and incidents were investigated and action was taken to prevent their future reoccurrence. Staff had been recruited safely and relevant checks were completed before they commenced working within the service.

We completed a tour of the service we found most areas to be clean and in a good state of repair. However, some area’s such as two communal toilets required refurbishment. We highlighted this to the supporting manager and assistant operations director who took immediate action to ensure people were cared for in a clean and hygienic environment.

We saw that historical internal auditing had highlighted concerns regarding the safe administration of medicines, although action had been taken and the more recent audits evidenced an improvement in this area we found some issues persisted, such as not completing medication administration records accurately. The temperatures in both medication rooms exceeded the medicines manufactures advice in relation to appropriate storage. However, portable air conditioning units were purchased during the inspection to rectify this issue.

People were supported by staff who had the skills and experience to carry out their roles effectively. Staff received effective levels of support, supervision and mentorship. People who used the service were supported to make their own decisions about aspects of their daily lives. The supporting manager followed the principles of the Mental Capacity Act 2005 when there were concerns people lacked capacity and important decisions needed to be made. People were encouraged to maintain a healthy lifestyle and eat a balanced diet. People’s needs were met by a range of healthcare professionals.

People who used the service told us they were supported by kind, caring and attentive staff who knew them well and understood their preferences for how care and support should be delivered. People were treated with dignity and respect throughout our inspection. It was clear staff were aware of people’s preferences for how care and support should be provided. Staff understood their responsibility to ensure people’s private and sensitive information was treated confidentially.

People or those acting on their behalf were involved with the planning and on-going assessments of their care when possible. We saw records confirming that reviews took place periodically. There was a complaints policy in place at the time of our inspection which was displayed at the entrance of the service. This helped to ensure people could raise concerns about the service or the individual care and support as required.

The supporting manager understood the requirements to report accidents, incidents and other notifiable incidents to the CQC. Audits and checks were completed; however, the consistency of the audits required improvement. We saw evidence to confirm when shortfalls were identified action was taken to improve the service. The supporting manager and regional operations director took immediate action to rectify the issues we highlighted during the inspection.

We re-visited the service to check that the necessary improvements had been made. We found improvements had been made to the care plan records; people's needs in all areas had been properly assessed and detailed care plans were in place to direct staff on the care support required.

People who used the service told us they were satisfied with the care support they received. One person told us, 'The staff look after us all very well, no complaints at all.' Relatives we spoke with told us, 'Mum has been in two other homes before moving here, she's really happy and has settled very well. She's well looked after.'

We observed staff interacting with people who used the service and this was carried out in a sensitive way. We observed lunch time and staff assisted those who needed help, this was done at their pace. People we spoke with told us the food was very good and they had plenty of choice.

People told us they were satisfied with the facilities however we found areas of the home required renewal and refurbishment.

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

People told us the staff worked very hard. One person said, "They are marvellous, all of them." However, they also said the staff were over stretched at times and they needed more staff. Comments included: 'They (the staff) don't stop, always on the go; they don't have so much time to spend with us these days' and 'Staff try their best, we have to wait for help sometimes, but not often.'

People were made aware of the complaints system. Those we spoke with said they had no complaints but would feel comfortable raising any concerns with the staff.