Brooklands Nursing & Residential Home

Brooklands Nursing and Residential Home is a residential care home providing nursing and residential care to up to 70 people. The service provides support to older people who require residential, nursing and/or dementia care. At the time of our inspection there were 58 people using the service. Accommodation is over three floors, with adapted facilities, and the home has accessible gardens and multiple communal rooms.

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

People who used the service told us their lives had been enhanced by living at Brooklands Nursing and Residential Home. They described care that was person-centred, attentive and compassionate. People spoke of dedicated staff who delivered care and support with respect, patience and kindness; they told us their needs were met.

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 told us they were involved in making decisions around the care they received, and relatives told us they were included in these decisions where this was appropriate. People spoke particularly positively about how well the service communicated and engaged with them.

The quality assurance systems the provider had in place had not been completely effective at identifying some shortfalls. However, the provider took immediate action to rectify the concerns and we found a culture that was open, reflective and proactive at learning lessons and implementing improvements.

People told us they would recommend the service. They told us this was because of the high-quality, attentive care people received and the confidence they had in the staff and management to meet the needs of the people they loved. People gave us examples of the positive impact the service had had on their lives and what this meant to them.

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 (report published on 18 July 2022) and there were two 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.

Why we inspected

The inspection was prompted in part due to concerns received about risk management and end of life care. A decision was made for us to inspect and examine those risks.

We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe and responsive sections of this full report.

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.

Follow up

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

Brooklands Nursing and Residential Home is a care home which provides personal and nursing care to people aged 65 and over who may be living with dementia, a physical disability or sensory impairment. The service can support up to 70 people. At the time of this inspection there were 59 people receiving support.

The home is built over three floors with one floor being dedicated to people living with dementia. All bedrooms have a wash hand basin and many have toilet facilities. In addition, there are shared bathroom facilities and shared living areas on each floor. Within the grounds there is an enclosed and accessible garden.

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

Risk assessments did not always include all necessary information to mitigate risk of harm to people. Where change had occurred, accurate updates of risk assessments had not always been conducted.

The quality assurance processes and systems in place were not robust and did not drive change and improvement to the quality of the service. The audits had not identified shortfalls in medicines, monitoring charts or risk assessments.

The provider had identified the current electronic system was less effective in recording person centred information. The provider advised the inspector a new system had been identified which was due to be implemented in the service.Training had been planned for all staff and a process was in place to transition and review all records when moving these to the new system.

People were supported by a staff team which were familiar to them. People and relatives were complimentary about the staff who they felt were caring and kind. People told us they felt safe. People, their relatives and staff felt the manager would address any concerns they had.

Staff had received an induction and training which prepared them for their role. Staff were confident in reporting concerns internally and to external organisations. Staff felt supported by the registered manager, who they found to be approachable and visible in the service.

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 did not support 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 the service under the previous provider was good, published on [19 November 2017].

Why we inspected

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.

We received concerns about the provider’s governance systems and oversight of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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 changed from good to requires improvement based on the findings of this inspection.

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

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Brooklands Nursing and Residential Home on our website at www.cqc.org.uk.

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 care planning, risk assessing, and the quality assurance processes at this inspection.

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

Brooklands Nursing & Residential Home is a care home that provides personal and nursing care for up to 70 older people. The service is delivered over three floors one of which is dedicated to people living with dementia. It is purpose built and all floors are serviced with a lift. There were a number of communal areas and an accessible garden. At the time of this inspection there were 62 people receiving the service.

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

We received very positive feedback about the service provided from people, relatives, staff, and an external healthcare professional. One relative told us, “I'd have absolutely no hesitation at recommending Brooklands, and I'd want it for my care. My [family member] is very lucky to be there.”

Systems were in place to help staff minimise risks to people. Staff understood the identified risks to people and followed guidance in place to keep them safe.

Measures were in place to manage the risks of COVID-19 including policies and risk assessments. Staff told us they had access to sufficient personal protective equipment (PPE) and had received training on how to keep themselves, and others, safe from the risks of COVID-19. The provider had robust contingency plans which could be implemented in the event of an outbreak.

The provider and registered manager had effective systems in place which helped ensure that staff delivered a service that met people's needs and kept them safe.

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 25 April 2017).

Why we inspected

The inspection was prompted in part due to concerns received about the safety of people at the service, and how staff and the registered manager treated people. A decision was made for us to inspect and examine those risks. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this full report.

The overall rating for the service has not changed following this targeted inspection and remains good.

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.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Brooklands Nursing & Residential Home 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.

Brooklands Nursing and Residential Home provides residential and nursing care for up to 70 older people. The service is delivered over three floors one of which is dedicated to people living with dementia. At the time of this inspection there were 64 people living in the home. It is purpose built and all floors are serviced with a lift. A number of communal areas are available to those living there as well as an enclosed and accessible garden.

There was a registered manager 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 service had procedures in place that minimised the risk of employing people not suitable to work at Brooklands Nursing and Residential Home. New staff received an induction and spoke of being well supported in their roles. Training was delivered that met the needs of those people who used the service.

Staff morale was good and people benefited from receiving support from staff who were happy in their roles. Staff felt valued, included and listened to. Good team work was evident and this benefited those that used the service. The home was welcoming and friendly and we saw that it ran smoothly and efficiently. There were enough staff to meet people’s individual needs.

Care and support was delivered in a professional, considerate and compassionate manner. People’s dignity, privacy and confidentiality were maintained and choice was encouraged and supported. Staff understood the importance of ensuring people were in control of their own decisions.

Procedures were in place to help protect people from the risk of abuse. Staff had knowledge of how to prevent, protect and identify potential abuse and all had received training in this. The management team liaised with the local safeguarding team as required and reported concerns, as instructed by law, to CQC.

The risks to individuals had been robustly identified, managed and reviewed and staff had knowledge of these. Risks relating to the environment, equipment and working practices had also been appropriately managed and mitigated. Accidents and incidents were recorded and used to minimise future risk. People received their medicines as the prescriber intended and the service followed good practice guidelines. Medicines records were accurate and complete.

The CQC is required to monitor the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS) and report on what we find. The service adhered to the principles of the MCA and the care delivered reflected this.

People received care and support that was individual to them and staff knew their needs and preferences well. Care plans were person centred and demonstrated that people had been involved in the development of them. They considered the person throughout.

People enjoyed the activities the service provided and told us they met their needs. The service had recognised the need for more activities and was recruiting new staff to support this. Staff knew the people they supported well and had built trusting, respectful relationships that used humour as appropriate.

The healthcare professionals we spoke with talked positively about the way the service met people’s health and welfare needs. The people who used the service, and their relatives, agreed. People had prompt and appropriate access to health care and the service was proactive and preventative in their approach to this.

People’s nutritional needs were met and they had enough to eat and drink. They told us they had choice and that they enjoyed the food provided. The service had recognised the importance of social interaction over food and encouraged and supported this.

The service had a positive and proactive ethos that welcomed suggestions and feedback in order to develop and improve the service. Robust systems were in place to monitor the quality of the service and this contributed to the improvements that people told us had been made in the service. The management team demonstrated an open and progressive attitude towards service development.

People spoke positively about the management of the home. They told us management were approachable, visible and forward thinking. People had confidence in them. Everyone we spoke with told us they would recommend the home.

We undertook this focused inspection in March 2017 to check that the service had met the warning notices and whether they now met legal requirements. This report only covers our findings in relation to the warning notices. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Brooklands Nursing and Residential Home on our website at www.cqc.org.uk.

Brooklands Nursing and Residential Home provides care and support for to up to 70 older people, some of whom may be living with dementia or requiring nursing care. The home is over three floors with the top floor dedicated to providing support to those living with dementia. At the time of this inspection, there were 60 people living in the home.

There was a manager in post although they had not yet applied to register with the Care Quality Commission. 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 manager had only been in post for a few weeks prior to our inspection. However, the manager had worked for the provider for a number of years and had previously managed the home.

At the last inspection carried out in November 2016, we asked the provider to take action to make improvements in the management of medicines and governance of the home. These actions had been completed although a period of sustained improvement is required in order for us to have confidence that these changes have been imbedded into everyday practice.

The service had an effective system in place to assess and monitor the quality of care people received. This system helped to drive development and improvement in the service which was noted at this inspection.

A system was in place to ensure people’s medicines were obtained in a timely manner to ensure they received them as prescribed. Additional audits were in place to monitor this.

A number of audits had been introduced since our last inspection and these helped to monitor the standard of care delivered. These included audits around fire prevention and management, care plans, staffing levels and the competency of staff to perform their roles effectively.

At this inspection, sufficient improvements had been made by the service and they were no longer in breach of Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Brooklands Nursing and Residential Home is a service that provides accommodation, personal and nursing care for up to 70 people. The home is split over three floors, one of which is dedicated to providing care to people living with dementia. During the inspection visit, there were 67 people living within the home.

There was a registered manager employed at the home. 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 and associated Regulations about how the home is run. The registered manager was not present during our inspection.

At the last inspection on 14 May 2015, we asked the provider to take action to make improvements in respect of the quality of care that was provided to people. At this inspection, we found that the necessary improvements had not been made. People’s medicines were still not being managed safely and risks to people’s safety in the event of a fire had not been managed effectively. The systems in place to assess, monitor and reduce the risk of people receiving poor care were not always effective. You can see what action we have told the provider to take at the back of our report.

There were enough staff to meet people’s care needs. However, they were often very busy and therefore did not always have time to spend with people interacting with them or providing them with stimulation to enhance their wellbeing.

Systems were in place to protect people from the risk of abuse. Staff had received training and this was monitored to make sure it was up to date. Most staff were kind, caring and compassionate. However, some staff demonstrated poor practice which resulted in some people not being treated with dignity and respect.

Staff provided people with choice so they could make decisions about how they wanted to be cared for. People’s individual care needs had been assessed and were being met.

People had access to a good choice of freshly prepared meals and snacks. Staff sought advice from other healthcare professionals and acted in a timely manner when they identified any concerns about people’s health.

The staff requested people’s consent before they provided them with care. Where people were not able to give consent, the staff made sure that they took any decisions they made on their behalf in the person’s best interests.

There was an open culture where people and staff could raise concerns if they wanted to. Staff were happy working in the home.

The provider had identified that they wanted to improve the quality of care being provided to people living in the home, the ultimate aim of which was to improve people’s quality of life and wellbeing. The chefs had received external training in how to improve the food people were offered. Improvements were planned which involved staff receiving further training regarding supporting people living with dementia and making changes to the environment.

As a result of the July 2013 inspection we required that the provider supply us with an improvement action plan, which we received. This plan told us what improvements would be made and when they would be completed by. This inspection established that improvements had been made.

In July we identified that care plan reviews, due monthly, had not been completed for two months for 9 of the 14 people living on the top floor of the home, known as 'Treetops'. During this inspection we reviewed a sample from 'Treetops' and the other two floors and found that all care plan reviews were up to date and complete.

A new care plan format had been introduced at the time of our previous inspection. The new documentation utilised MUST (Malnutrition Universal Screening Tool). However, the new format was not familiar to staff as it did not follow the original methodology to assess risk. This had caused confusion and the new methodology was not being fully adhered to. This inspection established that guidance had been given to staff about the implementation of this screening tool.

Implementation of the dementia toolkit had been put on hold.

We found written consent within people's care plans to show that either they, or their family members, had agreed with and were happy with the care plans in place.

Detailed risk assessments and care plans were in place. However, some had not been reviewed in recent months. The provider had introduced new care record formats. Two areas that required further improvement were the MUST (Malnutrition Universal Screening Tool) that is used to assess the risk of possible malnutrition and a dementia toolkit that needed further consideration and staff training in order to implement them effectively.

The premises and gardens were well maintained and clearly appreciated by people living at Brooklands. One person told us, 'Nice summer days as we have been having makes going into the garden a real treat.'

We were satisfied that the recruitment processes in place meant that staff employed were of good character. Subsequent checks and audits demonstrated that staff suitability was kept under review.