Brooklands Nursing and Care Home

Brooklands Nursing and Care Home is a small residential care home providing personal and nursing care to up to 8 people. The service provides support to people with acquired brain injuries and complex care needs. At the time of our inspection there were 7 people using the service.

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

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 were supported safely, and the provider had plans in place in case of emergencies. There were enough staff to meet people’s needs and the provider ensured staff were of good character. One person told us, Staff are kind, caring, welcoming. They are good. Every single one of them.” The premises were clean, tidy and maintained.

The service put people at the centre of the care they received and was focussed on delivering person-centred care and support which met people’s complex needs. Feedback we received included, “I cannot fault them. They are absolutely fantastic.” And, “I would say the care is excellent.” Staff understood their roles and responsibilities. The provider monitored the quality of the service using a range of systems.

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 outstanding (published 2 April 2019).

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.

The inspection was prompted in part by notification of an incident following which a person using the service died. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. 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 and post falls management. This inspection examined 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.

We carried out 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 remained outstanding based on the findings of this inspection.

Recommendations

We have made a recommendation to the provider about learning from adverse events and sharing lessons learned with the staff team. We have also made a recommendation to the provider about ensuring the effective operation of their quality assurance systems.

Follow up

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

At our last inspection in June 2016, we rated the service good. On this inspection the service had improved to outstanding. This was because the staff team had clearly shown the impact of the exceptional care and support they provided that gave people an excellent quality of life and well-being.

At the time of the inspection eight people lived at the home.

The inspection visit took place on 24 and 31 January 2019. It was unannounced on day one and announced on day two.

The registered manager explained they had been promoted within the company and would be cancelling their CQC registration for Brooklands Nursing and Care Home. The prospective registered manager was an experienced member of staff who was already managing the home on a daily basis, so any disruption would be minimal. 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 management team were hands on, visible, available for support and taught their staff team by example. They were passionate about improving people’s wellbeing and this was reflected in everything they did. They were excellent role models in the provision of high care standards. This enthused and inspired staff to do their utmost to deliver outstanding care. They were proactive in finding solutions to problems. The management team and provider worked extremely effectively and proactively together.

Staff monitored people’s health closely and acted quickly on any concerns. They were assertive in getting the right treatment for people and were persistent in advocating for people to get them the best care possible. We saw staff worked collaboratively and developed close working relationships with the other healthcare professionals to ensure the best possible and most appropriate care for each person. A health professional told us how the staff team went the extra mile for the people they supported and always engaged with therapy.

Staff excelled in the way they monitored people’s health and acted proactively on any concerns. They were highly skilled and knowledgeable about people’s nursing care needs and used this knowledge to provide exceptionally good care. They were exceptionally empathic and caring and used nonverbal communication, smiles and touch in their interactions. We found staff had an excellent working knowledge of people’s care needs and were passionate about meeting these.

We saw regardless of their perceived level of consciousness, people were involved in a variety of meaningful social and leisure activities. To enable staff to safely take people out of the home they had been exceptionally well trained in complex care regimes to ensure people’s safety and comfort. We were told three people had remained in bed in previous placements. At Brooklands Nursing and Care Home they were supported to get up each day, relax in the communal areas and go out on social activities they liked with staff support. People able to indicate their views, were clear that they enjoyed these activities. To enable staff to safely take people out of the home they had been exceptionally well trained in complex care regimes to ensure people’s safety and comfort.

Staff were extremely welcoming to people’s families and friends and encouraged people to retain their family relationships. People said this assisted their well-being. Relatives were exceedingly complimentary about the management and staff team and said they were exceptionally committed and caring and had significantly improved their family member’s quality of life.

People’s end of life wishes were recorded so staff were fully aware of these. Staff understood the importance of supporting people to have a comfortable, pain free and peaceful end of life. They went out of their way to meet and exceed these and to support their family, other residents and each other.

People’s care and support had been planned with them and was person centred and informative. We saw they had consented to their care and treatment wherever possible. People had been supported to have maximum choice and control of their lives and were supported in the least restrictive way possible. The policies and systems in the service supported this practice. People had information about support from an external advocate should this be required.

People received sufficient nutrition and the assistance they needed and staff were proactive in raising any difficulties. All people who lived at the home when we inspected received nutrition by a percutaneous endoscopic gastrostomy (PEG) or other artificial feeding tubes. These are used when people are unable to swallow or eat enough and need long term artificial feeding. However, where possible and under the guidance of the speech and language therapists, (SALT) people were supported to eat and drink.

People told us they felt safe and cared for by staff. There were procedures in place to protect people from abuse and unsafe care and staff were aware of their responsibilities in keeping people safe. Risk assessments had been developed to minimise the potential risk of harm to people. Any safeguarding concerns, accidents and incidents were dealt with appropriately.

Staff had been recruited safely, appropriately trained and supported. Staffing levels were good and staff appropriately deployed to provide safe care. They had skills, knowledge and experience required to support people with their care and social needs. There were enough staff to provide nursing care and social and leisure activities.

Medicines were managed safely and according to National Institute for Health and Care Excellence (NICE) guidelines. People received their medicines when needed and appropriate records had been completed.

We looked around the building and found it was clean and hygienic, had been maintained and was a safe place for people to live. There were safe infection control procedures and practices and staff had received infection control training. Staff wore protective clothing such as gloves and aprons when providing personal care to people so they did not risk causing cross infection. The design of the building and facilities in the home were appropriate for the care and support provided. We found equipment had been serviced and maintained as required.

The management team sought people's views in a variety of ways. They assessed and monitored the quality of the service through audits, meetings and surveys. People felt able to complain if they were not satisfied with their care and said action would be taken. They told us the management team were extremely supportive and approachable.

Further information is in the detailed findings below.

Brooklands nursing and care home is located in a residential area in the South Shore area of Blackpool. It is a purpose built home that provides residential and nursing care for up to eight people with acquired brain injury. There is a passenger lift for ease of access and the home is fully wheelchair accessible. There is a conservatory, garden and patio and a parking area to the rear of the building. At the time of the inspection there were seven people lived at the home.

At the last inspection in May 2014, the service was meeting the requirements of the regulations that were inspected at that time.

There was a registered manager in place. 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 had limited communication and all except one person had no verbal communication. Although people were unable to answer questions, we spent time talking with them and observing staff interactions. We communicated where possible through non-verbal communication and gestures and electronic communications. People indicated they felt safe living at Brooklands and liked living there.

Risks to people had been minimised because the registered provider had procedures in place to protect them from abuse and unsafe care. Staff had all received safeguarding training and knew what to do if they saw or suspected abuse.

We looked at how the home was being staffed. We saw there were enough staff to provide safe care and to provide one to one care for those people who required this. People we spoke with indicated there were enough staff to support them indoors and to go on trips and activities. Care records confirmed this.

We saw staff were familiar with people’s care needs, likes, dislikes and wishes. People indicated staff were friendly, caring and respectful. We saw staff supported them to remain as independent as they could be and encouraged them to make choices.

Recruitment and selection was carried out safely with appropriate checks made before new staff started working in the home. This reduced the risk of employing unsuitable people.

Staff managed medicines safely. Medicines were given as prescribed and stored and disposed of correctly. We saw people received their medicines when they needed them.

Staff had received training in care and in specialist skills which enabled them to provide safe care and support to people. People received nutrition by a percutaneous endoscopic gastrostomy (PEG) because they were either unable to swallow or to eat enough and needed long term artificial feeding. Staff ensured people received adequate nutrition safely.

Staff understood the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS). This enabled staff to work within the law to support people who may lack capacity to make their own decisions.

There was a transparent and open culture that encouraged people to indicate how they wanted to spend time. Relatives felt theirs and their family member’s needs and wishes were listened to and acted on. They said staff were easy to talk to and encouraged them to raise questions at any time.

There were procedures in place to monitor the quality of the service. The registered manager sought people’s views in a variety of ways and dealt with any issues of quality quickly and appropriately.

The home was comfortable, clean and hygienic with good infection control practices when we visited. There were no unpleasant odours. Relatives said they were pleased with the standard of hygiene and good infection control in the home.

Summary

The inspection was led by one inspector. Information we gathered during the inspection helped answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by the staff. Most people who lived at Brooklands had limited verbal communication. However they were able to indicate their views of the home and the care they received. People indicated that they felt safe and were receiving safe and appropriate care which was meeting their needs. They indicated that staff were very good and that they received care and support when they wanted it.

The home had policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Relevant staff had been trained to understand when an application should be made and in how to submit one.

Staff involved people in decision making. We saw that where people lacked mental capacity, best interests meetings had been carried out over important decisions. The person, the family and appropriate professionals had been involved in the decisions. This meant that people were safeguarded as required.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

The service was safe, clean and hygienic. Service contracts were in place. Maintenance records we looked at showed that regular safety checks were carried out. Any repairs were completed quickly and safely. These measures ensured the home was maintained so people were safe.

The registered manager set the staff rotas. People's individual care needs were taken into account when staffing the home. This helped to ensure that people's needs were always met.

Is the service effective?

People's health and care needs were assessed and reviewed. They were developed with them where possible, or with their relatives, where appropriate. This included the way each person's care was provided, their daily routines and their health needs. We saw that care plans were up to date and reflected people's specific needs.

People confirmed and records showed that visitors were able to see people in private and that friends and relatives could visit whenever they wished.

The individual needs of people were taken into account with the layout of the home enabling people to move around freely and safely. The premises were suitable to meet the needs of people with physical impairments.

Is the service caring?

People were supported by kind, attentive and informed staff. We saw that staff showed patience and gave encouragement and guidance when supporting people. Good care practices were observed.

People indicated that they were happy at Brooklands. They said staff were caring and supportive. A relative told us their family member had moved to Brooklands quite recently. They said he settled quickly and seemed very happy. They said they had been made to feel very welcome when they visited.

We also saw the comments from recent surveys relatives had completed for the home. One relative said of their family member, 'He feels very comfortable and at home. The staff are great.' Another relative commented 'I can visit anytime and I can relax myself. I couldn't have chosen a better home.'

Care plans had been regularly reviewed, recording the care and support people were receiving. Care records were being developed to show people's preferences, interests, aspirations and diverse needs. Care and support had been provided in accordance with people's wishes.

The views of people who lived at Brooklands, their relatives, friends and other professionals were sought. They were encouraged to complete satisfaction surveys. Where suggestions were made or shortfalls or concerns were raised these were quickly addressed.

Is the service responsive?

We saw that staff modified the assistance they provided for people as their health improved and they encouraged people to redevelop their skills.

We found a range of meaningful social and leisure activities were organised to stimulate people and maintain skills. People indicated that they enjoyed these and were enthusiastic about them. One member of staff said, 'It is great to see how much people enjoy the trips out.'

Is the service well-led?

The service had a quality assurance system in place. Records showed that any identified problems were addressed promptly and suggestions for improvements acted upon. Staff regularly reflected on whether an individual's care could be improved upon or managed more effectively. As a result of these measures the quality of the service was continuously improving.

Staff had a good understanding of their roles and responsibilities and of the ethos of the home. They felt that they worked together effectively. Meetings were held regularly so everyone could discuss support needs and any changes in care or routines. Staff also received regular supervision and training to assist with their development. This helped to ensure that people received a good quality service at all times.

Relevant employment checks had been carried out for most of the staff. However, references for one staff member had not correctly been taken up. The registered manager confirmed that the correct references would be sought. The home had a small set of audits and systems in place to monitor the quality of the service being provided. We saw that care plan records and risk assessments were regularly reviewed. There were monthly management meetings in place to monitor the services they provided. Staff meetings took place and we saw records of those meetings. We spoke with staff from the Continuing Healthcare Team regarding this service. They confirmed that they had no concerns regarding the operation of the service.