Brook House Care Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to outstanding. This meant people’s outcomes were consistently better than expected compared to similar services. People’s feedback described it as exceptional and distinctive.

This service scored 88 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider always made sure people’s care and treatment was effective by thoroughly assessing and reviewing their health, care, wellbeing and communication needs with them.

The provider ensured emerging needs were identified early and care was continually adapted to deliver consistently exceptional outcomes for people.

People were at the heart of the holistic assessment process. The pre-assessment and ongoing review of assessments were exceptionally robust and person-centred. This enabled the person to talk about themselves, share their life history, preferences, routines and interests and their expectations of residential care. The registered manager in most situations visited the person in their own home and encouraged a family member to be present to support them with the assessment, where the person agreed or where a family member held lasting power of attorney. A family member told us, ‘The manager and the deputy came to see [relative] at home, I was there.” Another family member said, “They did a home visit and assessed their needs and ability.” An initial care plan was then developed and shared with the person and their family member, providing an opportunity to ask questions, and make changes to ensure it reflected expectations, preferences and need.

We reviewed some care plans and found these to be exceptionally detailed, reflective, and insightful. They provided a comprehensive overview of the person’s needs, progress, preferences and any changes required. The review of care records demonstrated an insightful knowledge of each person and ensured care remained responsive, proactive and reflective of any changes. This ensured people’s care plans remained accurate and up to date, supporting consistently effective care that met people’s needs as they changed.

People’s assessed needs were regularly reviewed, using a range of assessment tools, and focused on all aspects of people’s care and support, including physical and mental health, communication, personal goals and wishes.

There was a proactive approach to reviewing people’s needs using a range of assessment tools and focused on all aspects of people’s care and support, including physical and mental health, communication, personal goals and wishes. Reviews were scheduled, and involved the person and, or their family member. A family member told us, “I’ve gone through the care plan, and we discuss their care regularly. Any changes, they tell me.”

Staff spoke positively of people’s care plans, informing us these were regularly reviewed and updated, and any changes communicated effectively and timely, by the updating of electronic care records, staff handovers and via the walkie-talkie system operated across the staff team.

The provider always planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation. They worked to develop evidence-based good practice and standards.

The provider used recognised assessment and monitoring tools based on best practice guidance. For example, validated tools to assess people’s individual needs such as mobility, nutrition and skin integrity. These tools were regularly reviewed and used in conjunction with people’s wishes, preferences and needs, to ensure they remained personalised. The tools enabled changes in people’s health and well-being to be noted at an early stage so as action could be taken, which had the potential to improve their overall quality of life.

The registered manager attended manager’s meetings with directors and registered managers from other services within the organisation. These meetings provided an opportunity to discuss best practice, share experiences, review regulatory updates and explore clinical developments with a view to ensuring any learning was embedded across all services. Information was then cascaded to staff, through meetings, supervisions, handovers, competency assessments and training.

Staff were knowledgeable about the national tools used to assess people and were able to provide examples of how the tools were used and why. For example, monitoring people’s dietary intake and skin integrity which identified if a person required supplements due to weight loss. Staff were aware of people’s dietary needs, which included people who ate a diabetic diet to manage their diabetes.

Working with health care partners, senior staff received additional training provided by district nurses in diabetes care, to ensure competency in the safe administration of diabetic medicines, including injectable treatments.

A member of staff who was the ‘oral champion’ for the service, spoke of the importance of good oral health care, which included to access to a dentist and supporting people to maintain good teeth and dental hygiene. The oral champion said, “I make sure people are eating and drinking well. Check if they have any denture difficulties or refuse food. These are telltale signs something is wrong.” All staff we spoke with were aware of the importance of people’s dietary and fluid intake, and how oral health could affect wider health, including skin condition.

People and their family members spoke positively about the quality of the food, telling us the chef responded to personal requests if they preferred something different to that which was on the menu. A person told us, “There’s plenty of food here, it’s good. You get a choice for every room. You can always have something else. There’s always drinks around, and water in my room.” Another person said, “The food is very good, there’s usually a choice of two. I didn’t fancy the two choices yesterday, so they gave me the vegetarian option instead. I have plenty of drinks and there’s water over there, so I can help myself. There’s always a jug of water in my room.” Whilst another person said, “I’m never without a drink. I’ve got red wine at the moment.”

People’s dietary needs and preferences were catered for and recorded within their care records. People at risk of malnutrition or dehydration were supported with fortified diets, for example high protein and calorific food, along with prescribed supplementary drinks. Ingredients were fresh and sourced locally, with all meals being homemade. We spent time in the dining room at lunchtime, and found it to be a relaxed, with carers smiling and talking to people, and people chatting with each other. A person told us, “I liked my Lamb Hot Pot today, the foods always lovely here.” Alcoholic and non-alcoholic drinks were served at lunchtime.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

The registered manager and management team had developed excellent internal communication systems and processes to ensure important information was shared effectively with care staff and the wider staff team, enabling consistently high-quality care. Staff spoke of excellent communication and support. Staff used walkie talkies frequently to contact each other in case they required support or assistance with people’s care. A manager monitored the radio conversations so assistance or support could be provided in a timely manner. A visiting health care professional told us, “I really like their communication here. Really like the walkie talkies, it’s an excellent method of transparent communication.”

Staff were seen using the ‘walkie talkie’ effectively, with staff being able to request timely assistance in responding to personal care, or where people became distressed and additional support was required. All communication was managed sensitively, people were not referred to by name, and no specific details as to why support was being requested was stated.

A significant managerial presence, and availability of senior care staff enhanced the effectiveness in how the service was led and co-ordinated. One of the two senior carers on duty was responsible for responding to changes in people’s health and well-being, including speaking with, organising and participating in consultations with external health care professionals.

Family members spoke of how they were kept informed of any changes to their relatives’ health and well-being. A family member told us, “They phone straight away about doctor visits or medication changes.”

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

People were encouraged and supported to make healthier choices to help promote and maintain their health, wellbeing and independence. A person told us, “I’m as independent as I need to be, they encourage me to do things for myself.” The service focused on identifying risks to people’s health and wellbeing early and worked with people to support and prevent deterioration. The use of recognised tools to identify early signs of deterioration, and staff’s ongoing monitoring of people’s needs. Staff told us the service promoted people’s independence in support of a healthier life.

Dietary intake was a key area in which the provider invested and demonstrated their commitment to promoting people’s physical health. All food was homemade, using locally sourced and fresh ingredients, which were presented with care and attention to detail to encourage people’s appetite. For example, people’s care records detailed the portion size so as not to overwhelm a person with the quantity of food on their plate. The chef spent time with people, seeking their feedback and making changes to the menu. We noted a person chose to eat their meal later in the day, the chef assisted them so as they were sitting comfortably. The person was asked if they would also like dessert, we saw the chef bring out the ice-cream as requested, topped with a sauce, an example of their consideration to the presentation of food.

A holistic approach to supporting people to live healthier lives focused equally on physical, emotional, psychological and mental health and well-being. A range of activities were provided in support of physical health, which included armchair aerobics, Pilates, and ‘boogie beats’ sessions to encourage movement, engagement and enjoyment through music and exercise. A person told us, “I like the exercises and going out.”

The provider monitored all people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they fully met both clinical expectations and the expectations of people themselves.

Care plans and records were holistic and outcome-focused, enabling staff to support with people to set meaningful goals, to improve and maintain health and well-being. This meant people experienced care that was safe and effective, and enhanced their quality of life.

There were many examples of the positive impact staff support had on improving outcomes for people, linked to social opportunities and taking on new challenges. A family member shared how staff had supported their relatives to achieve their wishes and try new activities. They told us, “My [relative] wants to be independent, and staff recognise this. [relative] often does the Facebook page. My [relative] gave a history talk on World War II at the local school.” This evidenced, staff’s role in supporting and facilitating people to improve their quality of life by accessing social opportunities.

Positive relationships developed with health care partners, meant referrals were comprehensive, detailed and timely. A health care professional informed us, “Staff identify patients that can benefit from dietician input, fall clinic or occupational or physiotherapist to improve mobility.” A health care professional visited the service weekly, or in response to specific requests due to concerns being noted.

The registered manager and management team demonstrated their commitment to collaborative working with a wide range of health professionals to ensure people received effective support when their health conditions to facilitate good outcomes for people. For example, where a change in a person’s mental health was noted, or they exhibited increased periods of anxiety or distress a referral was made to the in-reach community mental health team. In response, an assessment, including observations was undertaken, and recommendations were made as to how staff could adapt their approach to reduce anxiety or distress, which in some instances included changes to prescribed medicines. A visiting health care professional spoke positively of this approach, and how the staff’s ability to recognise and respond had a positive impact. They told us, “The home is exceptional at working with us. We’ve built a rapport and therapeutic relationship.”

Staff maintained continuous oversight of people’s clinical needs and quality of life, through daily observation, reviewing of their needs, clinical monitoring and by working in partnership with health care professionals. Any concerns were documented by staff within the electronic care record system. Basic observations, such as a person’s blood pressure and temperature were monitored, and the appropriate action taken where required.

Training provided to staff in topics related to promoting safety and prevention, for example falls awareness, diabetes and pressure ulcer prevention meant staff had the necessary skills to identify and respond to changes to improve people’s quality of life.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

People consistently told us that staff listened to and respected their wishes. “You can get up when you want to, they don’t force you. You can have a shower whenever you ask for one.” Another person said, “I’m free to move around as I like, I can go to bed if I want to. I can please myself; I could stay in bed in the morning if I wanted to.”

The Mental Capacity Act (MCA) 2005 in a law in England and Wales that protects and empowers people aged 16 and over who may lack the ability to make certain decisions for themselves. It sets out clear principles for assessing capacity, making decisions in someone’s best interests, and support people to be as involved as possible.

Where people lacked the mental capacity to consent to their care, MCA assessments had best interest decisions had been completed. These were decision-specific and demonstrated the least restrictive options had been considered, as documented within the quality statement ‘medicines optimisation’, within the key question ‘safe’.

Where necessary people’s capacity and ability to consent was considered, and they, or a person lawfully acting on their behalf, were involved in planning, managing and reviewing their care and treatment. A family member told us, “Staff phone straight away about doctor visits or medication changes, as I have Lasting Power of Attorney for health and welfare decisions.”

Staff told us they had received training in MCA. They said, they ensured peoples wishes and preferences were adhered to. One staff member told us, “Best interest decisions are used to ensure people are safe.”