London Residential Health Care Limited - Brook House Nursing Home

We found the following examples of good practice.

The care home’s measures to prevent and minimise the risk to people, staff and those that visited from catching or spreading COVID-19 were effective and robust.

Staff and managers wore personal protective equipment (PPE) appropriately, During our inspection, up to date infection prevention and control (IPC) and COVID-19 training was provided for staff that was routinely refreshed. There were suitable supplies of PPE that met current demand and any future outbreaks.

Staff followed IPC and PPE policies and procedures, that reflected ongoing changes to COVID-19 related guidance and were regularly updated. This covered contingency plans for managing adverse events, such as COVID-19 outbreaks and staff shortages. The registered manager conducted frequent care home walkabout tours to make sure staff were using PPE properly, and following guidance.

Whilst access to the care home was restricted, due to an outbreak, designated people such as essential care givers and visitors of people at the end of life could visit their relative or friend in line with Government COVID-19 care home guidelines. All visitors to the care home had to follow the home’s IPC guidance.

Alternative communication arrangements were made so people could maintain relationships with relatives and friends. Staff actively supported people to keep in touch with those who could not visit the care home by telephone and using video calls.

Currently the care home was not taking new referrals or people returning home due to a COVID-19 outbreak. Normally new admissions or people returning after a hospital stay were required to have a negative COVID-19 test and self-isolate for a minimum 14 days to reduce the risk of the virus spreading.

A ‘whole home’ COVID-19 testing program was followed, that ensured everyone living, working or visiting the care home was regularly tested for COVID-19. The provider knew how to order COVID-19 home testing kits and where from.

The care home was kept clean, hygienic, and detailed records were kept of staff cleaning schedules. This included continuously cleaning high touch surfaces, such as light switches, grab rails and door handles as part of a rolling programme.

The care home kept thorough assessments of infection risks for everyone living and working there and if people were deemed to be disproportionately at risk from COVID-19, appropriate action was taken to reduce the impact. Staff with underlying health care conditions or other restricting factors, did not work on floors where people who had tested positive for COVID-19 had been or were self-isolating.

The provider had minimised the number of agency staff they used to those that had previous experience of the home to reduce the risk of spreading infection.

The provider's IPC policy was up to date and last updated on 21 January 2022.

London Residential Health Care Limited - Brook House is a care home providing personal and nursing care to 29 people aged 65 and over at the time of our inspection. The service can accommodate up to a maximum of 32 people. This purpose built home has two floors, each with their own separate adapted facilities.

People’s experience of using this service

At the service’s last inspection they were rated requires improvement overall and a breach of regulation in relation to infection prevention and control was made.

At this inspection we found the provider had made enough improvements to ensure they were no longer in breach of Regulation 12 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because we found the provider had made enough improvement in relation to how they prevented and controlled infection. The premises were kept hygienically clean and staff followed relevant current best practice guidelines regarding the prevention and control of infection.

People continued to be cared for and supported by staff who knew how to manage risk and keep them safe. Medicines systems were well-organised, and people received their prescribed medicines as and when they should. The service was adequately staffed by people whose suitability and fitness to work in an adult social care setting had been properly assessed.

The provider recognised the importance of learning lessons when things went wrong and were keen to continuously improve the service. The quality and safety of the service people received was routinely monitored by managers and nursing staff at both a provider and service level. The provider promoted an open and inclusive culture which sought the views of people using the service, their relatives and staff. The provider worked in close partnership with other health and social care professionals and agencies to plan and deliver people’s packages of care and support.

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 requires improvement (published 22 December 2020) after we found a breach of regulation. The provider completed an action plan after the last inspection to show us the action they planned to take to improve their infection control arrangements. At this inspection we found improvements had been made and the provider was no longer in breach of this regulation.

Why we inspected

We undertook this unannounced focused inspection to check the provider had followed their action plan to improve how they prevented and controlled infection. This report only covers our findings in relation to the Key Questions Safe and Well-led.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for London Residential Health Care Limited - Brook House Nursing Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor the service and information we receive about them. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

London Residential Health Care Limited - Brook House Nursing Home can provide nursing and personal care for up to 32 people. At the time of our inspection 28 older people were living at the care home, most of whom were living with dementia and required nursing care.

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

People spoke positively about the standard of care and support they received at Brook House Nursing Home. People said it was a pleasant and safe place to live.

However, at this inspection we found people were not always kept safe. This was because staff did not follow relevant national guidelines regarding infection prevention and control (IPC). Although we were assured the provider was meeting IPC guidelines in relation to shielding and social distancing rules and keeping the premises hygienically clean; We found some staff did not always wear their face coverings correctly.

The care home was adequately staffed by people whose suitability and fitness to work in such an adult social care setting had been properly assessed. However, the service had been over reliant on temporary agency staff in recent years, but following a successful recruitment drive a number of new permanent nursing and care staff have now started working at the care home. This meant people living in the care home now received better more consistent care from staff who were familiar with their needs, wishes and daily routines. New staff continued to undergo relevant pre-employment checks to ensure their suitability and fitness for their role. Staff received up to date training and support they required to effectively meet the needs of people they cared for.

People were also supported by staff who knew how to prevent and manage risks and to keep them safe from avoidable harm. People received their medicines as they were prescribed.

People spoke positively about the way the care home was managed. The provider had recently appointed a new suitably qualified nurse to manage the care home along with the experienced deputy manager who had been in day-to-day charge for the last 18 months. The provider had established governance systems in place that were effectively operated. This ensured the quality and safety of the service people received was routinely assessed and monitored. The provider consulted people, their relatives and staff as part of their on-going programme to continuously improve the service. The provider worked in close partnership with other health and social care professionals and agencies to plan and deliver positive outcomes for people using the service.

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

Rating at the last inspection

The last rating for this service was good (published 11 July 2018).

Why we inspected

We received concerns in relation to the way the service prevented and managed falls and used agency nursing and care staff to meet people’s needs. As a result, we undertook a focused inspection to review the Key Questions of Safe, Effective and Well-led only.

We also looked specifically 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 coronavirus and other infection outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified in the other Key Questions and therefore did not inspect them. Key Question ratings from this inspection and the previous comprehensive inspection were used in calculating the overall rating for the service.

We found evidence at this inspection that the provider needs to make improvements. The overall rating for the service has therefore changed from Good to Requires Improvement.

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 have identified a breach of regulation in relation to the prevention and control of infection.

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 continue to monitor the service and information we receive about them. If we receive any concerning information we may inspect sooner.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for London Residential Health Care Limited - Brook House Nursing Home on our website at www.cqc.org.uk.

At our last inspection in March 2016 we rated the service “Good”. At this inspection we found the evidence continued to support the rating of “Good” and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People were protected from avoidable harm. There were assessments in place, which identified support needs and how care was to be delivered. People were protected by staff who knew how to recognise if a person was experiencing or at risk of abuse. Staff recruitment procedures ensured that people received care from staff who were safe to work with people. There were sufficient numbers of staff to meet people’s care needs, including supporting people to take their medicines as prescribed.

People's needs had been assessed and there were care plans in place to ensure they received safe and effective care. Staff received induction and on-going training which meant they were able to meet people's specific care needs, including support to receive specialist health care services. People were supported to eat and drink enough to meet their needs. There were policies and procedures to ensure people had maximum choice and control of their lives and that they were not restricted unnecessarily.

People were supported to maintain relationships that were important to them. This enabled people to develop meaningful relationships with the other people and staff at the service. People were involved in making decisions about matters important to them. They were encouraged to express their views as much as they could. We observed people being treated with privacy, dignity and respect.

The service was responsive to people's needs and staff listened to what people had to say. Staff responded to people promptly and respected people's individual wishes and choices. The service supported people to communicate their needs and understood information that was given to them by providing this in a way they could understand.

People and their relatives were confident that any concerns or complaints they raised would be dealt with. The service was well-run and had received compliments from people and their relatives. The registered manger and the rest of senior management were aware of their regulatory responsibilities. The service monitored the quality of care people received and acted to improve how people were supported.

Brook House provides accommodation, nursing and personal care to up to 32 older people, some of whom are living with dementia. At the time of our inspection 32 people were using the service.

The service had 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 registered manager was also the registered manager for another of the provider’s services. Whilst the registered manager was at their other service the head of care and other senior members of staff undertook the day to day management of the service.

People received the support they required from staff to have their health and social care needs met. Staff were knowledgeable about the people they supported. This included their preferences, routines and their support needs. Staff provided people with the support they required in line with their care plans. Staff regularly discussed people’s needs to identify if the level of support they required changed, and care plans were updated accordingly.

Staff were knowledgeable about signs and symptoms that a person’s health may be deteriorating and liaised with healthcare professionals as required to meet those needs. Staff were aware of the support people required with their nutritional needs and in regards to risks to their safety. Risk management plans were developed and we observed people being supported in line with these plans to maintain their health and safety. People received their medicines as prescribed and safe medicines management processes were followed.

Staff ensured people were engaged and a range of activities were provided at the service. This included implementation of programmes to keep older people active and providing people with dementia with sensory stimulation.

Staff had built caring and friendly relationships with people. People were aware of who the staff were and we observed people and staff engaging in friendly conversations. There were sufficient staff to meet people’s needs, and staffing levels were flexible to provide people with the support they required. People told us there were always staff around and if they needed any assistance a staff member came to support them promptly. We observed staff spending time with people in communal areas as well as engaging with people in their rooms.

People were involved in decisions about their care and staff offered people choices about daily activities. Staff were aware of who had the capacity to make decisions and supported people in line with the Mental Capacity Act 2005. Where appropriate, staff liaised with people’s relatives and involved them in discussions about people’s care needs. People were supported to make decisions about end of life care and how they would like to be supported during that time.

Staff received the training their required to ensure they had the knowledge and skills to undertake their role. Systems were in place to ensure staff remained up to date with the training considered mandatory for their role. Staff were supported by their line manager and received regular supervision and annual appraisals.

The registered manager and the management team monitored the quality of service delivery. A range of weekly and monthly audits were undertaken, and information was gathered about key aspects of service delivery. Where it was identified that improvements were required these were undertaken promptly.

There were open and honest conversations amongst the staff about service delivery. Staff were invited to express their views and opinions, and these were used when looking at service improvements. People and their relatives were also encouraged to express their views about the service and where they had made suggestions for improvements these had been implemented.

When we visited Brook House there were 31 people using the service. We spoke with four of the people using the service, five relatives, the registered manager and five other members of the staff team. We reviewed four people's care plans and five staff files.

Was the service safe?

People told us that they felt safe living at Brook House. One person said, 'Oh yes, it's really safe here, the team approach makes it like a home from home'. People said if they had any concerns then they would speak to staff or the manager. Safeguarding procedures were robust and staff understood how to safeguard the people they supported. There were mechanisms in place to help to safeguard people from the risks of abuse. People were treated with respect and dignity by the staff.

The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. Relevant staff had been trained to understand when an application should be made.

The manager had ensured there were sufficient numbers of staff on duty, appropriately qualified to meet the support needs of people who used the services. This has helped to ensure that people's needs were met.

The manager set the staff rotas. They took people's care needs into account when making decisions about the numbers, qualifications, skills and experience required. This had helped to ensure that people's needs were met.

Staff recruitment procedures were robust to ensure that only suitable people were employed.

Is the service caring?

People were assisted by kind and supportive staff. We saw that staff showed patience and professionalism and gave appropriate encouragement when supporting people. The people we talked to said the staff treated them well and respected their wishes, dignity and privacy. Relatives of people living in the home were very positive about the care given to people. We observed that staff knocked on doors before entering people's rooms and asked if it was convenient for them to go in. This reflected the caring environment that we found on the day of the inspection.

Is the service responsive?

The way in which care should be provided was set out clearly in care plans and we saw that care was delivered in line with this. Relatives of people who use the services told us that if a person's needs changed, their care and support was tailored to those changed needs. We saw that care plans were reviewed regularly and changed appropriately. This was important as this helped staff understand what people wanted or needed or how they were feeling.

All the people who use the services we spoke with knew how to make a complaint. There was an appropriate complaints procedure in place and discussions we had with relatives and staff indicated that they would be supportive of anyone who needed to complain. People can therefore be assured that complaints would be investigated and action taken as necessary.

Is the service effective?

People were protected from the risks of inadequate nutrition and hydration. Also, people told us that they liked the food they were provided with and we saw that it met their cultural needs. People's needs were regularly assessed. Care plans were "person-centred" focusing on people's individual needs. We found that care was delivered in line with these care plans.

People's health and care needs were assessed together with them, and they were involved in their care and support planning. All the risk assessments and care plans that we saw had been signed by people indicating their agreement with what was written down. People told us that they had been involved in their care and support plans and that the plans reflected their needs. One person said, 'Staff explained to me what was in my care plan after an earlier discussion with me and my daughter about what I needed'. We inspected four people's care files. They included essential information about the person, needs and risk assessment information, care plans and records of health care appointments.

Is the service well-led?

Systems were in place to effectively assess and manage risks in relation to people's health, safety and welfare. The service worked well with other agencies and services to make sure people received their care in a joined up way.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure that people received a good quality service at all times.

The home was registered in February 2013 and many staff were newly recruited or transferred from other homes operated by the provider. Staff said they had the checks required. We saw the recruitment process included the required checks being completed before new staff started work.

People told us that staff gave them the help and support they needed and described staff as "kind", "caring", "responsive" and "wonderful". They said that the home was kept clean and that they had all they needed in their room. Comments about the food included "the food is good", "we get enough to eat" and "always plenty".

Relatives said they had visited and decided that the home was the right place and said that the care and support provided met their expectations. They said there were enough staff who were responsive to people's needs and that communication was good because they were kept informed and updated about any changes. People made positive comments about the environment and said it was kept clean. Visitors said that they were made to feel welcome and offered drinks.

Staff said that they had the required checks before they started work and completed an induction that gave them the information they needed to do their job. Staff told us that one of the things they did well was provided good care and support to people who use the service.

We saw some good interactions between staff and people who use the service with staff clearly knowing people and how to meet their needs. Although the home was newly built we found some communal areas were very warm during our visit.