22 & 23 July 2014
During a routine inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.
This was an unannounced inspection on 22 and 23 July 2014. At the last inspection on 9 October 2013 we found that there were two breaches in the legal requirements and regulations associated with the Health and Social Care Act 2008. We found care and treatment was not planned and delivered in a way that was intended to ensure people’s safety and welfare. We also found people who used the service, staff and visitors were not protected against the risks of unsafe or unsuitable premises. The design and layout of the home did not appropriately support people who lived there.
A requirement of the service’s registration is that they have a registered manager. The registered manager is a person who has registered with the Care Quality Commission to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider. There was a registered manager in place at the time of our inspection.
Brookvale provides accommodation and nursing care for up to 60 people who have nursing or dementia care needs. The home was divided into three floors. People with nursing needs were visited on a daily basis by visiting professionals to offer the nursing support they needed.
We found that people’s safety was being compromised in a number of areas. We found people who used the service, staff and visitors were not protected against the risks of unsafe or unsuitable premises because the premises were not being adequately maintained. The registered manager was not ensuring the maintenance of appropriate standards of cleanliness and hygiene within the home.
We saw that there were appropriate policies and procedures in relation to the MCA and DoLS to ensure that people who could not make decisions for themselves were protected. We saw from the records we looked at that where people lacked the capacity to make decisions, appropriate referrals to the local safeguarding authority had been made and as a result of assessments, best interest decisions were made.
Improvements needed to be made to ensure medicines were managed safely.
Staff received the appropriate training and support to carry out their roles to ensure people received all their assessed care and support needs in an appropriate way.
People were offered the nutrition they required, and were supported to eat at times that suited their individual needs.
People we spoke with were complimentary about the care and support they received from care staff at the home. Staff we spoke with were knowledgeable about people’s needs.
People were confident when approaching staff for requests or support. Staff held conversations with people whilst being mindful of people’s humour and preferred communication style.
People or their relatives were involved in planning their care. This was supported in the care plans we looked at and from our observations.
Regular monitoring of people’s healthcare was in place to ensure that any changes were discussed and referrals made where appropriate to health care professionals for additional support or any required intervention.
Relatives, people who used the service and staff were encouraged to provide feedback about the service to continuously monitor and improve the quality of the service provided.
There were not effective procedures in place to monitor and improve the quality of the service. We saw the service completed regular quality audits, but these did not always highlight all the areas the home needed to improve in.
You can see what action we told the provider to take at the back of the full version of this report.