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 Good. At this assessment the rating has changed to Requires Improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

This service scored 54 (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 did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

Some care plans and risk assessments were not always detailed or consistent enough to fully guide staff in meeting people’s needs. For example, catheter care plans did not include important information such as when the catheter was last changed, when it was due to be changed next, or how long the person had been catheterised.

Repositioning records showed that people were being repositioned at the required intervals. However, the position used was not always recorded, which meant it was not clear whether people were being supported to relieve pressure effectively. Records relating to personal care and hygiene also showed gaps, particularly for washing and oral care. This meant it was not always clear whether people had received the support they needed.

Oral care records did not consistently show patterns of refusal or provide clear guidance for staff on how to support people who were reluctant to accept oral care. Risk assessments for behaviour that may challenge were in place but were brief and lacked clear, person-centred guidance to help staff respond safely and consistently.

The manager acknowledged these issues during the inspection and confirmed that care plans and risk assessments would be reviewed promptly to ensure they are more detailed, decision-specific, and provide clearer guidance for staff.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

People’s care and treatment were planned with them and reflected what was important to them. Risk assessments, including MUST (Malnutrition Universal Screening Tool), Waterlow, choking, and falls, were used to monitor people’s health and wellbeing. People were supported to meet their fluid targets, and modified diets were provided where needed. Referrals were made to the Speech and Language Therapy (SALT) team or dietician when required.

People’s nutritional and hydration needs were generally met in line with current guidance. Records showed that people had enough to drink during the day to reduce the risk of dehydration, and meal plans were appropriate and well presented.

However, records showed that the first meal of the day was usually served between 9:00am and 10:00am, and the last meal was served before 6:00pm for most people. There were no records to show that meals or snacks were offered or taken between 6:00pm and 9:00am. This meant it was not always clear whether people were supported to meet their nutritional needs overnight.

This concern was raised with the manager, who explained that snacks are sometimes offered during this period but are not always recorded. The manager confirmed she would review this with staff and take action to ensure snacks are offered consistently and clearly documented.

The provider worked with a range of health professionals, including GPs, the Speech and Language Therapy (SALT) team, and the Tissue Viability Nurse (TVN), to support people’s care and treatment. Referrals were made when needed, and staff followed up on actions agreed with external professionals.

Staff worked well together to share information and plan care. They told us they had easy access to care plans, which helped them provide consistent support. Staff said communication within the team was good and that information about people’s needs was shared promptly, both within the service and with external healthcare professionals when required. One staff member told us there was good teamwork across the service.

However, it was identified that care staff had previously not been included in handovers, which had affected the sharing of important information. This was raised with the manager and addressed promptly. The manager confirmed that care staff now attend handovers as part of routine practice to improve communication and continuity of care.

Relatives also spoke positively about communication with external professionals. One relative told us, “Yes, the GP comes regularly into the home, and the senior carer keeps us informed of her health issues.”

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.

Food and fluid charts were completed well, and people and relatives spoke positively about the quality of food provided. The service responded promptly when people’s health needs changed, making timely referrals to appropriate health professionals and acting on their advice.

People’s vital signs and weight were monitored regularly, and concerns were identified and addressed quickly. This supported early intervention and helped people maintain or improve their health. Staff were knowledgeable about people’s care needs and understood how to support and promote good health, while also respecting people’s choices and wellbeing.

Relatives shared positive feedback about the impact of care on people’s health. One relative told us, “She has a good appetite. Previously she had lost a lot of weight. They weigh her often and feed her up. She has put on weight. It’s like being in a hotel.”

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

Systems and processes were in place to monitor clinical care outcomes and support ongoing improvement. Records showed that staff worked closely with external professionals to coordinate care effectively and ensure people received the right support at the right time.

Staff demonstrated a good understanding of people’s individual needs and how to promote their health and wellbeing in their day-to-day care. Relatives spoke positively about how health concerns were managed. One relative told us, “She has had a urine infection. They managed it well and organised antibiotics.” Another relative said, “Her mobility is not good now and she is mainly in a wheelchair. The nurses are on hand to help her.”

Accidents and incidents were reviewed monthly, which helped the service monitor trends and take action to improve outcomes for people.

The provider did not tell people about their rights around consent or respect these when delivering care and treatment.

Decision-specific Mental Capacity Assessments (MCAs) and Best Interest decisions were not consistently in place. Where they were completed, they often lacked sufficient detail and did not clearly cover all areas of people’s care. This meant it was not always clear how decisions were being made for people who lacked capacity.

CCTV was in use in communal areas, but there was no documented consent or MCA and Best Interest decision in place for people who lacked capacity. This raised concerns about whether people’s rights were being fully protected. The provider acknowledged this issue and confirmed that action would be taken to address consent and legal compliance.

Our observations showed that staff supported people to express their views and respected their day-to-day choices. The manager demonstrated a good understanding of their responsibilities under the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) and involved people and their representatives in best interest decisions where these were in place.

The provider acknowledged the shortfalls in documentation during the inspection and took immediate steps to improve records and strengthen oversight. However, at the time of inspection, these systems were not embedded or consistently effective.