Brockworth House Care Centre

Brockworth House Care Centre is a residential care home providing care to a maximum of 55 people. The service predominantly provides support to people who live with dementia. At the time of our inspection there were 46 people using the service.

People are accommodated in one purpose-built building across two floors; on two units upstairs and one-unit downstairs. The different units provide the opportunity for people to be supported at various stages of their journey in care. Providing the freedom for people who are more mobile and a quieter environment for people who are more physically and mentally frail.

Each unit has its own communal spaces comprising of a kitchenette, dining space and a selection of areas to sit and relax or take part in social activities. Each person has their own bedroom, toilet and washing facility and there are adapted bathrooms on each floor. A large enclosed garden supports people to safely enjoy the outside.

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

The information held about people’s medicines was not always sufficient to provide staff with clarity on the administration and use of some prescribed medicines, to ensure the risk of medicine errors occurring from this were fully mitigated. At the time of the inspection processes to ensure people’s prescribed medicines were obtained in a timely manner ready for administration, still required improvement to avoid gaps in people’s treatment.

Infection, prevention and control (IPC) practices and arrangements were not always supporting the prevention of infection spreading.

The provider’s quality monitoring processes were not fully effective. They had not identified the shortfalls found at this inspection, in relation to medicines and IPC. This had not resulted in necessary improvement action being taken to address these shortfalls. Managers were not using enhanced monitoring processes to assure themselves that an outbreak of COVID-19 in the home was managed safely.

Improved scrutiny was needed to ensure the provider’s quality monitoring and governance systems were effectively implemented to ensure the service remained compliant with necessary regulations and best practice.

The service experienced significant challenges during the pandemic and since and the provider had taken action to provide staff with leadership and enough staff to keep people safe.

Risks which otherwise may impact on people’s physical and mental health were assessed and managed. These included those associated with the premises and environment, people’s mood and behaviour, poor mobility and falls, eating and drinking, potential choking and pressure ulcer development.

Arrangements were in place to protect people from abuse and to act if abuse was suspected. Processes were in place to ensure people, relatives and staff felt comfortable in reporting poor care or discrimination so this could be acted on. People were supported to live safely with dementia. Staff supported people’s preferences in relation to their protected characteristics.

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.

We observed interactions and actions taken by staff which demonstrated a dementia friendly and person-centred culture was in place. Joint working with social care and health care professionals, community and church leaders took place to support people’s health and wellbeing needs.

Staff felt supported by senior staff and had access to training which suited their learning needs, and which helped them perform their roles safely.

Relatives were kept informed of their relative’s health needs and informed of any accidents or incidents involving their relative.

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 good (published 10 August 2018).

Why we inspected

The inspection was prompted in part by notification of an incident following which a person using the service required medical assistance. 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 risks associated with swallowing problems and potential choking. This inspection examined those risks.

Action had subsequently been taken to ensure the person received the right care and treatment to meet their needs. Processes and practices had been reviewed to ensure the safe use of thickeners (sometimes used in people’s drinks to help them swallow safely).

This focused inspection reviewed the key questions of safe and well-led only.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

For those key questions not inspected, we used the ratings awarded at the last rated inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement. 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 Brockworth House Care Centre on our website at www.cqc.org.uk

Enforcement

We have identified breaches in relation to the management of people’s medicines and quality monitoring processes at this inspection.

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 work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Brockworth House Care Centre has a range of communal areas for people to use, including lounges, a secure garden and a dining room. People’s bedrooms were spread over two floors and people were able to freely move around the home. The home had a dedicated visiting room which had been set up in accordance with COVID-19 visiting guidance.

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

People’s mobility support needs and risk of falling were assessed and guidance was available for nursing and care staff on how to manage any related risks. These assessments provided staff with clear guidance on the support and equipment needed to assist people with their mobility.

Nursing and care staff understood people’s needs, how to assist them and how to protect them from avoidable harm. Staff knew which people were taking anticoagulant (blood thinning) medicines and the additional actions they needed to take if a person taking these medicines fell.

The management team and provider had systems in place to assess and monitor people’s health and wellbeing. The registered manager reviewed all incident and accident records to ensure appropriate action has been taken to identify trends and reduce the risk of repeat incidents.

People had regular access to medical review and emergency services support as required.

The service had infection control processes and systems in place to reduce the risk of people contracting COVID-19. The service was supporting relative visiting in accordance with government guidance.

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.

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

Rating at the last inspection

The last rating for this service was Good (published 10 August 2018).

Why we inspected

We undertook this targeted inspection following a review of our internal intelligence in relation to people’s mobility and risk of falling. A decision was made for us to inspect and examine those risks.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Follow up

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

Further information is in the detailed findings below.

At our previous inspection in October 2015 the service was rated "Good". At this inspection we found the service remained "Good".

Brockworth House Care Centre 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.

Following our previous inspection recruitment practices had been improved and records showed the required pre-employment checks had been completed. Improvements had also been made to ensure people’s medicines would be available when needed and people continued to receive their medicines as prescribed.

We heard positive comments from people using the service at Brockworth House Care Centre such as, “I would recommend Brockworth House to people and have done” and “The home nowadays has a good reputation amongst the local population and clinicians are happy to go there.”

The personalised care people received were exceptional and the service was outstandingly responsive to the changing needs of people living with dementia. Digital systems were used creatively to enable people to access material that they enjoyed and held meaning for them. Activities available to people were highly personalised and staff went out of their way to ensure people had a stimulating and enjoyable day.

People were protected from harm and abuse through the knowledge of staff and management. Risks in respect of people's daily lives or their specific health needs were assessed and appropriately managed with plans in place to reduce or eliminate those risks. Sufficient staff were deployed. The care home was clean and had been well maintained.

Staff were supported to maintain their skills and knowledge to support people. People were assisted to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People were consulted about meal preferences and enjoyed a varied diet. People's health care needs were met through on-going guidance and liaison with healthcare professionals.

People received support from caring staff who respected their privacy, dignity and the importance of their independence. People were supported to maintain contact with those important to them.

People and their representatives could be assured that complaints would be thoroughly investigated. Care was provided for people at the end of their life.

Effective quality monitoring systems were in operation. The registered manager was approachable to people using the service, their representatives and staff.

Further information is in the detailed findings below.

The care home specialised in the care of people who lived with dementia or mental health needs. Some people had become more frail and their predominant needs were now of a physical nature. The care home could care for up to 55 people and at the time of our inspection there were 50 people living there. Nursing care was provided by nurses who were on duty at all times. People’s care was delivered across two floors and areas were separated into units. Each unit had its own communal area, bedrooms and bathrooms. People could visit other units but they tended to remain on their own. There were extensive grounds outside to be enjoyed and a safe enclosed garden meant people could enjoy the outside safely and independently if they chose to.

The care home did not have a registered manager in post but a new home manager had been recruited and was due to start in August 2016. It was planned that this manager would apply to the Care Quality Commission (CQC) to become the new registered manager. A registered manager is a person who has registered with the CQC 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.

During this inspection we followed up breaches of the regulations which were identified in our last inspection; that inspection had been on 30 June, 1 and 2 July 2015. The provider had been asked to take action and address these breaches. These had included unsafe care delivery, a lack of personalised care, people not being treated with respect and dignity and staff not providing understanding and compassion. It also included care records not being sufficiently maintained in order for safe and consistent care to be delivered. The provider wrote to us with their action plan on how they would address these shortfalls and by when. During this inspection we found these actions had been taken and the shortfalls addressed.

We did however find people were at risk of not being cared for by staff who were suitable because some recruitment checks had not been fully completed. However, the two examples we identified were addressed at the time of the inspection and just after the inspection. The forms used by the provider had not prompted staff to explore these areas and this was going to be addressed. Arrangements to ensure people were fully assessed and their moving and handling needs were met safely had been implemented. Staff were now consistently ensuring people were supported to move safely. People’s dependency levels had been reviewed and had continued to be reviewed and there were enough staff to meet people’s needs.

The care home had problems in ensuring people’s medicines were available when needed. This was a problem with the way the Pharmacy received prescriptions and managed these. The care home had put strategies in place to try and reduce the risks arising from this to people. The care home’s arrangements for medicines were likely to change because of this. Safe practices were in place in the care home for the administration and storage of people’s medicines once they arrived.

We received information prior to the inspection that the management staff had confused staff over what constituted abuse. We explored this with the management staff who after the last inspection had reminded staff that in forcing people to do something they did not want to do or to move them in a way they had not been assessed to be moved constituted abuse. The staff we spoke with were very clear about what abuse was, what this looked like and what they would do about this if they witnessed or suspected it had taken place. They were very clear about the fact people could not be forced to receive care they did not consent to but, in order to deliver the care people needed and to meet their duty of care, this had to be done lawfully.

People lived in a safe environment which was kept clean.

People’s relatives told us the care their relatives received was effective and met their relative’s needs. They were very happy with the standard of care being provided. Staff had received a lot of training and support since our last inspection and we observed this training embedded in staff practices. People now received care which met their personal needs. As reported above people received care which was delivered lawfully. People who lacked mental capacity to give consent and to make their own decisions about their care and treatment were protected under relevant legislation which staff adhered to. People were provided with appropriate support to eat and drink and particular risks relating to this were identified and addressed. Arrangements were in place to make sure people received the medical care they needed and referrals were made to specialist health care professionals appropriately. Staff were particularly proactive in making sure people had access to the right professional. The care home received good support from people’s GPs.

We observed people being treated with respect and dignity. Staff approached people with kindness and compassion and showed a genuine desire to ease people’s distress. Relatives told us they also felt supported and involved. Communication with those involved with people's care was good.

The staff were able to respond to people’s needs because there was detailed guidance in place for staff to follow in terms of people’s care plans and risk assessments. The maintenance and content of people’s care records had improved. Staff hand-over meetings also provided staff with relevant information.

People had improved opportunities to socialise and take part in activities. We observed examples of this and saw people engaged and enjoying themselves. People could raise complaints, have these investigated and responded to. Any area of dissatisfaction or complaint was seen as an opportunity by the management staff to reflect on what had happened and to learn from this.

Despite there not being a registered manager in place the provider had made arrangements for the care home to receive strong leadership. This had taken staff through a period of improvement which had benefitted people. The provider’s quality assurance system had resulted in improvements being made although how completed actions were actually recorded did not make it easy for senior management staff to evaluate its full effectiveness. We fed back our observations on this which the senior management team took on board and would look at reviewing.

The views of people, their relatives and staff had been sought and considered when making improvements to the service. This process would be further used when the new manager was established in post.

Where possible staff encouraged people who used the service to make choices about their care. We observed staff asking people which activity they wanted to take part in or what they wanted for lunch. Each person had individual support plans (care plans) that had been reviewed each month. This meant people were receiving up to date care based on their individual needs. Systems were in place for the safe administration of medicines and this was carried out by trained staff. We also saw systems in place to monitor the quality of the service provided within the home.

The relatives told us 'it's a very nice home'. 'I can't speak highly enough about it, very friendly'. 'They care for my mother very well and make her feel comfortable'. 'Our mother has deteriorated, but the staff have adapted the care accordingly and are very aware of her needs'. 'The staff always have time for our mother and we are reassured she is getting good care'.

The staff knew people very well and the communication between them was friendly and attentive but respective of their individual needs. During our inspection we found nothing that gave us cause for concern.

We spoke to four relatives of people using the service. One relative told us 'its brilliant here, they look after her and care for her very well. I meet with other relatives and they all say the same thing'. Another relative told us that 'I can come and go whenever I want too and I can't fault it here'. Another relative told us 'My mother came here in July this year, and I looked at 12 other homes but decided to wait until she could come to Brockworth. There are lots of activities and she always joins in. My mother always looks very happy'