An unannounced comprehensive inspection visit took place on 18 December 2018 and we returned on 19 December 2018 to speak with staff and to review their quality assurance systems. Brookdale Nursing Home is registered to provide personal care to older people including people living with dementia. Brookdale Nursing Home is a nursing home, which provides care for up to 40 people across two floors. At the time of our inspection there were 31 people living at Brookdale Nursing Home. People had their own bedroom and not all the bedrooms had en-suite facilities and four bedrooms were for shared occupancy. People had the use of shared communal lounges, dining rooms and bathrooms on each floor. To aid people’s movement around the home, a passenger lift and stairs helped people move between floors.
People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
At our last inspection we rated the service Good overall. Prior to and immediately following this inspection visit, we received information raising concerns about continence care, infection control and limited opportunities for people to pursue their interests. We looked at these concerns at this inspection and we found standards in how people were cared for had not been consistently maintained. In Well Led, people and staff told us changes to the feel and culture of the home had changed and although some improvements were noted, these needed to be embedded further to determine if they improved people’s care and welfare. Overall, the rating has now changed to Requires Improvement.
The service did not have a registered manager, although a manager was appointed at the home in September 2018 and was in the process of applying for registration with us. 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.
Not all staff were positive about the changes in management, however staff agreed the changes being implemented by the manager were to improve people’s experiences and care outcomes.
Staffing levels helped ensure people received the consistent care they needed, although staff said the use of agency staff meant the shift did not always operate effectively. The regional manager was confident staff levels were right and said staff needed to be deployed and managed more closely to improve the delivery of care. Staff did not always have time to sit and spend time getting to know people more. Our observations during this visit, were of positive and friendly interactions between staff and people but they were limited.
Staff did not always treat people with dignity and respect. Relatives and staff told us people wore other people’s clothes and the laundry system was not effectively managed to ensure people’s own laundry items were returned. People’s clothing was transferred to other areas of the home in black bin bags which showed no respect for people’s personal property. Some people said staff entered their rooms without knocking which they did not appreciate.
Staff had a good understanding of abuse and the safeguarding procedures that should be followed to report abuse and incidents of concern. Risk assessments were in place to manage potential risks within people’s lives, whilst also promoting their independence.
People’s care plans provided information about the person’s preferences and included some knowledge staff had gained about the person’s interests and life history. Care records were reviewed and evaluated to ensure they remained up to date and changes made as required. However, some care plans we reviewed required more specific details to ensure staff provided consistent care. Staff had a hand over meeting held daily but some of the descriptions about people, were not always accurate. Staff said if people’s needs changed, they were informed by way of a handover, however this needed to be more reflective of people’s needs.
A process was in place which ensured people could raise any complaints or concerns. Concerns were acted upon and lessons were learned to reduce potential for similar complaints. The provider had systems to monitor the quality of the service. Actions were taken and improvements were being made, although some of the issues we found had not been identified. During and following our visit, the manager had taken action to make some improvements.
People were safe and satisfied with the support they received although most people said there was limited stimulation to keep them occupied. There were times people sat in different parts of the home with very little to do. The manager following their appointment, had begun to improve people’s access to hobbies and interests.
Training records showed staff training was being completed and staff were equipped with the skills and knowledge to look after those in their care.
Staff worked within the principles of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff for the majority of time, sought people’s consent before any care and support or choices were provided but there was inconsistency in staff practice.
People received support from nursing staff and other health care professionals. People were registered with a GP practice who visited people when needed. If people required other healthcare support in an emergency, staff were available 24 hours a day to seek that help or medical intervention.
People received their medicines safely by trained staff and regular checks on administration and storage ensured medicines were given safely and as prescribed.
There were examples of completed audits and checks that gave the provider confidence people received a safe, responsive and effective service. However, some of these audits were not accessible to us until following our visits because they were unable to be located, or IT problems meant they could not be accessed or shared. Significant changes in the management of the home and the staff team meant that changes needed to become embedded within the practice of the home. Changes with the manager and the care staff within the home becoming ‘one team’ needed more time to embed as some staff raised concerns with that poor communication and a lack of consistent teamwork impacted on the quality of care people received.
Further information is in the detailed findings below.