Brookdale House Care Home

Brookdale House Care Home is a residential care home providing accommodation and personal care to up to 27 people. The service provides support to older people and people living with dementia. At the time of our inspection there were 15 people using the service.

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

People enjoyed living at the home and felt safe. However, improvements were required in some areas. Relevant recruitment checks were conducted before staff started working at the service to make sure they were of good character and had the necessary skills. However, we did find that more robust procedures for checking full employment histories were required.

Medicines administration records (MAR) confirmed people had received their medicines as prescribed. However, we found some concerns in relation to recording of when prescribed creams were applied. The service has since put in some measures to improve medicines.

The home was clean, and measures were in place for infection prevention and control. We were assured that most infection prevention and control practices were in line with current guidance. However, the home was in the middle of a refurbishment programme so areas were worn and in places were an infection control risk. Plans were in place to update the whole home.

The risks to people were minimized through risk assessments. Staff had received training in safeguarding adults and knew how to identify, prevent and report abuse. There were enough staff to keep people safe. People were supported with their nutritional needs. People received varied meals including a choice of fresh food and drinks. Staff knew people well and treated people with kindness and compassion.

There were effective systems in place to monitor and improve the quality of the service provided. Staff felt supported by management and enjoyed working at the service. The provider had an open and honest approach to care delivery and reported accidents and incidents and informed those involved as necessary.

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 last inspection and update

The last rating for this service was requires improvement (published 06 July 2022) and there were breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about staffing and by a review of the information we held about the service. A decision was made for us to inspect and examine those risks. We looked 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 COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed to good based on the findings of this inspection.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Brookdale House Care Home is a residential care home providing accommodation and personal care to up to 27 people. The service provides support to older people and people living with dementia. At the time of our inspection there were 22 people using the service, two of whom were in hospital.

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

The systems in place for managing infection control risks were not always implemented safely or effectively. Whilst there were systems in place to monitor the safety of people’s care and the environment, these systems were not always effective. This put people at risk of harm. Improvements were needed to ensure that the use of topical medicines was managed safely. The use of covert medicines was not taking place within legal and best practice frameworks. The numbers of staff deployed was insufficient to consistently meet people’s needs. Recruitment practices were safe. Staff had received training in how to identify and report any concerns of abuse. There were systems in place to record and monitor incidents and accidents, these were investigated, and any lessons learnt were used to improve care practice.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. People were not offered meaningful choices of meals that reflected their dietary needs. People’s care and support needs were assessed before they moved into home and detailed care plans were then developed in line with national best practice guidance. However, this was not always followed by staff. Staff training, induction and supervision was implemented inconsistently. The staff worked with a range of health professionals to ensure people’s healthcare needs were met.

We observed that staff sometimes lacked consideration and there was little evidence of truly person-centred support. The management and oversight of the home had been ineffective, and a number of essential standards were not being met. The manager in post was inexperienced. However, robust arrangements had not been put in place to provide them with the support they needed. Systems and processes were in place to help monitor care delivery and the environment; however, these had not always been ineffective. There had been a high turnover of managers and staff and this had had an impact on staff morale which was low. Staff and relatives told us the manager was trying to make improvements and was approachable and helpful.

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 when published in May 2021.

Why we inspected

We looked 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 COVID-19 and other infection outbreaks effectively.

We received concerns in relation to the management of medicines, people’s care needs, the environment and staffing. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective 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.

The provider has started to take action to mitigate the risks.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Brookdale House on our website at www.cqc.org.uk.

Enforcement and Recommendations

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 will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to; person centred care; consent; safe care and treatment; the environment; good governance and staffing.

Please see the action we have told the provider to take at the end of this report.

We have made recommendations that the provider has regard to best practice in dementia care and the environment when completing their refurbishment and that they take account of relevant guidance and local protocols to support safe visiting?

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Brookdale House Care Home is a residential care home that can support up to 27 people in one adapted building. The accommodation is arranged over two floors with a stairlift available to access the upper floor. People also have access to a garden and patio with seating area. Brookdale House Care Home does not provide nursing care. At the time of the inspection, 21 people aged 65 and over were using the service, many of whom were living with dementia.

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

There had been an incident whereby a relative had viewed a message to staff that included information about people other than their family member. The provider took immediate action to rectify this.

We have made a recommendation about how the provider obtains and records people’s consent for their care records to be shared with others.

In some cases, changes to people’s needs had not been fully recorded in all relevant care plans. However, staff knew people well and the provider was in the process of amending people’s care plans.

People had a range of risk assessments in place, which staff followed to meet people needs and reduce risks to them.

People were supported in a kind and caring way.

The premises were well-maintained and there were on-going plans for improvement. The provider carried out required checks to ensure the premises were safe.

There were enough staff to meet people’s needs safely. Recruitment checks had been appropriately carried out to ensure that staff had the required skills and did not pose a risk to people.

People received their medicines as prescribed from staff who were competent and received regular training.

We observed good practice in relation to infection prevention and control.

The provider’s quality assurance systems effectively monitored the quality and safety of the service and action was taken to address any concerns identified. When incidents occurred, the provider analysed these to identify learning and make changes to improve people’s care.

We received mostly very positive feedback from people, relatives and professionals about how the service communicated with them and kept them involved in people’s care. Feedback from people and staff was listened to and acted upon.

The service had not had consistent management, however, we received overall positive feedback about the provider and leadership team from people, their relatives, staff and professionals.

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

Rating at last inspection and update

The last rating for this service was requires improvement (18 December 2020) and there were multiple breaches of regulation. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We carried out a short-notice focused inspection of this service on 22 September 2020. Breaches of regulations were found. The provider completed an action plan to show what they would do and by when to improve safe care and treatment, staffing and governance.

We undertook this focused inspection to check they had completed their action plan and confirm they now met legal requirements. This report only covers our findings in relation to the key questions safe and well-led which contain those requirements.

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.

We looked 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 COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Brookdale House Care Home on our website at www.cqc.org.uk.

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.

Brookdale House is a care home, without nursing, accommodating up to 27 people. The accommodation is arranged over two floors with a stairlift available to access the upper floor. There is no passenger lift. There is a mature garden to the rear and a patio with seating areas. Many of the people using the service were living with dementia. Brookdale House is owned by Tuella Limited who, throughout this report, are referred to as the provider. At the time of our inspection there were 23 people using the service.

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

Some of the risks to people’s wellbeing had not been adequately managed or mitigated.

Learning following a recent significant safety related incident at the service had not been sufficiently embedded.

Medicines continued to not be managed in line with best practice guidance and the provider’s policies and procedures.

The provider’s guidance on the use of personal protective equipment (PPE) was not consistently followed. Records did not provide assurances that cleaning schedules were completed as planned.

We were not assured that there were sufficient staff, effectively deployed, to meet people’s needs.

We have made a recommendation about records relating to recruitment.

Where incidents of safeguarding concerns had occurred, these had been escalated appropriately to external agencies.

Rating at last inspection (and update)

The last rating for this service was requires improvement (Published January 2020). We found one breach of the Regulation regarding safe care and treatment. The provider completed an action plan after the last inspection to show what they would do, and by when, to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

We carried out this short notice, focussed, inspection of this service on 22 September 2020 to check that the provider had followed their action plan and to confirm they now met legal requirements.

The inspection was also prompted in part due to concerns we had received from whistle-blowers about medicines management, staffing levels and staff culture. There had also been a recent safety related incident and we wanted to be assured that steps had been taken to prevent similar incidents from happening again.

We did look 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.

Audits and quality assurance checks were not being fully effective at driving improvements or embedding change.

Records relating to people’s care did not always support staff to meet people’s needs in an effective or safe way. We were not assured that the provider had robust systems in place to always keep records securely and to ensure they are only accessed by people authorised to do so.

We have made a recommendation that the provider implement systems to ensure that the information required by the Care Quality Commission is readily available and accessible in the service in order that they can demonstrate their compliance with relevant Regulations.

Staff raised concerns about morale and told us they had lost confidence in the provider to address their concerns.

Most relatives felt the service engaged with them well, although this was not everyone’s experience.

In discussions with the nominated individual they demonstrated a good understanding of their responsibility to be open and honest with external agencies and with people using the service and there was evidence that the service worked in partnership with other organisations to meet people’s needs.

This report only covers our findings in relation to the key questions safe and well-led which contain those requirements. We reviewed all the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them.

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 remained the same. This is based on the findings at this inspection.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Brookdale House on our website at www.cqc.org.uk.

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 will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, staffing and governance.

Please see the action we have told the provider to take at the end of this report

Follow up

We will continue to monitor information we receive about the service and we will continue to work with partner agencies. We will also request a specific action plan to understand what the provider will do immediately to ensure the service is safe. We will work alongside the provider and the local authority to closely monitor the service. We will return to visit in line with our re-inspection programme. If we receive any concerning information we may inspect sooner.

Brookdale House is a care home accommodating up to 27 people. The accommodation is arranged over two floors with a stairlift available to access the upper floor. There is no passenger lift. There is a mature garden to the rear and a patio with seating areas.

People in care homes receive accommodation and their care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided and both were looked at during this inspection. Brookdale House is owned by Tuella Limited who, throughout this report, are referred to as the provider. At the time of our inspection there were 19 people using the service.

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

We identified concerns with regards to how the service was managing risks associated with people’s dietary needs. Insufficient action had been taken to safely manage risks associated with legionella. There were sufficient staff available to support people. The service was visibly clean throughout. Staff received training in safeguarding adults from harm and had a positive attitude to reporting concerns.

Staff were trained, well supported and had the necessary skills and knowledge to perform their roles and meet their responsibilities. Significant improvements had been made to the internal environment which helped to ensure that it created a pleasant environment for people to live in. Further improvements were also planned. 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.

Staff had developed caring and meaningful relationships with people. People were encouraged to make decisions about their care and staff understood the importance of providing dignified care and of maintaining people’s independence.

The small and stable staff team knew people well and this helped to ensure that they received person centred care that met their individual needs. Peoples communication needs were identified and planned for. Improvements had been made which helped to ensure that people had regular opportunities for meaningful interaction and a range of social activities tailored to their individual needs were provided.

Feedback about the registered manager was positive and demonstrated that people, their relatives and health care professionals had confidence in their ability to lead the service and drive ongoing improvements. The registered manager was open and collaborative and worked in partnership with local organisations and agencies to strengthen local relationships and improve care.

Rating at last inspection

The last rating for this service was ‘Requires improvement’ (November 2018). There was one breach of the legal requirements in relation to safe recruitment. The provider completed an action plan to show what they would do and by when to improve. No new staff had been recruited since our last inspection but there was evidence that the registered manager and provider understood their responsibilities and knew how to safely recruit staff. We will continue to monitor this at future inspections.

This is the third consecutive inspection that the service has been rated as ‘Requires improvement’. We will work with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Why we inspected

This was a planned inspection based on the previous rating.

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.

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

The service does not have a registered manager. 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 and associated Regulations about how the service is run. The registered manager who had been in post at our last inspection left in March 2018. In August 2018, the deputy manager was appointed as manager and is applying to register as manager with the Care Quality Commission.

We last inspected Brookdale house in October 2017. That inspection identified four breaches of the Regulations. People had not always received safe care and treatment, safeguarding concerns had not always been escalated appropriately to relevant agencies. The Care Quality Commission (CQC) had not been notified of events which had occurred within the service as required by the Regulations and the governance and quality assurance arrangements were not sufficiently robust.

We also made four recommendations. These were:

- That the medicines arrangements within the service reflected best practice guidance.

- That the use of covert medicines and the assessment and documentation of mental capacity assessments. was underpinned by the principles of the Mental Capacity Act 2005.

- That staff received an appraisal to support their ongoing development.

- That the activities provision be reviewed to ensure this met the needs of people using the service.

This inspection found that some improvements had been made but that many of these needed to be embedded further. There had been a period of five months when the service had been without a registered manager and this had delayed progress with addressing some of the areas where improvements were required. There was evidence that the manager was now acting to address these.

The provider had not completed all the relevant checks before employing staff.

Improvements were needed to ensure that the premises were decorated and adapted to a consistent standard throughout and in order to meet people’s needs.

We continued to find that some risks to people’s health and wellbeing were not being adequately assessed.

The use of covert medicines was being reviewed but best interest’s consultations still needed to be more clearly documented.

People told us the food was tasty and that there was sufficient choice. However, records did not reflect that people were always being offered regular fluids. Aspects of the meal time experience could be improved.

The cleaning arrangements needed to be more robust.

Overall medicines were managed safely, but there were some areas where further improvements could be made.

Records did not demonstrate that new staff were completing the provider’s induction in a timely manner.

More could be done to ensure that each person’s faith and spiritual needs were documented and catered for. Improvements were needed to ensure that people were supported to develop a personalised end of life care plan.

Improvements were still needed to ensure that people had regular opportunities for meaningful interaction and to take part in a range of social activities tailored to their individual needs.

A provider information return (PIR) had been requested, but due to an oversight by the provider, this had been prepared, but not submitted.

Notifications to the Care Quality Commission (CQC) had not been submitted in a timely manner.

Improvements had been made to the governance arrangements, but these needed to be embedded and sustained in order to be fully effective at driving improvements and identifying compliance with the Regulations.

There were sufficient numbers of staff deployed to meet people’s needs.

Staff asked for people's agreement before providing their care and gave people the time they needed to make and express their choices.

Staff had received supervision periodically and had an appraisal of their performance. A training programme was provided.

Where necessary a range of healthcare professionals had been involved in planning and monitoring people’s support to ensure this was delivered effectively.

People were cared for by staff who were kind, caring and attentive. The atmosphere in the communal areas was good natured and people looked relaxed and happy in the company of the staff

Staff provided care in a manner that was mindful of people’s privacy and dignity.

Feedback about the manager from people and their relatives was positive. The manager demonstrated a good knowledge of all aspects of the home including the needs of people living there and the staff team. They took an active role within the home, delivering care and serving as a role model to the staff team through their hands-on approach.

We found one breach of the legal requirements. You can see what action we have taken at the end of this report.

The service had a registered manager. 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 and associated Regulations about how the service is run.

Improvements were needed to the governance arrangements within the service. There was a no robust programme of audit to assess and monitor the quality and safety of the service. The registered manager did not have an accurate oversight of events affecting the safety and wellbeing of people within the service.

Risks to people’s safety had not always been identified and addressed. Incidents and accidents had not always been reviewed to identify trends and minimise the risk of reoccurrence.

Some aspects of medicines management required improvement.

The registered manager had failed to notify the local authority and CQC of a number of safeguarding incidents which had occurred within the service.

Consent had not always been sought in line with the requirements of the Mental Capacity. Relevant applications for a deprivation of liberty safeguard (DoLS) authorisation had been submitted by the home and had either been authorised or were waiting to be assessed by the local authority.

People told us the food was tasty and that there was sufficient choice. Where people required a modified diet, this was provided and presented in an attractive manner. However, records did not reflect that people were being offered regular fluids. Tools used to monitor people’s nutritional needs were not yet being used effectively.

Aspects of the home’s décor and furnishings needed to be updated or replaced and cleaning arrangements were not always effective. The premises had not been designed or adapted for the needs of people living with dementia. The provider had plans to refurbish the premises and it was anticipated that this would start in November 2017.

There were sufficient numbers of experienced staff to meet people’s needs. Staff were provided with an induction, regular supervision and training opportunities but had not received an appraisal.

Where necessary a range of healthcare professionals had been involved in planning and monitoring people’s health and wellbeing support to ensure this was delivered effectively.

People were cared for by staff who were kind, caring and attentive. The atmosphere in the communal areas was good natured and people looked relaxed and happy in the company of the staff.

Overall, staff were observed to provide care in a manner that was mindful of people’s privacy and dignity.

People had care plans which provided guidance for staff although these were not always updated to reflect changes in people’s needs. People received care and support which suited their needs and wishes. Overall, staff were generally well informed about people’s needs and how to meet these.

People and their relatives were positive about the activities provided and were encouraged to follow their interests and hobbies.

People knew how to raise concerns or complaints and records showed that complaints were dealt with appropriately.

The registered manager took an active role within the home, delivering care and serving as a role model to the staff team through their hands on approach.

We found four breaches of the Health and Social care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.