Brookdale House Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

There was a focus on safety within the service. Staff, people, and relatives were encouraged to speak out about any concerns. The registered manager and the nominated individual both wanted to hear about any concerns and to learn from them. Staff understood how to keep people safe from the risk of abuse. There was a commitment to take action promptly to keep people safe and an open culture of reporting. People’s rights were only restricted where required for their safety and in accordance with legal requirements. Staff used a range of tools to identify and assess risks to people. Where risks were identified guidance, processes and equipment were in place to manage them. Not all staff provided positive feedback about the recent reduction in staffing. However, the change had followed an analysis of people’s staffing needs which was being kept under review. People still received their care as required. Staff were supported well in their role.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Relatives told us they felt encouraged and supported to raise any concerns they had and felt confident to do so. They said they could give their feedback through reviews of their loved one’s care and the completion of feedback forms and questionnaires. They could also raise concerns using the home’s complaint’s box. People had information about how to raise complaints in their bedrooms. Relatives told us their views were listened to and acted upon to make improvements. For example, the garden had previously been in a poor state and had not promoted people’s physical or mental well-being. Staff had recently re-developed the garden into an interesting and stimulating space for people living with dementia to explore and enjoy. People and relative’s feedback had been incorporated into the design and features, which reflected their ideas and included items which were personally significant to them. We heard from people and relatives about the positive impact of this space upon people. In terms of being able to walk, socialize and host activities. There was also a 'You said we did' board displayed to inform people of the actions taken in response to their feedback.

Leaders told us there was an open-door policy, which encouraged staff to speak out about any issues. We observed leaders were readily available and accessible. The nominated individual told us they completed spot checks on both records and staff's practice, in order to identify any potential risks to people. Any learning from these checks was then shared with staff via the shift handovers, team meetings and supervisions. Staff demonstrated their understanding of the incident reporting process. They completed a body map if people had sustained an injury and followed the post falls protocol to monitor people after any falls. There was a record of the actions taken following incidents to reduce the risk of repetition. Leaders confirmed they then reviewed the incident reports to identify any further required actions or learning, which was shared with the staff team. The registered manager understood their responsibility under the duty of candour to notify relevant people if a notifiable safety incident had occurred.

The provider audited the service and reviewed their data in relation to incidents and complaints in order to identify and act upon any emerging trends or issues. The nominated individual told us earlier in the year trends monitoring had identified an increase in the number of falls people experienced. In response to this, they had arranged face to face falls training for staff to supplement their online training. The provider promoted an open and transparent approach to learning. There was a display board where people and relatives could read about how to reduce the risk of falls and about their findings and the actions taken. The provider had recently commissioned an external consultant to audit the service. Their report which noted the improvements made since their previous visit was displayed for people and relatives to read.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

People said they felt safe and secure in the care of staff. A person told us, “I’m very safe here because the staff are ever so nice, and they are always here to help me.” A relative said, “The best thing of all is that I know (name of person) is safe here.” Another relative told us they were informed by staff when a safeguarding alert had been made about their loved one. Most people had restrictions in place to keep them safe, which they lacked the capacity to consent to. A relative told us how staff had consulted them before they made an application to authorise the use of restrictions for their loved one. This demonstrated staff understood the legal processes they had to follow and consulted relevant people. Relatives confirmed they were able to visit their loved ones freely and to take them out.

Staff told us they had completed safeguarding training and understood what to report, how and to whom. Leaders told us they reported any potential safeguarding concerns externally as required. Partner agencies confirmed safeguarding concerns were reported and relevant actions taken. Leaders told us how a session had been held with staff to discuss the learning outcomes from a safeguarding referral. Senior staff had also developed a presentation for staff to support their learning. Leaders and staff understood what could constitute a restriction upon a person’s liberty, the legal requirements and who was subject to the Deprivation of Liberty Safeguards (DoLS). Leaders told us where a person had an additional condition upon their DoLS, staff had worked closely with them to explore the options to meet it in the way the person wanted. They understood the need to work with people and to uphold their rights.

We saw people were happy and relaxed with staff. They recognised them all whatever their role and felt comfortable with them. Staff were observed to be kind and caring to people. People trusted the staff and approached them all freely, including the leaders. We saw the leaders were highly visible and people and staff would just drop into the office and speak with them. People were treated as individuals and were given choices about their care and what they wanted to do and where. People were physically safe, there was a secure keypad on the front door to prevent people leaving without staff's knowledge and the rear of the property was secure.

Staff were required to complete both safeguarding adults and children training which they updated annually. Staff had access to relevant polices and guidance to inform them. The safeguarding records showed what had happened, the action taken to keep the person safe, any referrals made, and the actions taken. People were consulted wherever possible when a safeguarding occurred about what they wanted to happen. People had financial care plans in place to safeguard their finances. There was a focus on ensuring any restrictions upon people were the minimum required for their safety. Staff had worked with health care professionals to review the administration of medicines covertly and 2 people no longer received their medicines covertly. There were regular staff meetings booked, so staff could speak up and be updated about any concerns.

Relatives told us risks to people were both identified and managed whilst still respecting the person’s wishes. For example, a relative told us how their loved one still enjoyed being able to spend some nights away from the home. Relatives said they participated in their loved one’s care reviews. Relatives felt staff were knowledgeable and attentive and communicated with them about their loved one’s well-being and any concerns. A relative told us how they had participated in a dementia training day run at the home and how helpful this had been in enabling them to gain an insight into dementia and how it impacted their loved one.

The nominated individual told us staff spoke with people and their relatives about potential risks and how they wanted them managed. Leaders said people were supported to take positive risks, such as going on holiday and going on trips out of the home. Staff we spoke with understood who was at risk from pressure injuries and described the equipment and processes in place to reduce these risks. Staff told us they had attended challenging behaviour training and learnt how to identify people's triggers and how to diffuse situations. Staff told us when people were not keen on using the equipment provided to support them or to accept the care provided, they worked with them and then documented and escalated any concerns. The registered manager told us if a person's behaviors and level of risk could still not be met, then they requested a care review with the local authority Staff were aware of the risks to people from choking and weight loss. Staff had received training in modified diets and told us guidance was displayed in the kitchen to ensure people received a right meal of the correct consistency for their needs. We saw people who required modified diets and thickened fluids were provided with them.

Staff all knew people well, a person was slightly agitated, and a member of the team knew exactly how to support them to enable them to feel calmer. Another staff member encouraged and supported a person to stand up safely. Staff involved people in daily life in the home, by asking them to lay the tables and whether they wanted to go with them when they went out to the shop, rather than doing everything for them. We saw the chef showing people how to make smoothies which they used if people were at risk of weight loss, which people then wanted to try. At lunchtime people were shown sample bowls of the choice of meals which both enabled them to decide which they wanted and reminded them it was time to eat. We saw people had the equipment they needed to manage identified risks to them.

People had a range of risk assessments in place relevant to their needs. People’s records showed where possible risks were discussed with them. People's risk management me their needs. For example, a person who was sight impaired had their door frame painted red to distinguish it and there was dementia friendly signage if required to enable people to orientate themselves. Staff followed best practice guidance when assessing risks to people and used recognised tools to aid their assessment. When risks to people were identified which required external input, relevant referrals were made. People’s records showed processes were in place to ensure they were checked upon regularly through the night. Records showed people's baseline observations were taken monthly, which enabled staff to monitor and escalate any emerging concerns about people's health.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

People and relatives were happy with the staff who they thought were very caring and committed. They told us how staff would go beyond their role, for example by fetching a relative who could not otherwise visit. Staff deployed were either permanent or bank staff, there was rarely any use of agency staff. Relatives told us there was a low staff turnover and consistency of staffing for people. A relative said, “There is very little turnover of staff, it feels like family here.” Relatives told us they visited at various times of the day and felt there were sufficient staff. A relative told us they had been impressed by staff’s skills when they responded to an emergency.

Care staff had recently been reduced by 1 most days following a reduction in the number of people with high staffing needs. The shift cut had been rostered from 09:00 to 21:00, so the staff member had been able to support both the day staff and the night staff during the evening. Although staff did not feel this had stopped people receiving their care as required. Some staff said they felt they were rushed now at particular times of the day, such as in the mornings. Staff said although they could manage, the extra staff member had enhanced people's experience and reduced the overall pressure on them. Staff feedback included that it was, “more relaxed with the extra person.” The nominated individual told us staffing was responsive to people’s needs and that the change was made following analysis of peoples’ staffing needs and consultation. They had also worked on the floor to see if the workload was still manageable. Staff said they worked well as a team and that the manager would work on the floor with them if required. Staff told us they had received an induction to their role, regular training, and the opportunity to undertake further professional development if they wished. Staff who were undertaking further study felt well supported. Staff told us how in addition to their role, they tried to use their skills to add value to people's experience through arranging regular events such as the recent ‘Las Vegas’ themed night and the makeover of the garden.

Staff were responsive to signs of people's distress and reacted promptly and warmly. We saw a person regularly pressed their bell, but staff were understanding and patient. People's care did not appear rushed. Staff had the required level of knowledge and skills to care for people safely. Some staff were trained to undertake more than one role and staff worked as a team. We saw a staff member working in their ancillary role, stop their work and guide a person as they leant on their arm. We saw the registered manager supported staff by accompanying a person to their appointment. We heard staff working together as they discussed who had received their care and who still required assistance. Although staff had distinct roles, they worked well together as a whole team to ensure they met people’s needs.

There were robust staff recruitment processes and staffs required pre-employment checks were complete. Staff were required to complete a range of training to ensure they had the knowledge, and skills for their role. Staff received regular supervision of their work. The provider used a staffing dependency tool to calculate people’s needs for various aspects of their care, this was then used to calculate the number of staff required. Processes were in place to monitor call bell response times, which showed they were responded to in a timely manner. A team leader led each shift and organised staff and allocated work.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.