Brookfield Residential Home

Brookfield Residential Home is a residential care home providing personal care to up to 29 people. The service provides support to older people who may be living with dementia. At the time of our inspection there were 25 people using the service.

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

Some risks to people’s individual health and safety were not fully assessed, and management plans were not always up to date or consistent, however staff knew people well. There were safety and maintenance issues related to the building, including risks related to fire. Aspects of medicines were not appropriately managed. There were enough staff deployed to keep people safe.

People were not always 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’s mental capacity to consent had not been assessed in line with relevant legislation. Visiting restrictions remained in place where government guidance had been withdrawn, and the service had not demonstrated this had been risk assessed in line with people’s needs and best interests.

The service did not always ensure relevant healthcare professionals’ advice and guidance was sought related to food and drink, or that their advice was incorporated into care plans and escalated if there were issues in implementing it. Staff skills varied. We observed most staff were skilled, with some very good practice but we also observed some poor practice by staff when supporting people.

The governance system within the home, maintenance of the building and record keeping required improvement to ensure the home was providing safe and effective care to people.

People were positive about the food and appeared comfortable with the staff. Staff we spoke with knew people well and were positive about the management and support in the home. People’s relatives praised the home and felt their loved ones were well looked after. We received positive feedback from the local GP partnership regarding their working relationship with the home.

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 23 October 2019). The last inspection of the service was 20 December 2020; however, the service was not rated at that inspection.

Why we inspected

We received concerns in relation to infection control, medicines management, the condition of the building, poor quality care and the management of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We inspected and found there was a concern with consent to care and eating and drinking, so we widened the scope of the inspection to include the key question of effective. 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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Brookfield Residential Home 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 consent, safe care and treatment, premises and equipment and good governance.

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.

We found the following examples of good practice.

The provider had acted to make sure people could have visitors safely. Accurate temperature and symptom checks were made prior to entry. Hand washing was also required. Family booked appointments to visit the home and saw their relatives in a protective screened area in the front lounge. Those unable to visit used an electronic tablet to see and speak with their relatives virtually.

Staff had spent time with people to help them to understand the need for personal protective equipment (PPE) and how they were feeling about the changes.

The provider followed government PPE guidance and practice. The registered manager followed the risk reduction framework in documentation. Senior staff had training to support staff to follow best practice.

The provider followed government guidance testing staff weekly.

The staff room had screens in place to protect staff. Staff changed their clothes at the start and end of their shift to reduce the risk of transmission of infection. The staff team had responded positively to the new infection prevention and control procedures. Staff were well supported by the provider.

The provider worked well with GPs conducting rounds in the home.

There were detailed and thorough risk assessments undertaken by the registered manager.

Further information is in the detailed findings below.

Brookfield Residential Home is a residential care home providing personal care to 28 people at the time of inspection. The service can support up to 29 people with a range of needs, including people living with dementia. The home is an adapted building which offers accommodation across two floors and people had access to a passenger lift where required. People had access to a range of communal areas including separate lounge and dining areas.

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

At the last inspection we found the registered person did not always ensure systems and processes in place were effective to monitor and drive improvement across the service. This was a breach of regulation. At this inspection we found enough improvement had been made and there was no longer a breach in regulation 17. The registered manager had improved the systems in place to monitor and review the delivery of the care people received, which was supported by a range of service monitoring and audits to drive improvement. There was a clear sense of leadership and we received feedback from a range of healthcare professionals that the service was well-led.

We reviewed findings in the safe domain which were identified at the last inspection as requiring improvement. At this inspection we found improvements had been made. There were clear and effective infection control procedures in place and people were supported to receive their medicines as prescribed by trained staff. Improvements had been made to ensure people’s prescribed creams were managed effectively, where we identified the robustness of temperature monitoring could be further improved this was addressed and actioned immediately during the inspection. Where people were prescribed fluid thickener, this was managed and stored appropriately to ensure people were safe. People were protected from the risk of experiencing abuse. Potential risks to people had been assessed and measures were put in place to minimise and manage risks. There were clear safeguarding processes in place to identify, record and respond to incidents and accidents.

There was a strong person-centred culture and people and their relatives liked the homely atmosphere. People and their relatives praised staffs’ efforts and we observed people had positive relationships with staff and received good-quality care. People were encouraged to maintain their independence where possible, and staff treated people wit compassion, dignity and respect.

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. Staff told us they felt valued and supported and had access to a range of training opportunities to enable them to develop their skills. People enjoyed the meals on offer and people’s preferences were accommodated appropriately.

People’s care plans were detailed and promoted person-centred care. Care planning recognised people’s strengths and abilities and steps staff should take to promote this. People received appropriate levels of care and support that was responsive to their needs. People were encouraged to participate in range of daily activities with support from dedicated activities staff.

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 requires improvement (published 20 November 2018) and we found there had been a breach of one regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve systems to monitor the overall governance of the service. At this inspection we found improvements had been made and the provider was no longer in breach of the regulation.

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.

Brookfield Residential Home is registered to provide accommodation for up to 29 older people. There were 29 people, some living with dementia, at the home at the time of the inspection. It is situated in a residential area of Alverstoke. The home is an adapted building with single occupancy bedrooms provided over two floors. A passenger lift provides access between the floors. There are three communal lounges, two dining rooms and appropriate toilet, bathing and shower facilities. At the front of the home there is a non-enclosed garden adjacent to the car park.

Brookfield Residential Home is a ‘care home’. People in care homes receive accommodation and personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Effective quality assurance process had not identified areas for improvement found during this inspection and most quality monitoring was informal. Risks to people were not always managed effectively as not all risks had been assessed and staff did not always follow actions required to minimise risks. Some medicines were not always managed safely and systems to protect people for the prevention and control of infection were not always followed.

The manager took immediate action to assess and manage the areas of concern around risks which we identified to them.

The premises and equipment were safely maintained. Incidents or accidents were reviewed and action taken to reduce the likelihood of any reoccurrence.

Sufficient numbers of care and ancillary staff were deployed to meet people's needs. Checks were made to ensure staff were suitable to work in a care setting. Staff were trained and supervised and felt supported and valued.

People's nutritional needs were assessed and people were supported to eat and drink. There was a choice of food. Health care needs were monitored and referrals made to other services to ensure there was a coordinated approach to people's care.

People were treated with kindness, respect and compassion. People's privacy and dignity were promoted. People were supported to have choice and control of their lives and staff promoted independence where possible.

Care and support were centred on the individual needs of each person and staff responded promptly when people's needs changed. People and external health professionals were positive about the service people received.

Staff supported people to receive end of life care that helped ensure their comfort and their dignity.

Activities were provided seven days per week offering a range of mental and physical stimulation.

There was an effective complaints procedure and people and their relatives confirmed they were listened to and changes made when requested.

Staff were organised, motivated and worked well as a team. They felt supported and valued by their managers.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The registered provider for this location was an individual registered with the commission to provide this service. 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.

People were supported by staff who had a good understanding of how to keep them safe, identify signs of abuse and report these appropriately. Processes to recruit staff were in place which ensured people were cared for by staff who had the appropriate checks and skills to meet their needs. Staffing numbers were sufficient to meet the needs of people.

Medicines were administered, stored and ordered in a safe and effective way by staff who had received appropriate training.

Risk assessments in place informed plans of care for people to ensure their safety and welfare, and staff had a good awareness of these. External health and social care professionals were involved in the care of people and care plans reflected this.

Where people were unable to consent to their care the provider was guided by the Mental Capacity Act 2005. Where people were legally deprived of their liberty to ensure their safety, appropriate guidance had been followed.

People’s nutritional needs were met in line with their preferences and needs. People who required specific dietary requirements for a health need were supported to manage these.

People’s privacy and dignity was maintained and staff were caring and considerate as they supported people. Staff involved people and their relatives in the planning of their care.

Care plans in place for people reflected their identified needs and the associated risks. Staff were caring and compassionate and knew people in the home very well.

A complaints process was in place and people new how to use this, although the home had not received any recent complaints.

The service had effective leadership which provided good support, guidance and stability for people, staff and their relatives. People, their relatives and staff spoke highly of the registered provider and manager who were very actively involved in the home. Audits and systems were in place to ensure the safety and welfare of people.

Processes were in place that ensured that people were supported to make informed choices about the care and support they received.

People had their individual needs and wishes recorded in a plan of care that was kept under regular review. Risks to people's safety were assessed and recorded.

We spoke with staff and reviewed records which showed us that people were protected from risk of abuse. Staff had received safeguarding training and were aware of their responsibilities.

The staff team were well supported and received regular supervision and appraisal. They received training relevant to their role.

Complaints and concerns were recorded, investigated and fed back to complainants in a timely manner.

Comments from two healthcare professionals that spoke with us included. 'The care provided is always excellent. The manager knows the needs of residents well and they are very caring and supportive to people."

Staff we met on the day told us about the training they had attended recently and that they were able to speak openly with the manager and provider about any concerns.

As not everyone who lived at Brookfield was able to tell us what they thought about the care and support provided, we used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. We spent 30 minutes in the lounge and a further 15 minutes in the dining area. We saw that the staff were friendly and respectful and that they were quick to respond if anyone appeared unhappy or needed something.