This inspection took place on 10 and 11 April 2018 and was unannounced. Brook House is a ‘care home’ with nursing. People in care homes receive accommodation and nursing or personal 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. The home is owned and operated by Barchester Healthcare Homes Limited. Brook House is registered to provide care and accommodation for up to 47 people. At the time of the inspection there were 45 people living in the home.
At our last inspection on 4 April 2016 the home met regulations inspected and was rated good. The home remained good at this inspection.
There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (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.
People who lived in the home and their relatives told us they were satisfied with the care provided in the home and spoke positively about care staff and management at the home. Some people in the home had complex needs and were therefore unable to provide us with feedback. We therefore spent time observing interaction between people and staff. During the inspection we observed people were well cared for and appeared relaxed and comfortable in the presence of care staff. We observed positive engagement between staff and people. Staff were respectful of people and showed a good understanding of each person’s needs and abilities.
Risks to people had been assessed, updated and regularly reviewed to ensure people were safe and risks to people in relation to treatment or care were minimised.
People we spoke with told us they felt safe in the home and around staff and this was confirmed by relatives we spoke with. Staff had received training on how to identify abuse and understood their responsibilities in relation to safeguarding people, including reporting concerns relating to people’s safety and well-being.
Skin integrity was effectively managed by the home. We saw good evidence of diligent skincare and clear guidance was detailed in care plans. Pressure sore repositioning charts were well maintained for people at high risk of developing pressure ulcers.
Medicines were managed safely and staff were appropriately trained. We however found that there was no provision to dispose of unwanted cytotoxic medicines [medicines that have a toxic effect on cells] at the home and made a recommendation in respect of this.
We discussed staffing levels with management and they advised that staffing levels were assessed depending on people's needs and occupancy levels. The home used their own dependency tool to monitor this. The majority of staff we spoke with told us there were sufficient numbers of staff to safely meet people’s individual care needs. During the inspection, we observed staff did not appear to be rushed and were able to complete their tasks.
The home had appropriate fire and emergency systems in place. There was a record of essential maintenance carried out and this was monitored and maintained by the home's maintenance manager.
Staff received on-going training and spoke positively about the training they received. Regular supervisions and appraisals ensured staff performance was monitored.
All staff we spoke with told us they were well supported by management at the home and said that morale in the home was positive.
People received a comprehensive initial assessment of their needs with their families’ involvement before moving into the home. The pre-admission assessment included information about people’s health and care needs. Individualised care support plans were then prepared using the detail from pre-admission assessments and plans identified people’s preferences, needs, and included details of how staff were to provide them with the care they needed.
The home worked well with external health and social care agencies to ensure people received the care, treatment and support they needed. We saw evidence that people’s healthcare needs were closely monitored by the home.
People were supported 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. The home operated within the principles of the Mental Capacity Act 2005 (MCA).
Where people were unable to leave the home because they would not be safe leaving on their own, the home had made applications for the relevant authorisations called Deprivation of Liberty Safeguards (DoLS).
People spoke positively about the food available in the home. There was a four weekly food menu which changed every three months according to the season of the year. We looked at how people were protected from poor nutrition and supported with eating and drinking. Care records demonstrated that the home monitored the nutritional needs of people. We observed some people had low weight and a low body mass index and saw that there was clear information about how to support the person with the nutritional needs, preferences and clear guidance for staff detailing how to encourage the person to eat.
The home had held a nutrition and hydration week from 12 to 18 March 2018. To celebrate this event they had organised some form of food or drink activity every day for that week. The purpose of this week was to raise awareness in the home about the importance of eating healthily and drinking fluids.
The home had a varied activities programme which was devised based on people’s interests. Different activities were held weekly so that people experienced a variety of activities. During the week of the inspection, we noted that the following activities were available; art and crafts, culinary craft, movies with popcorn and hotdogs, flower arranging and music from an entertainer. We noted that a 50’s and 60’s themed party was scheduled for 12 April 2018.
Procedures were in place for receiving, handling and responding to comments and complaints. We saw evidence that complaints had been dealt with appropriately in accordance with the policy.
The home had carried out a formal satisfaction survey in January 2018 to obtain feedback from people and relatives. The feedback obtained was positive.
The home had a system in place to obtain feedback about the level of care provided to people. This included an extensive range of comprehensive checks and audits carried out by management in various areas relating to care people received, maintenance and the management of the home. Management carried out a range of monthly and quarterly audits in respect of care documentation, health and safety, safeguarding, medicines, complaints/compliments, infection control, activities, staff files and training.
Management carried out “daily walkabouts” where observations around the home were carried out. This looked at checking care plans, MARs, clinical issues, dining experience, pressure sore care, the call bell, accidents and incidents.
We observed care documentation was well maintained, up to date and comprehensive. The home had a range of policies and procedures to ensure that staff were provided with appropriate guidance to meet the needs of people. These addressed topics such as infection control, safeguarding and health and safety.
People’s care records and staff personal records were stored securely which meant people could be assured that their personal information remained confidential.
There was a clear management structure in place and staff told us morale within the home was positive and staff worked well with one another. Staff told us management were approachable and there was an open and transparent culture. They said communication in the home was good and they were informed of changes.