Brookland House

About the service

Brookland House is a residential care home providing personal care and accommodation to 2 people with a range of physical and learning disability needs at the time of the inspection. The service can support up to 3 people.

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

The service was able to demonstrate how they were meeting the underpinning principles of right support, right care and right culture.

Right Support:

People were supported by staff that had the skills and knowledge to meet people’s needs and keep them safe. The quality of the service provision was regularly reviewed to ensure it continually reflected people’s needs. Relatives received information in a timely way in order for them to be involved in any decisions.

Right Care: Care is person-centred and promotes people’s dignity, privacy and human rights. Staff knew people well and understood people’s individual care and support needs. Staff received the training they needed to provide people with the right care and support. Staff understood how to protect people from avoidable harm or abuse. People’s care records reflected their current needs and how these should be met.

Right Culture: The ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives. Staff supported people in a positive and respectful way. Staff were aware of their responsibilities to keep people safe and report any concerns they might have.

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 8 January 2020).

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.

At our last inspection we recommended that all windows in the service were checked to see if they complied with best practise guidance. At this inspection we found additional window restrictors had been fixed to windows to improve safety.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

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 requires improvement to good. This is based on the findings at this inspection.

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

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.

Follow up

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

Brookland House is a residential care home providing personal care and accommodation to 2 people with a range of physical and learning disability needs at the time of the inspection. The service can support up to 3 people.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

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

People were not always safeguarded from abuse and safeguarding processes were not always robustly followed. Risks were assessed, and staff understood people’s needs in relation to these risks well. Medicines were managed well, and staff were recruited safely. The provider had seen a reduction in incidents through consistent staff support and thoughtful monitoring of people’s triggers, behaviours and wellbeing.

The environment had been adapted as much as it could to meet the needs of people. People were supported by trained staff who knew them well and were kind and caring. We saw evidence of positive outcomes where people had been supported to improve their daily living skills and communication skills.

Professionals and relatives told us people were happy living in the service and had their preferences and needs met. People were supported to do activities they enjoyed and went out when they wanted to.

People were not always supported to have maximum choice and control of their lives. The staff did not support them in the least restrictive way possible and in their best interests. Policies and systems in the service did not support this practice as records were not up to date.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service did not always reflect the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent. However, the concerns we found with regards to safeguarding and consent were not in keeping with the principles of Registering the right support.

Staff felt supported by the registered manager and had structured supervisions and team meetings.

However, we did identify some areas for improvement and found three breaches of regulation around safeguarding, consent, and good governance.

We made a recommendation around the restriction of windows.

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

Why we inspected

This was a planned inspection based on the previous rating.

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

Enforcement

We have identified breaches in relation to safeguarding people, consent, 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 for the provider to understand what they will do to improve the standards of quality and safety and meet with the provider and registered manager to discuss how they will make changes to improve their rated to at least good. We will work alongside the provider and 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.

Since the last inspection the service had a new registered manager in post. 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.

We met and spoke to both people during our visit. People were not all able to fully verbalise their views and used other methods of communication, for example pictures and sign language. We therefore spent some time observing people.

At the last inspection on 10 and 11 November 2015 we rated the service as Requires Improvement overall. This was because systems for recording and reporting incidents did not ensure people were safeguarded from abuse or unsafe practice. There was often a high use of agency staff, which meant there were times when people were supported by people who did not work in the home on a regular basis. There was no written induction programme for staff employed by the service and therefore no evidence to demonstrate how the registered manager had assessed new staff to be competent to work unsupervised in the home. Information on people’s care plan did not reflect the actual activities people were involved in. Care plans in relation to people’s health needs did not in all cases reflect the complexity of people’s needs or the type of support being provided. We found some gaps in the monitoring of records could mean people were not protected by the service. The registered manager undertook a monthly audit of how many incidents had taken place but did not in all cases have an overview of what had happened or a system for checking the action taken by staff was appropriate or safe. The provider sent us an action plan detailing how they would make improvements.

At this inspection we found improvements had been made.

People were encouraged and supported to make decisions and choices whenever possible in their day to day lives. A staff member said; “Things have improved so much, more regular staff and people go out more.” A relative recorded on a completed quality assurance questionnaire; “I think the overall service is very very good.”

People who lived at Brookland House were not able to verbalise their views and used other methods of communication, for example sign language or pictures to assist them, therefore people’s relative’s opinions were sought. There were quality assurance systems in place. Feedback was sought from relatives to assess the quality of the service provided. All significant events and incidences were documented and analysed. Evaluation of incidents was used to help make improvements and keep people safe. Improvements helped to ensure positive progress was made in the delivery of care and support provided by the staff.

People’s risks were well documented, monitored and managed to ensure people remained safe. People lived full and active lives and were supported to access local areas and activities. Activities reflected people’s interests and individual hobbies. People were given the choice of meals, snacks and drinks they enjoyed while maintaining a healthy diet. People had input in preparing some meals and drinks.

People’s care records were detailed and personalised to meet their individual needs. Staff understood people’s needs and responded promptly when needed. People were not all able to be fully involved with their care plans, therefore family members and professionals supported staff to complete and review the care plans. People’s preferences were sought and respected.

People had their privacy and dignity maintained. Staff were observed supporting people with patience and kindness.

Staff understood their role with regards to ensuring people’s human and legal rights were respected. For example, the Mental Capacity Act (2005) (MCA) and the associated Deprivation of Liberty Safeguards (DoLS) were understood by the registered manager and staff. They knew how to make sure people, who did not have the mental capacity to make decisions for themselves, had their legal rights protected and worked with others in their best interest. People’s safety and liberty were promoted.

Staff had completed safeguarding training and had a good knowledge of what constituted abuse and how to report any concerns. Staff understood what action they would need to take to protect people against harm and were confident any incidents or allegations would be fully investigated.

Staff described the registered manager as being very approachable and supportive. Staff talked positively about their roles.

The registered manager and registered provider had an ethos of honesty and transparency. This reflected the requirements of the duty of candour. The duty of candour is a legal obligation to act in an open and transparent way in relation to care and treatment.

People required additional support and had two to one staffing arrangements in place. Staff confirmed there were sufficient employed staff to meet these requirements and agency staff were rarely used. Staff had completed appropriate training and had the right skills and knowledge to meet people’s needs. New staff received a comprehensive induction programme when they started work. People were protected by the company’s safe recruitment procedures.

At the time of this inspection people were in good health. The only medicines prescribed to them were medicines that could be purchased ‘over the counter’ as homely remedies. These were stored safely and when administered documented correctly. Staff received appropriate training and understood the importance of the safe administration and management of medicines. People were supported to maintain good health through regular access to health and social care professionals, such as psychiatrics.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with staff and management and looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We saw that people's support plans were being updated to ensure that the information was based on what people wanted and needed. This information was detailed and easily accessible to the staff team. We observed the care being provided and saw that staff had a good understanding of people's needs and communication methods. Staff were able to use their knowledge and skills to support people promptly and appropriately when they became agitated or distressed. We observed that people who used the service had positive and trusting relationships with the staff team and this helped create a relaxed and happy atmosphere in the home.

Systems were in place to ensure that people's health needs were closely monitored, and prompt action was taken when people became unwell or if health needs changed. Records confirmed that when a person lacked capacity to make decisions about their health the service had acted appropriately to protect their rights and to ensure their rights and best interests were protected.

Sufficient staffing levels were in place to meet people's assessed needs and staff said they felt well supported by colleagues and management. The staff we spoke to had a good understanding of safeguarding and understood their responsibilities to protect the people they supported.

Although auditing processes were under review at the time of the inspection we still found that some records in the home were not completed as required. Incident reports had not in all cases been signed off by a manager, and the homes auditing processes had not picked up these gaps in a timely manner.

Is the service effective?

The staff we spoke to were knowledgeable about the people they cared for, and felt well supported in their roles. People's care plans were individualised and considered all aspects of their health and social care. The service monitored people's health needs and liaised appropriately and promptly with healthcare professionals when required.

Is the service caring?

We observed that people appeared relaxed and happy within their environment. We saw that people looked to the staff to support them when they wanted help or if they were confused or distressed. Staff were familiar with the way people communicated and were able to use their skills and knowledge of each individual to provide reassurance and to prevent difficult behaviours from escalating.

Staff recognised the importance of enabling people to maintain contact with their family and other relatives. Records showed that the service supported people to visit their family as well as keeping family members informed of any important issues concerning their health and care needs.

Changes had been made to the management structure whilst the Registered Manager was absent from the home. The General Manager who was overseeing the service said that these changes would ensure that the staff continued to feel supported and to have someone to talk to at all times. Staff told us that they felt supported and that some recent changes had had a positive impact on the staff team and how people worked.

Is the service responsive?

Support plans were based on people's individual health and social care needs. The service liaised regularly with external professionals and updated care plans to reflect any new guidelines or changes in need. Staffing levels were organised to meet the needs of individuals and these were reviewed regularly to ensure they remained appropriate and safe.

Staff we spoke to had a good understanding of people's communication methods and were able to use their skills and knowledge of each individual to respond promptly and sensitively to any requests or changes in mood. We observed one person's behaviour change as they finished a morning activity. We saw that staff recognised these changes in mood and sounds and responded quickly offering a music activity. This was clearly what the person wanted and resulted in them becoming calm, happy and settled.

All the staff we spoke to said that they would know what to do if they witnessed any poor practice or if they felt that a person was at risk of harm or abuse. Staff said they would not hesitate to report any concerns and felt that the service would act swiftly to ensure people were safe and protected.

We saw that people's health needs were closely monitored and any changes or concerns were promptly addressed.

Is the service well-led?

Staff told us that they understood their roles and responsibilities and felt confident to seek advice from their colleagues and management.

At the time of the inspection staff were being supported by the general manager for the service who had been overseeing the running of the home during the temporary absence of the Registered Manager. All the staff we spoke to said that they had felt well supported during this time.

The General Manager said that part of their role during this time had been to review some of the systems and records in the home. This had included a review a people's support plans and daily monitoring forms. We saw an example of an updated support plan, which included clear guidelines for staff about how people chose and preferred to be supported. The General Manager said that they would also be looking at how the service could further develop staff involvement in people's support plans, particularly the planning and monitoring of activities.

We saw that a range of audits were carried out in the home to assess and monitor the quality of the service. This included the auditing of records, environment and people's finances. However, we did find that there were some gaps in records, such as incident charts, which had not been signed off by management. In addition to this we found that the service did not have a system for monitoring and reviewing people's activities and community involvement and staff did not in all cases have a clear plan for future training needs.

A relative we spoke to said 'Staff have a good understanding of people's needs' and 'I am kept well informed as we discuss what is in X best interests, such as holidays'

We saw that staff had a good understanding of how people communicated and used this knowledge to encourage people to make choices when possible.

Some of the information relating to people's behaviours was not sufficient in detail to ensure that behaviour was managed appropriately and safely.

People were supported to lead an active lifestyle. On the day of our visit one person was enjoying the sunshine in the garden and another person went out for a walk and lunch with staff.

Staff we spoke to said that they felt well supported by their colleagues. Records confirmed that new staff had undertaken a thorough induction programme, which prepared them sufficiently for their role within the home. One staff member said 'I am still learning, but the induction gave me the information and skills I needed to support people when I first started'

Parts of the environment were in need of updating and repair.

We spent time in the home speaking to staff, looking at records and observing people while they were being supported by staff.

During our visit we saw that staff treated people respectfully at all times. The staff had a good knowledge of people's needs and how they communicated, and used these skills to encourage people to make choices whenever possible.

The management and staff were aware of people's rights and we saw examples of when meetings had taken place to ensure that decisions were being made in people's best interests.

Information about people's needs was clearly documented and step by step guidelines were available to staff to ensure that support was provided in a way that was consistent and safe.

Sufficient staffing levels were in place to ensure that people's social and leisure needs were met. People were supported to maintain positive relationships with their relatives and visits home were planned and supported by staff.

Systems were not in place to formally review peoples care plan arrangements or to ensure that the environment was maintained to an appropriate standard at all times.