Brooklands Care Home provides nursing and personal care for a maximum of 63 people, some of whom may be living with dementia. Accommodation consists of single occupancy rooms situated in four units over two floors. At the time of our inspection 46 people were using the service.The service had a 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 undertook this unannounced inspection on the 1 and 2 August 2017. The last full inspection took place on 20 and 21 June 2016 and although no breaches in regulations were identified we rated the service ‘Requires Improvement’ for two of the five key questions and rated the service ‘Requires Improvement’ overall.
During this inspection, we found some concerns regarding quality monitoring which had resulted in shortfalls not identified through the audit programme or when shortfalls were identified, timely action had not been taken to address these. Examples included gaps in care plans, supplementary charts for recording food and fluid intake and records to support consent to care.
There was some inconsistency with the application of mental capacity legislation. Some people had assessments of capacity and records about the restrictions they had in place, but this was not consistent throughout the service. One person was subject to low level physical interventions which had not been agreed or assessed as being in their best interest.
People had care plans in place, however, we found these were not always person-centred and missed important information regarding how staff were to care for them. This meant that important care could be missed.
You can see what action we told the provider to take regarding the above three areas at the back of the full version of the report.
The CQC had not received a notification of an incident which affected the welfare of a person who used the service. On this occasion we are writing to the provider to address this shortfall.
We received a mixed response from people who used the service, staff and visiting relatives with regards to staffing levels at the home. There were occasions when people were not supervised appropriately and staff reported being over stretched at times during shifts and unable to spend time with people. Some relatives considered staff were not visible enough and some people felt they had to wait at times for care. We have made a recommendation that the provider reviews the number and deployment of staff on shifts.
Staff were recruited safely which ensured employment checks were in place prior to new staff starting work. Staff had received training in how to protect people from the risk of harm and abuse. There were also policies and procedures for additional guidance. Staff knew what to do if they had concerns but some staff were not aware of the external agencies they could raise these with.
Generally, there were safe systems in place to manage risks to people’s health and safety although the area director took action during the inspection to ensure one person’s risk of falling was reviewed and action was taken to better protect their safety.
People had access to community health professionals for advice and treatment. Staff knew when to consult these professionals although the guidance provided was not always followed consistently.
Staff completed assessments of people’s nutritional needs and monitored their weight. They referred people to dieticians when required. We saw the menus provided people with a choice of nutritious meals. People told us they liked the meals provided for them and staff were flexible if they wanted an alternative to the main menu choices each day. During the day, we observed people were served drinks and snacks between meals. We found improvements could be made with some people’s accessibility to drinks on the nursing unit.
People told us staff had a kind and caring approach. We saw people’s privacy and dignity was respected and observed many positive interactions between staff and the people they cared for. Staff knew how to promote people’s independence and need to make their own decisions.
We saw people were encouraged to participate in a range of activities at Brooklands and in the community. Relatives told us they could visit at any time and we saw staff supported people who used the service to maintain relationships with their family.
Medicines were managed safely and people who used the service received them as prescribed. People told us their medicines were administered to them in a timely way.
Records evidenced that staff received appropriate induction, training, supervision and support, which enabled them to feel skilled and confident when supporting people who used the service.
Staff, people who used the service and their relatives, told us the manager had an open-door policy and was available to speak with them when required. There was a complaints procedure on display in the service and it was included in information given to people. Staff knew how to manage complaints and people spoken with felt able to raise concerns. There were systems in place to enable people to share their opinion of the service provided and the general facilities at the home.
We found the environment was clean and safe, and equipment used was serviced regularly and maintained on a day to day basis.