Little Brook House

Updated 29 July 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was undertaken by 1 inspector and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Little Brook House is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under 1 contractual agreement dependent on their registration with us. Little Brook House is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was not a registered manager in post. The last registered manager had left in January 2023. A new manager had been appointed and started in January 2023. They had started the process to become registered as manager.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We received feedback from 1 health and social care professional.

We used all this information to plan our inspection.

During the inspection

We spoke with 6 people and 5 relatives. We also spoke with the manager, deputy manager, chef, 3 care staff and the operations manager.

Following the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records. We received feedback from a further 11 relatives and 2 health and social care professionals.

Updated 29 July 2023

About the service

Little Brook House is a residential care home providing personal care to up to a maximum of 25 people. The home does not provide nursing care. At the time of our inspection there were 24 people using the service, some of whom were living with dementia.

Little Brook House is a repurposed, 17th Century, grade II listed, former farmhouse which retains many period features. In addition, there are two purpose built, modern wings in which most people are accommodated. There is a communal lounge, separate dining room and 2 conservatories. There is a large, accessible garden.

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

We continued to find improvements were needed to ensure the safe management of medicines. Some risks to people had not always been assessed and planned for. The systems and processes to safeguard people from the risk of abuse or avoidable harm needed to be more robust. The systems in place to report, investigate and learn from incidents affecting people’s safety were not fully effective. Planned staffing levels were not always being achieved but this had not impacted on people’s needs being met.

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. Improvements had been made to ensure that the Mental Capacity Act 2005 was fully understood and implemented in line with legal frameworks. Completion rates for training improved, but the supervision programme needed to be further embedded. People received appropriate support with eating and drinking. Improvements were underway to ensure all areas of the home were safe, clean and well maintained. Overall, staff worked closely with a range of community healthcare professionals to meet people’s healthcare needs.

Governance processes were in place but needed to be more effective. People received person centred care but records did not provide assurances that they were consistently being supported to participate in regular social and leisure activities. The leadership team and staff worked with a range of health and social care professionals to meet people’s needs and to drive improvements within the service.

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 1 December 2022).

Why we inspected

This inspection was prompted by a review of the information we held about this service, to review the rating, and to follow up on breached of the legal requirements found when we last inspected.

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 the service can respond to COVID-19 and other infection outbreaks effectively.

We conducted an unannounced focused inspection of this service on 25 October 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, arrangements for consent, good governance at this inspection.

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.

The overall rating for the service remains requires improvement.

We have found evidence the provider needs to make improvements. Please see the safe, effective and well led key question sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement

We have identified breaches in relation to risk and medicines management, the effectiveness of the safeguarding systems in place, governance, and the recruitment of staff.

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