Brooke House

Updated 9 June 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

2 inspectors 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

Brooke House is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Brooke 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.

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. Prior to the inspection we reviewed information we held about the service since our last inspection to help with inspection planning.

During the inspection

We spoke with the operations manager, deputy manager and director of compliance, 3 members of care and 2 members of ancillary staff. We spoke and interacted with 7 people living at the service and observed care provided in communal areas. We spoke with 1 person's relative about the care provided.

We reviewed a range of records, including 10 people's care records and 10 medication records. We looked at staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

We continued to seek clarification from the provider to validate evidence found.

Updated 9 June 2023

About the service

Brooke House is a residential care home providing personal and nursing care to up to 35 people. The service provides support to people mainly aged over 65 years, and many of the people were living with dementia. The service consists of a main house with bedrooms and shared facilities across 2 floors, with a people carrying lift, and then a ground floor unit joined to the main house, which supported people living with more advanced stages of dementia. At the time of our inspection there were 26 people using the service. The service was surrounded by spacious grounds offering people the opportunity to spend time outside.

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

From reviewing accidents and incident records, as well as medicine management records we identified examples of incidents which had not been reported to the local authority safeguarding team and to CQC, as required, to maintain people’s safety and welfare.

We identified risks within the care environment, where equipment needed to be replaced, changes were needed to reduce the risk of harm to skin from hot and uncovered surfaces and unsecured access to risk items, which placed people at risk of potential harm. This was of particular concern because many of the people at the service were living with dementia and relied on staff to maintain their safety.

Some areas of medicine management needed to be improved to ensure staff were working in line with local and nationally recognised best practice. We observed some people’s teeth and finger nails to be visibly dirty, their daily records indicated gaps in the completion of these basic care tasks.

Provider level auditing and oversight of the service, in the absence of a registered manager required some improvements, as areas of risk and shortfalls identified at this inspection had not been found as an outcome of their own audits and quality checks.

Inspection findings have resulted in breaches of the regulations and a recommendation being made to support improvement at the service. We found the provider team to be responsive to our feedback from the inspection, and they acted promptly to make changes and address risks to support improvement and safety at the service.

People were supported to engage with visitors, friends, and members of the local community to reduce the risk of social isolation. We observed there to be sufficient numbers of trained staff on shift to respond to people’s needs.

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.

We observed caring and friendly interactions by staff and members of the management and provider team with people and their relatives. Members of the provider team were familiar with people’s needs and we observed they made time to meet with relatives and visitors during the inspection.

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 service was rated good at the last inspection (published 04 November 2017).

Why we inspected

This inspection was prompted by a review of the information we held about this service. There had also been some concerns brought to our attention relating to the management of people’s pressure care needs. A decision was made for us to inspect the service and examine those risks. This was a focussed inspection looking at safe and well-led. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate overall rating.

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.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this report for further details. 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 Brooke House on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to protecting people from the risk of harm or abuse and safe care and treatment. The service is required to have a registered manager, the lack of a registered manager also impacted on the rating given for well-led.

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.