Brookfield Residential Home

We found the following examples of good practice.

On arrival to the service, visitors were asked to use the side entrance. Before entering the service, the visitor was asked to answer some questions and have their temperature and blood oxygen levels checked. Hand sanitizer and face masks were available if the visitor arrived without personal protective equipment (PPE).

The registered manager told us how difficult it was to maintain social distancing when a person had dementia. This was because the person either could not understand the need to do this or could not retain the information. As such, the communal areas of the home had some furniture removed to create spaces between people.

Staff tried to make sure the same small number of people sat together in communal areas of the service in ‘friendship bubbles.’

The provider had recently purchased some new chairs for the communal lounges. These were of a material that was easier to frequently clean with anti-bac cleaning products.

Further information is in the detailed findings below.

Brookfield Residential Care Home consists of a two storey building and is registered to accommodate up to 14 people. At the time of this inspection there were 10 older people living at the service.

This unannounced inspection took place on the 21, 22 and 23 March 2018. At our previous inspection on 5 February 2016 the service was rated as 'Good'. At this inspection the rating had improved to 'Outstanding'.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission 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 remained safe because there were systems and processes in place to protect them. Staff, as a result of their training in safeguarding people, understood the different types of harm and to who they could report this to. Risk assessments were in place and these promoted people's safety such as when mobilising around the service. Incidents such as falls were used as an opportunity for learning and to help drive improvements. Medicines were administered, recorded and stored in a safe manner and all staff who administered medicines had received suitable training to do this. Enough staff were employed to ensure that people’s needs could be met in a timely manner. Staff were aware of infection control measures and the service was clean and well maintained. Staff were subject to checks on their suitability before they were offered employment. People who used the service were involved with the recruitment of staff.

People received an effective service and were supported by staff who had received an appropriate induction. Staff were encouraged to take up training opportunities and to further their knowledge, especially around people’s health care conditions. 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. Staff knew when people needed support and also when to respect people's independence. Staff were supported in their role and they knew what standard of care was expected. People were enabled to access healthcare services. People's nutritional needs were met by staff who knew each person's needs well.

People received outstanding care. We received extremely positive comments from a range of people about the caring nature of the service. People received very high quality care from staff who had the time to spend with them and their families. Staff showed kindness to people in everything they did by offering exceptionally friendly support around their individual needs. People were able to retain their interests and routines, and staff fitted in around these. People were at the heart of the service as staff put people first and foremost in everything. People's care plans contained relevant personalised information and these gave staff the information they needed in meeting people's needs. Staff used people's life histories to help them to understand what was important to each and every person. Staff told us about how it was important that people were enabled to be independent. They told us how they worked in a way to protect people’s privacy and dignity.

People received an outstanding responsive service. There was plenty of meaningful stimulation for people and many opportunities for people to stay connected to their pasts. Staff encouraged people to retain their independence and uphold people's dignity. People were completely involved in their care. Staff saw people's well-being and community engagement as being important. The service and its staff team supported people to feel good about themselves and to have positive emotions by encouraging people to stay active and socialise with others. This also enabled people to play an active part in the community. There were regular planned and spontaneous activities, which took into account people's individual interests and hobbies and this helped prevent social isolation. Concerns were responded to before they became a complaint Staff worked well with other stakeholders to ensure that peoples end of life care was well managed.

People received a well led service. The registered manager had fostered a highly positive working relationship between staff and relevant stakeholders. The registered manager motivated the staff team with regular meetings, formal supervisions and mentoring. The registered manager understood their responsibilities and worked with people, staff and the provider to improve the quality and safety of care that was provided. Quality assurance procedures, a programme of audits and leadership were effective in driving continual improvements to the quality of service that was provided.

Further information is in the detailed findings below.

This unannounced inspection took place on 5 February 2016.

The service had a registered manager. 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.

Staff were knowledgeable about identifying and reporting any incident of harm should this ever occur. People were cared for and looked after by enough staff to support them with their individual needs. Satisfactory pre-employment checks were completed on staff before they were employed and allowed look after people who used the service.

People were supported to take their medicines as prescribed and medicines were safely managed. An effective induction process was in place to support new staff. Up-to-date risk assessments to help safely support people with risks to their health were in place and these were kept under review according to each person’s needs.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The registered manager and staff were knowledgeable about when an assessment of people’s mental capacity was required. Appropriate applications had been made by the registered manager to lawfully deprive of their liberty. People using the service who currently met the criteria to be lawfully deprived of their liberty had applications in place. However, not all staff had an understanding of the MCA and how a DoLS would be determined. This meant that there was a risk that people could be provided with care that was not always in their best interests.

People had sufficient quantities of their preferred food and drink choices including fresh fruit and snacks during the day. This included a choice of appropriate diets for those people at an increased risk of malnutrition, dehydration or weight loss. However, there were missed opportunities for people to be as independent as they could have been with their eating, drinking and independence. People were supported to access a range of health care services and their individual health needs were met.

People were cared for and supported with their needs by kind and attentive staff. They and their relatives were involved in the review of people’s individual care plans. People’s privacy and dignity was respected by staff.

People were provided with information on accessing independent advocacy if any person required this support.

People were given various opportunities to help identify and make key changes or suggestions about any aspects of their care. Several occasions were not identified to support people with their care needs in an individualised manner.

A range of audit and quality assurance procedures were in place. These were used as a means of identifying areas for improvement and also where good practice had been established. Information regarding the running of the service and people’s care was shared through a range of forums including residents’, managers’ and staff meetings.

People received the care and support they required to improve their health and well-being. Care records were written in detail and provided clear guidance to staff members. One person told us they were happy living at Brookfield and, "Nothing could be done better".

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

Recruitment checks were carried out or obtained prior to new staff members starting work with the service.

Systems were in place to regularly check and monitor the way the service was run.