De Brook Lodge

De Brook Lodge (known as De Brook) is a residential care home providing personal care and support for up to 52 older people, some of whom live with dementia. Communal rooms and individual bedrooms are provided on each of the three floors. Aids and adaptations are provided throughout. At the time of the inspection there were 37 people living at the home.

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

A new manager had recently been appointed. It was acknowledged by the management team that improvements were needed to ensure people received safe and effective care. A range of audits and checks had been completed to review the service. Action had been taken to address the shortfalls.

Safe recruitment procedures were in place. Following review, staffing levels had been increased so that sufficient numbers of staff were always available. Further recruitment was taking place and shift patterns reviewed providing more flexibility in support at core times.

Systems were in place to help manage people’s prescribed medicines. Staff responsible for the administration of medication completed training and assessment to check their practice was safe. Issues identified in one unit were resolved during the inspection.

Individual care plans were in place. These were personalised detailing people’s wishes and feelings. Where risks had been identified these had been assessed and planned for. Support and advice was sought from health professionals where there had been changes in people’s needs.

People and their visitors spoke positively about the care and support provided by staff. A range of activities and opportunities were provided offering variety to people’s day.

Suitable arrangements were in place to ensuring the premises and equipment were kept safe. Good hygiene standards were maintained, and guidance adhered to in relation to COVID-19.

Systems and processes were in place to deal with any safeguarding concerns and complaints. People and their visitors said they felt able to raise any issues with the staff team. Managers had worked closely with the local authority to resolve recent concerns and improve systems so people received safe and effective care.

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 good (published 28 September 2020).

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

We received concerns in relation to the number of falls, weight loss and the management of the service. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe, responsive and well-led sections of this full report.

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

De Brook Lodge (known as De Brook) is a residential care home providing personal care to 32 people aged 65 and over at the time of the inspection. The service can support up to 52 people over three floors.

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

This was a focussed inspection looking at the key questions safe and well led.

Medicines were now being managed safely. The home had worked with the GP surgery, clinical commissioning group (CCG) and pharmacist to ensure all medicines were delivered on time. Improvements had been made to the management medicines which were administered on an as required basis.

Changes to the admissions process, personal protective equipment (PPE) and cleaning schedules and checks had been made in light of the Covid-19 pandemic and government guidance. The risks people may face were identified and plans put in place to reduce risk. We have made a recommendation to ensure consistency throughout the care plans when one risk factor changes, which also impacts on other areas of the support plan.

The quality assurance system had been improved by ensuring heads of staff were not auditing their own departments. The new registered manager promoted that audits had to reflect any issues found so that action could be taken to rectify them. Staff said they enjoyed working at the home and knew how to report any accidents or concerns. Relatives told us they were able to contact the staff and managers for information about their relative or if they had any issues.

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 16 July 2019) and there was a breach of regulation 12, Safe, care and treatment. 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 this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 20 and 21 May 2019. A breach of legal requirements was 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.

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 and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. 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 De Brook Lodge on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

De Brook Lodge is a residential care home that was providing accommodation and personal care to 50 people aged 65 and over at the time of the inspection.

People’s experience of using this service:

Improvements had been made with regards to the care plans and risk assessments at De Brook. A computerised care planning system had been fully implemented and care plans and risk assessments were reviewed each month. However, there was not always enough detail to guide staff how they should support a person if they became anxious or agitated.

People did not always receive their medicines as prescribed as they were out of stock at the home. De Brook had tried to resolve this issue with the supplying pharmacy and repeatedly chased the medicines required; however, they had not escalated this issue to the local clinical commissioning group (CCG) or local authority safeguarding.

Information on how to administer medicines covertly had not been obtained from a qualified person. Arrangements were not robust for ensuring medicines were given at the correct time with regard to food. Staff did not always follow the arrangements for ensuring there was a sufficient gap between doses of medicines.

There were enough people on duty to meet people’s needs. Staff were safely recruited.

Incidents and accidents were recorded through the computerised care planning system. These were analysed by the registered and care managers for any patterns and to ensure actions had been taken to reduce the risk of a re-occurrence.

The home was visibly clean throughout. All equipment had been serviced and maintained. Weekly and monthly health and safety checks were completed.

The home was well decorated and maintained. Signs were used to assist people living with dementia to orientate themselves within the building. Part of the building had been decorated to represent an old post office and plans were in place for an old style corner shop to be set up.

Staff received the training and support to carry out their roles. A training dash board was used so that refresher training was organised in a timely way.

People’s health needs were being met. Referrals were made to medical professionals when needed and any equipment recommended to support people was obtained.

People said they enjoyed the food and had a choice of meals. People’s nutritional needs were being met.

The service was working within the principles of the Mental Capacity Act (2005) (MCA) People’s capacity was assessed and best interest decisions made where they were assessed as lacking capacity to make a particular decision.

People and relatives were complimentary about the care staff, saying they were kind and caring. Staff knew people’s needs and encouraged them to complete tasks for themselves where possible to maintain their independence.

Staff members said they enjoyed working at the service and said the management team were approachable and supportive.

People and / or their relatives were involved in an initial assessment and reviewing and agreeing their care plans. A range of monthly surveys were completed to obtain feedback form people, relatives and other professionals.

A regular programme of activities was arranged, as well as trips out. People and relatives were happy with the activities available at De Brook.

A ‘make a wish’ programme had been started, where people were asked what they wished to do and where possible this was arranged. Links had been made with local schools, who visited the home as well as people also visiting one school for their sports day.

A quality assurance system had been embedded within the service which gave the registered, regional and quality managers greater oversight of the service. A range of monthly audits were completed.

Rating at last inspection:

At the last inspection the service was rated as Requires Improvement (published 30 May 2018). Following the last inspection, we met with the provider to discuss the improvements they planned to make to improve the service and address the shortfalls we had identified. Improvements had been made in these areas, however further issues were identified in other areas of the service. This service has been rated as required improvement for the last four inspections.

Why we inspected:

This was a planned inspection based on the previous rating.

Enforcement: We have found evidence that the provider needs to make improvement. Please see the safe and well led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

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

At our last inspection in March 2017 we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. There was a lack of clear guidance for the use of ‘as required’ medicines and staff did not always sign to state they had applied topical creams. Staff had not received refresher training and supervision meetings. The service did not have a robust quality assurance system in place to ensure they were meeting the requirements of the fundamental standards.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safe, effective, responsive and well led to at least good.

At this inspection we found improvements had been made in all three areas. However new breaches were identified with regard to risk assessments and care plans not being reviewed and updated during the transfer of the care plans to a new computerised system called PCS, which meant there was a continued breach in good governance. You can see what action we told the provider to take at the back of the full version of the report.

De Brook Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

De Brook can accommodate 52 people over three floors. At the time of our inspection 45 people were living at the home.

There was not a registered manager in post at the time of our inspection. A new manager had started working at De Brook the week before our inspection and had initiated the process to become the registered manager. 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.

De Brook was introducing a new computerised care planning system called PCS. However, at the time of our inspection, the vast majority of care plans and risk assessments continued to be paper files. The paper care plans and risk assessments had not been reviewed since January or February 2018. Some care plans had been updated where people’s needs were known to have changed; however others had not. This meant the care plans and risk assessments may not be reflective of people’s current needs.

Significant improvements had been made in the quality assurance systems used at the home. Audits and monitoring were now in place for falls, nutrition, medicines, pressure area care, infection control and staff training and supervisions. Actions taken after each incident, accident or audit were recorded and monitored to ensure they were completed. However it had been noted in managers meetings in December 2017 that the care plans and risk assessments needed to be reviewed and kept up to date during their transition to the PCS system and this had not been done.

People received their medicines as prescribed from trained staff, whose competencies in medicines management were observed annually. The temperatures of the clinic rooms and medicines fridge were not consistently recorded. We have made a recommendation that the medicines audit is reviewed so they cover all areas of the national guidance for the management of medicines in care homes.

Health and safety checks were made and equipment was serviced in line with national guidance and the manufacturer’s instructions. Water was sampled for Legionella’s disease; but a written Legionella’s risk assessment was not in place and boiler water temperatures were not checked. We have made a recommendation that the service consults the national Health and Safety Executive and Department of Health guidance for controlling Legionella in healthcare settings.

People we spoke with, and their relatives, said they felt safe at De Brook and were positive about the staff at the home. Staff supported people with kindness and respect. People were supported to maintain their independence by completing tasks for themselves where they were able to.

We saw there were sufficient staff on duty to meet people’s assessed needs, although agency staff were being used at the time of our inspection to cover staff vacancies.

A safe recruitment process was in place. Staff had received the training they needed to effectively meet people’s assessed needs. A new training matrix enabled the manager to track what training was due to be refreshed and make arrangements for this to be completed. New staff completed training that met the standards of the care certificate.

People were supported to maintain their health and nutrition. A new scheme had been started whereby a GP visited the home each day with a view to reduce the number of hospital admissions by treating minor ailments quickly. The GP was positive about De Brook, stating the staff were knowledgeable about the people they supported and were able to provide the information they required.

People enjoyed the food served at De Brook. The chef knew people’s nutritional needs, the food was well presented and people could have seconds if they were hungry. The menus we saw were not for the correct day and were not in an easy read or pictorial format so more people would be able to access the information. We have made a recommendation that national guidelines are followed to provide key information is available in different formats to enable more people to be involved in their care.

A new ‘lifestyle’ manager had been appointed to co-ordinate and arrange activities within the home. They were in the process of devising a timetable of activities for each floor. Trips out were arranged and there was a bi-monthly ‘pop-up’ themed restaurant evening.

Dementia friendly signs were used to support people to orientate themselves around the home. Reminiscence items and old photographs of local places were on each floor.

The service was working within the principles of the Mental Capacity Act (2005). People's capacity to make decisions was assessed and applications made for Deprivation of Liberty Safeguards where applicable.

De Brook Lodge is owned by Ideal Care Homes (Number One) Limited. The service is a purpose built care home that provides residential care for up to 52 people. All the bedrooms are single rooms with en-suite facilities. The home has three floors accessible by lift. Each floor has a lounge / dining area. At the time of our inspection there were 48 people living at the home.

The service had a new manager who had worked at De Brook for six weeks prior to our inspection. They were in the process of being registered with the Care Quality Commission. 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.

Prior to the new managers’ appointment the home had had a series of temporary managers after the previous registered manager left in November 2016.

We found the new manager was now completing a full system of audits to monitor and improve the home. Care plans were being re-written and new recording tools had been introduced.

The staff we spoke with were all positive about the new manager and the changes they had made.

We found a new medicines ordering policy had been agreed with the pharmacy and implemented. This should ensure the home does not run out of people’s prescribed medicines as had happened previously.

We found Medicine Administering Records (MARs) were fully completed for prescribed medicines. However there were gaps in the recording of topical creams and guidelines for when ‘as required’ medicines, for example pain relief, were to be administered.

All the people we spoke with said they felt safe living at De Brook and that the staff were kind, caring and knew their needs well. We heard and saw positive interactions between people and staff members throughout the inspection.

There were sufficient staff on duty to meet people’s needs. Staff told us the new manager had addressed the high levels of sickness that the home previously had.

A safe system for recruiting new staff suitable for working with vulnerable people was used. A thorough induction process was in place, with training and staff shadowing experienced staff to get to know people and their needs. However refresher training was not up to date. The new manager was aware of this and was arranging for the refresher training to be completed. Staff had not received regular supervision meetings. The new manager had a plan in place for completing supervisions every two months with every staff member.

A handover was completed between each shift to inform incoming staff about any changes in people’s needs; for example due to illness. One diary had been introduced for the whole home to ensure items were not missed by having separate diaries on each floor.

Care plans and risk assessments were in place for each person. Two thirds had been re-written since the new manager had been appointed and they were written in a person centred way. The care plans included details of people’s needs and guidelines for staff in how to meet these needs. However we found two care plans that did not fully reflect people’s needs. Risk assessments identified risks to people’s health and well-being and how these were to be mitigated. Care plans were now being evaluated on a monthly basis.

The provider had introduced new capacity assessment forms, which were in the process of being completed with each person and their family where appropriate. These detailed whether the person had the capacity to consent to their care at the home. If they did not have capacity a Deprivation of Liberty Safeguards (DoLS) application was made. Staff did not fully understand the requirements of the Mental Capacity Act and further training was being arranged.

Incidents and accidents were recorded and analysed to identify any patterns; for example falls. We saw referrals to the falls team or dementia crisis team were made where required.

Systems were in place to meet people’s health and nutritional needs. People were regularly weighed in line with the assessed risk and referrals made to the Speech and Language Team (SALT), district nurses and other medical professionals as needed. The weekly menu was not currently displayed in the home. We were told the menu was being reviewed and copies would be available on each floor when it had been finalised so people could choose what meal they wanted to have.

Information about people’s wishes at the end of their lives was not detailed. A new booklet had been obtained that would enable people and their families to record their end of life wishes.

All areas of the home were clean. Procedures were in place to prevent and control the spread of infection. Dementia friendly signs were in place, as well as stencils on the walls to promote conversation and memory boxes outside people’s rooms so they could orientate themselves around the home.

Systems were in place to deal with any emergency that could affect the provision of care, such as a failure of the electricity and gas supply. Regular checks were in place of the fire systems and equipment.

People, relatives and staff were asked for their feedback about the service through regular meetings. The provider had surveys they sent to relatives and staff, however the new manager had not seen any results of these surveys since joining the service.

The service arranged some trips out for people to take part in, for example to Blackpool or to local shops. There was also a ‘pop up’ restaurant which had themed nights; for example an Italian evening. Entertainers visited the home and ‘open house’ lunches were arranged for local elderly people to join the people living at the home for a meal. These were enjoyed by the people who used the service. However there were few day to day activities taking place, for example craft or reminiscence groups. A new activities officer was being recruited to organise day to day activities and to complete life stories with people.

During this inspection we found three breaches of Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. However the new manager had plans in place which would meet the Regulations. You can see what action we told the provider to take at the back of the full version of the report.

De Brook Lodge is owned by Ideal Care Homes (Number One) Limited. The service is a purpose built care home that provides residential care for up to 52 people. All the bedrooms are single rooms with en-suite facilities. The home has three floors accessible by lift. Each floor has a lounge / dining area.

The service had a registered manager in place. 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.

All the people living at De Brook Lodge and their relatives told us they felt safe. They said the staff were kind and caring and knew their needs well. Staff had received training in safeguarding adults and knew the correct action to take if they witnessed or suspected abuse. Staff were confident that the deputy managers and registered manager would act on any concerns raised.

There were enough staff rota’d to work to meet people’s needs. The registered manager acknowledged there had been some staff shortages due to long term staff sickness. Disciplinary action had been taken where staff had a poor attendance record. We saw the rota’s had the correct number of staff rota’d to work. The number of staff for each shift had recently been increased to meet people’s needs and staff recruitment was underway to fill any vacancies.

A system was in place to hand ensure staff had the information they needed to meet people’s needs. Staff were able to read a person’s care plan when they moved to the home and received a verbal handover of their needs. A staff handover was completed at the start if every shift. A seniors communication book was used and each person had daily notes completed. However during our inspection we found that staff returning from annual leave had not been given information about one person whose needs had changed whilst they had been off. The staff had not had time to read all the notes from when they had been off before starting to support people. In this instance this meant the person did not receive their drinks thickened as required. We have made a recommendation that the service use current good practice guidance for ensuring staff are provided with information about any changes in people’s needs following an extended period off work.

People told us they received the care they needed. Care records we reviewed showed that risks to people’s health and well-being had been identified and guidance was in place to help reduce or eliminate the risk. Care plans were written in a person centred way. The care records had been updated when people’s needs changed; however they had not been formally reviewed each month as per the homes policy due to senior care staff being on long term sick leave. People were supported to make advanced care plans for the end of their lives. The registered manager had implemented a plan to ensure all care plans were reviewed.

A robust system was in pace to recruit suitable staff. Staff completed mandatory training and received an induction when they started to work at the home. Some staff had not completed all their refresher training. Staff said they felt supported by the deputy managers and registered manager and could approach them at any time if they had a concern. Formal supervisions were held every three to six months. These had not been as frequent as planned due to the long term sickness of two senior carers. The registered manager was implementing a plan to ensure all supervisions were completed.

People received their oral medicines as prescribed. However topical cream charts did not contain the prescribing instructions. We found signatures were missing from the topical cream charts and medicine administration records (MAR). Protocols for the use of ‘as required’ medicines were not clear whether people could verbally tell staff if they required the medicine or not as they had not photocopied well. More detail was required for staff to know how a person who could not verbally ask for ‘as required’ medicines would communicate that the medicine was needed. Systems were in place to monitor the stock of medicines and that all MAR had been signed. However they were not completed each day and we could not see that issues identified had been actioned.

Systems were in place to help ensure people’s health and nutritional needs were met. Records we reviewed showed that staff contacted relevant health professionals to ensure people received the care and treatment they required.

All areas of the home were clean. Procedures were in place to prevent and control the spread of infection. Systems were in place to deal with any emergency that could affect the provision of care, such as a failure of the electricity and gas supply. Regular checks were in place of fire systems and equipment.

The service was working within the guidelines of the Mental Capacity Act. An assessment of people’s capacity to consent to their care and treatment was completed. Best interest meetings were held where required and applications were made for Deprivation of Liberty Safeguards appropriately.

A programme of activities was in place to help promote the well-being of people who used the service. Plans were in place to improve the activities available with a café area and cinema area being added to the home.

We saw people, their relatives and staff had been asked for feedback about the service. There were effective systems in place to investigate and respond to any complaints received by the service. Any lessons learnt from the investigations were communicated to the staff team to reduce the likelihood of the incident re-occurring. All the people we spoke with told us they would feel confident to raise any concerns they might have with the manager.

We noted there were a number of quality audits in the service; these included medicines, care records and the environment. Action plans were completed following the audits. We saw that there had been an improvement in the audit results throughout 2016. However the medicines audits had not been robust enough to resolve the issues with medicines we noted.

During this inspection we found a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because improvements were required in the management of medicines. You can see what action we told the provider to take at the back of the full version of the report.