Brookview Nursing Home

Brookview Nursing Home is a residential care home providing accommodation for up to 60 adults who require nursing or personal care. This includes people who may have dementia or a physical disability. At the time of our inspection there were 33 people using the service, including 13 people receiving nursing care.

People’s experience of the service and what we found

The provider’s governance systems were not effective, to consistently ensure the quality and safety of people’s care and timely service improvements when needed. Effective management, communication, decision making and accountability for people’s care was not fully assured.

Premises and equipment were not always kept clean, secure, properly used and maintained. The environment did not provide effective signage for people’s safety, orientation and independence.

Staff were not always effectively informed, supported or trained to perform their role and responsibilities. Provider assurance regarding planned staff training and supervision sent following this inspection, did not yet include all areas of training needed, or fully demonstrate embedded and sustained staff supervision arrangements ongoing.

We found gaps in care plan record keeping and concerns relating to the arrangements for people’s medicines, health and least restrictive care needs. Equality Act considerations were not always fully ensured for people’s care.

Staff mostly followed the MCA to obtain people’s consent or appropriate authorisation for their care when needed. However, staff did not always support people in the least restrictive way possible, in their best interests. Systems did not consistently support this practice.

Remedial actions agreed with the local safeguarding authority, were in progress following concerns raised, to help prevent any reoccurrence and demonstrate lessons learned. However, related service improvements were not yet fully demonstrated as embedded or sustained.

The provider did not consistently ensure good care outcomes or individualised care for people. Systems relating to Equality Act considerations, care plan record keeping and staff training did not fully support this. People’s care was not always delivered in a way that sought to optimise opportunities for their orientation, communication, independence, choice and comfort.

Staff often understood people’s individual health and related care needs and supported people to help maintain or improve their health. Referral to external health professionals was not always timely, or without delay, when needed for people’s care.

People were supported to eat meals they often enjoyed, which met their dietary requirements. People's hydration needs were not always effectively accounted for. People could be supported at the end of their life, to have a comfortable, dignified and pain free death.

People were often treated with dignity, respect and supported well by staff who generally knew them well. Access to relevant advocacy services was promoted and supported when needed for people’s care.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessment and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it. At this inspection there was no person with a learning disability or autistic people receiving care at the service. Some staff had received recognised training to support people in this way, if needed.

People were supported to engage in home life and maintain contacts with family and friends who were important to them. Whist the home did not have their own transport to access the local community, staff would hire a mini bus to arrange trips to the local cafes and garden centres.

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 January 2021).

At this inspection sufficient improvements had not been made and we found breaches of regulation in relation to premises and equipment, staffing and governance. The service remains rated as requires improvement. This is based on the inspection findings. The service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

The inspection was a comprehensive ratings inspection, which was prompted in part due to concerns received about environmental cleanliness, staffing, medicines, care planning, restrictive care practices, management and governance arrangements. A decision was made for us to inspect and examine those risks.

The overall rating for the service remains requires improvement. This is based on the findings at this inspection.

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

You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Brookview Nursing Home on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to Premises and Equipment, Staffing and Governance

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

Brookview Nursing Home is a residential care home, registered to provide personal and nursing care for up to 60 older adults. There were 27 people accommodated at this inspection. The home is set over two floors and has two large communal spaces with an additional small room used as a library.

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

The registered manager had made improvements to the auditing and quality checks on the home. This had ensured that any actions identified were addressed swiftly or reviewed through an agreed process. A weekly clinical document was completed to provide the manager with up to date information on each person using the service. Any additional support or guidance was put in place to ensure people’s health and social care needs were being addressed.

There was enough staff to support people and they had been trained in current and ongoing areas to support their role. When staff were recruited the required checks had been completed.

People felt supported by kind and caring staff who had information to enable them to share their daily needs or life history. The care plans had been completed, however the provider told us they were making developments in this area to make these more person- centred. There was a choice of meals and specialist diets were catered for.

Medicines were managed safely. Some recording issues were noted, and these were addressed immediately. We saw that measures had been taken to prevent the spread of infection. Policies were in place and shared with staff, which directed the required safety measures and the use of personal protective equipment.

People were supported to be safe and any risks had been assessed and where possible mitigated. Staff understood how to keep people safe and any safeguards raised had been investigated and actions completed.

There was an open culture at the home and any required reporting had been completed. This ensured we could monitor the home.

The provider and registered manager worked in partnership with a range of health and social care professionals. This ensured they could support people’s individual needs or follow the latest guidance.

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 19 December 2019)

Why we inspected

We carried out an unannounced focused inspection of this service on 30 November 2020 to review the key questions of safe and well-led only. 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 coronavirus and other infection outbreaks effectively.

Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. The overall rating for the service remains Requires Improvement , however the safe and well-led areas have improved 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 Brookview Care Home on our website at www.cqc.org.uk.

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.

Brookview Nursing Home is a residential care home, registered to provide personal and nursing care for up to 60 older adults. There were 34 people accommodated at this inspection, including 17 people who were receiving nursing care.

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

Safety improvements were made since our last inspection to ensure effective pressure sore prevention measures for people’s skin care. Safeguarding, staffing, medicines and risk management arrangements, mostly helped to protect people from the risk of harm and abuse. But staff training, instruction and care plan record keeping measures did not always fully ensure this.

Cleanliness and hygiene measures for the prevention and control of infection at the service, helped to protect people from the risk of an acquired health infection. The provider acted to ensure people’s safety when things went wrong at the service and to prevent any reoccurrence.

People were generally happy with their environment, which was well maintained, decorated and furnished to a high standard; but did not fully support people’s orientation needs or sufficient storage for equipment.

People’s care was not always effectively informed or consistently ensured because of gaps in staff knowledge, training and supervision. Management remedial measures had commenced to rectify this, but were not yet completed, or demonstrated as embedded and ongoing. Staff consulted with relevant external health professional for people’s care and supported people to maintain or improve their health and nutrition when needed.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. The systems in the service did not always fully support this practice in relation to DoLS, which were not fully understood by staff or accounted effectively for. Management remedial measures identified to rectify this, were not yet completed, or demonstrated as embedded or ongoing for people’s care.

Staff treated people with kindness and ensured people’s dignity, equality and rights when they provided care. People were appropriately supported and informed, to express their views; and involved in making decisions about their care.

Staff understood and were committed to delivering the principles of person centred care but staffing and care plan record keeping arrangements did not fully ensure this. The provider was meeting the accessible information standard for people’s care. Additional measures, that may further and optimise this were not fully considered.

People were often supported to engage in home life, with the local community and friends and family who were important to them. There were regular arrangements for social and recreational activities at the service, but these did not always maximise people’s individual interests, access or participation.

Governance systems were not always effectively operated to consistently ensure the quality and safety of people’s care and related record keeping. Revised management arrangements were recently introduced with related service improvement measures, either planned or in progress to rectify this. However, these improvements were not yet fully demonstrated or embedded ongoing.

Staff mostly understood their role and responsibilities for people’s care. Operational management arrangements were sufficient to ensure effective communication, partnership working and safe information handling for people’s care and staff employed.

Staff treated people with kindness and ensured people’s dignity, equality and rights when they provided care. People were appropriately supported and informed, to express their views; and involved in making decisions about their care. People and relatives were informed and knew how to make a complaint or raise a concern if they needed to. Complaints were accounted for and acted on.

With the exception of a required notification oversight, which the provider subsequently rectified when we asked them to. The provider had met with the legal requirements relating to their duty of candour; to tell us about important events when they happened at the service and to ensure the required public display of their most recent inspection rating for 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 Good (published May 2017).

Why we inspected

This was a planned inspection based on the previous rating of the service.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective, Responsive and Well Led sections of this full report.

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.

Our last inspection took place on 5 July 2016 and at that time concerns were identified relating to staffing levels and inconsistent quality monitoring and record keeping. We found the provider was in breach of two regulations, relating to governance and staffing. Following this the provider sent us their action plan telling us about the improvements they intended to make. During this inspection we looked at whether or not those improvements had been met. We found some improvements had been made but other improvements were still required.

We found significant improvements had been made regarding the quality monitoring systems, staffing levels and the opportunity for people to pursue meaningful person-centred activities. This meant the service was no longer in breach. However we did identify some concerns regarding the ineffective and inconsistent management of pressure areas.

A registered manager was in post and present on the day of the inspection. 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 received care from staff who were appropriately trained and confident to meet their individual needs. They were supported to access health, social and medical care, as required.

People’s needs were assessed and their care plans provided staff with guidance about how they wanted their individual needs to be met. Care plans we looked at were centred on the individual and contained the necessary risk assessments. These were regularly reviewed and amended to ensure they reflected people’s changing support needs.

Policies and procedures were in place to help ensure people’s safety. Staff told us they had completed training in safe working practices. We saw staff supported people with patience, consideration and kindness and their privacy and dignity was respected.

People were protected from the risk of harm or abuse by thorough recruitment procedures. Appropriate pre-employment checks had been made to help protect people and ensure the suitability of staff who was employed.

People received their medicines in a timely way. Medicines were stored, administered safely by staff who had received the necessary training.

People’s nutritional needs were assessed and records were accurately maintained to help ensure people were protected from risks associated with eating and drinking. Where risks to people had been identified, these had been appropriately monitored and referrals made to relevant professionals.

Staff received training to make sure they knew how to protect people’s rights. The service acted in people’s best interests and maintained regular contact with social workers, health professionals, relatives and advocates.

There was a complaints process in place. People were encouraged and supported to express their views about their care and staff were responsive to their comments.

Our last inspection took place on 25 January 2015 and at that time concerns were identified relating to staffing levels and inconsistent quality monitoring and record keeping. We found the provider was in breach of two regulations, relating to governance and staffing. Following this the provider sent us their action plan telling us about the improvements they intended to make. During this inspection we looked at whether or not those improvements had been met. We found some improvements had been made regarding record keeping, however other improvements relating to staffing levels and quality monitoring were still required.

During this inspection we found quality monitoring systems were inconsistent and ineffective and had failed to identify shortfalls within the service. Insufficient staff on duty at times meant people’s care and support needs were not consistently met and the opportunity to pursue meaningful person-centred activities was limited.

A registered manager was in post and present on the day of the inspection. 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 received care from staff who were appropriately trained and confident to meet their individual needs. They were supported to access health, social and medical care, as required.

People’s needs were assessed and their care plans provided staff with guidance about how they wanted their individual needs to be met. Care plans we looked at were centred on the individual and contained the necessary risk assessments. These were regularly reviewed and amended to ensure they reflected people’s changing support needs.

Policies and procedures were in place to help ensure people’s safety. Staff told us they had completed training in safe working practices. We saw staff supported people with patience, consideration and kindness and their privacy and dignity was respected.

People were protected by thorough recruitment procedures. Appropriate pre-employment checks had been made to help protect people and ensure the suitability of staff who was employed.

People received their medicines in a timely way. Medicines were stored and administered safely and handled by staff who had received the necessary training.

People’s nutritional needs were assessed and records were accurately maintained to ensure people were protected from risks associated with eating and drinking. Where risks to people had been identified, these had been appropriately monitored and referrals made to relevant professionals.

Staff received training to make sure they knew how to protect people’s rights. The registered manager told us that to ensure the service acted in people’s best interests, they maintained regular contact with social workers, health professionals, relatives and advocates.

There was a complaints process in place. People were encouraged and supported to express their views about their care and staff were responsive to their comments.

We identified one breach and one continuing breach under the Health and Social Care Act (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the report.

People were particularly pleased with their environment, which they said was always fresh and clean. One person told us, 'I like my own room, which I chose because of the quiet and its garden aspect.' People also told us that staff usually listened and acted on what they said and assisted them when needed.

However, we found that medicines were not always safely managed and that some of the arrangements for ensuring staff competency to practise and provide care and support for people did not always ensure people's best interests.