Archived: Brookfield House Care Home

Brookfield House Care Home is a residential care home providing personal and nursing care to 28 people living with dementia time of the inspection. The service can support up to 51 people.

Brookfield House Care Home accommodates 51 people across five separate wings over two floors, each of which has adapted facilities. The home specialises in providing care to people living with dementia.

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

During this inspection we found improvements regarding medication however additional improvements were needed and so we have made recommendations in regard to medication. We also made additional recommendations regarding and risk management.

Care plans and risk assessments were in place that reflected the needs of the people, however we identified that some information held in care plans was basic and in need of review. The registered manager was aware of this and this was planned for as the provider was transitioning to an electronic care planning system.

Improvements were needed to be made in some areas of the environment. The registered manager informed us that they were already in discussion with the provider to make improvements.

We observed care being delivered in the home and saw that this was done in a caring and patient manner. We saw that people were comfortable in the presence of staff and positive and familiar relationships had developed between people receiving support, relatives and care staff. Visitors told us staff were kind and treated their relatives with dignity and respect.

Staff were recruited safely and received regular training, attended staff meetings and had regular practice checks. Staff we spoke to said that they felt well supported.

Complaints, accidents and incidents were managed appropriately, and referrals were made to other professionals in a timely manner when people living in the home were in need.

The provider employed an activities co-ordinator and people were able to choose and access meaningful activities that were person centred. The feedback received regarding the food being provided was all positive and peoples dietary needs were catered for.

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.

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 14 February 2019) and there were two breaches of regulation. 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.

Why we inspected

This was a planned inspection based on the previous rating.

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.

Brookfield House is a ‘care home’ close to Nantwich town centre. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission [CQC] regulates both the premises and the care provided, and both were looked at during this inspection. Brookfield House Care Home provides care and accommodation for up to 51 adults with needs associated with old age, dementia and/or physical disability. Access between floors is via a passenger lift or stairs. The home is set within well maintained gardens. At the time of this inspection there were 27 people living at Brookfield House.

We previously inspected this service on 8, 9 and 14 May 2018 and identified breaches of regulation relating to person-centred care, safe care and treatment and good governance. We rated the service as Requires Improvement overall.

In June 2018, we received serious whistleblowing concerns which we reported under local safeguarding procedures and to the police. The information raised several allegations of significant concern about the safety and welfare of the people who lived at Brookfield House Care Home. Although the management team were aware that allegations had been made, they had not reported them to the relevant authorities.

As a result of this information we carried out an inspection on 4 and 7 July 2018 which focussed on two key questions only, safe and well-led and awarded a rating of Inadequate in both. This resulted in an overall rating of Inadequate and the service was placed into ‘Special Measures’ by the CQC. We identified continued breaches of regulation relating to safe care and treatment, person-centred care and good governance in addition to a breach of regulation relating to safeguarding people from abuse and improper treatment.

Since the last inspection the provider had worked with the local authority to address the concerns raised and improve standards. During this inspection we found that although further improvements were required, the service was no longer in ‘Special Measures’. We found that the provider was no longer in breach of regulations relating to, person-centred care and safeguarding people from abuse and improper treatment. However, we identified a continued breaches of regulation relating to safe care and treatment and good governance. This was because we found that risk assessments were not always in place, we identified some concerns around the management of topical applications [creams and lotions] and protocols for 'as required' medicines were not always in place. In addition, we did not see sufficiently established and effective quality assurance systems and records were, at times, disorganised, not available or there was confusion as to where they were kept. The provider’s quality assurance processes had not identified the issues highlighted during this inspection. You can see what action we told the provider to take at the back of the full version of this report.

Following the whistle-blowing concerns received in June 2018 the registered manager resigned from their post and cancelled their registration with the CQC. 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.

Since that time the area manager had been responsible for day to day management of the service. In November 2018 a new home manager was recruited and they have submitted their application to become the registered manager of the service. At the time of the inspection they had been in post for approximately six weeks, which included three weeks pre-booked leave. Staff were complimentary about the new manager and the difference they had made since their arrival.

Staff had received training about protecting people from abuse and demonstrated an improved understanding. We saw that staff had recently reported practice which they knew to be improper and that this had been dealt with appropriately by the area manager. The incident was reported under local safeguarding protocols and to the CQC as required.

During our inspections carried out in May and July 2018 we found short falls regarding safe management of medicines. When we observed a medicine round during this inspection we found it was carried out professionally and safely. However, we found that improvement was still required in relation to management and recording of topical applications, that protocols were not always in place for medicines to be taken ‘as required’ and that not all staff were not clear about the amount of fluid thickening agent that a person was prescribed. Risks associated with the use of paraffin based ointments were not assessed and were not identified on personal evacuation records. We recommend that the management team include this area in their review of topical application management.

During our July 2018 inspection we identified concern about people's lack of choice about when to get up and go to bed. During this inspection people told us that they could choose when to go to or get up from bed. We saw that some people had chosen to stay in bed later in the morning and that their choice was respected.

At the time of our inspection four people were receiving ‘end-of-life’ care. The GP had been involved with care planning and medicines that may be required at this stage of life had been prescribed. Some people had a ‘Do not attempt resuscitation’ [DNAR] instruction in place and the manager had worked with the GP to ensure that robust documentation was in place to support these decisions. A visitor told us about the “exemplary” end of life care that staff had been recently provided.

Risks to people’s safety were assessed for example, falls, skin integrity and use of bedrails. However, we found there was no risk assessment in place for two people who were at risk of self-neglect. We discussed the need for this to be reviewed with consideration to each person’s mental capacity with the home manager. Applications had been submitted to the local authority to ensure that people’s liberty was only restricted with legal authorisation.

There was a process in place to record and monitor accidents and incidents however a more robust system of analysis would assist in better identification of potential themes and trends to ensure any learning was captured.

During our July 2018 inspection we identified concerns about the accuracy of records used for recording such as food/fluid intake, personal care and safety checks. This was because they were not completed at the point of care and therefore could not be relied upon. However, although some improvement had been made, we observed a member of staff completing records retrospectively. We also found that advice given by a District Nurse regarding deterioration in skin integrity had not been updated in the person’s care plan. This demonstrated that the improvements we had been told about were not fully established and the provider was not maintaining a contemporaneous record of care delivery.

Since the last inspection staff had received training in a wide range of topics and a programme of supervision and appraisal was underway. Regular staff meetings had been held and staff told us they now felt supported by the manager.

Recent improvements had been made to the lunchtime service after concerns were identified by an external auditor. We observed the breakfast and lunchtime meal service and found that people could choose from different options and that staff supported them in a caring manner.

Since the last inspection staff had received additional training regarding accurate us of the malnutrition universal screening tool [MUST]. A sample of recently completed records evidenced that they had been completed correctly. Unintentional weight loss was captured on a matrix and the GP had been informed as required.

The environment was visibly clean and free from odours with plans underway to refurbish some of the bathing facilities. Arrangements were in place to check the environment to ensure it was a safe place for people to live including gas, electricity, lifting equipment and fire safety.

People had access to a range of health professionals to maintain their health and well-being. Throughout the inspection we observed caring and attentive interactions between staff and the people living at Brookfield House.

Consideration was given to people’s privacy and we saw that care records were kept in a lockable cupboard. However, during the inspection we heard staff discussing personal information which could be overheard by others.

During our May 2018 inspection we found that there was a lack of organised activities and that people were not supported to access the community. The provider had employed two activity co-ordinators and improvement was noted with regard to activity provision. We saw that a variety of activities had taken place, future events were being planned and that people had been supported to access the community, for example the library, town centre and shopping.

Care plans included information about people’s likes, dislikes and communication needs. There was a full-service review underway to improve the quality of care plans. The manager informed us that this was 60% completed with the remainder due to be completed by the end of January 2019.

There was a policy and procedure in place to handle and respond to complaints. The complaint log provided had not been updated since March 2018. During the inspection a visitor raised some concerns with us which we brought to the attention of the manager. They implemented measures to manage one of the c

This focused inspection of Brookfield House Care Home was undertaken following our receipt of a number of concerns by four people who told us they knew the home. We visited the home on Wednesday 4 and Saturday 7 July 2018. This inspection was unannounced.

This location requires a registered manager to be 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. Although there was a registered manager in post at the time of our inspection they were not present throughout the time we visited.

At the last inspection which we carried out on the 8, 9 and 14 May 2018 we found that the service was safe and caring but not always effective, responsive or well led. We identified breaches of the regulations on Person-centred care, Safe care and treatment, and Good governance and awarded the home a rating of requires improvement overall.

This inspection focused on two key questions only safe and well led. We found that the service was not safe or well led and people were at risk of receiving unsafe and ineffective care. We identified breaches of the regulations in respect of Person Centred Care, Safe Care and Treatment, Safeguarding service users from abuse and improper treatment, and Good Governance.

The registered manager and the deputy manager had failed to protect people from the risk of abuse when allegations of abuse were made. The registered manager failed to notify the Commission of allegations of abuse and when we asked why they gave us false and misleading information.

We found that people did not always receive care that was centred on their needs. We identified institutionalised care practices, including day staff getting people ready for bed in the early evening purely as a measure to assist night staff and night staff dressing people in the early morning and putting them back to bed fully clothed purely to assist day staff.

Care was not being provided in a safe way. The registered person was not always assessing the hazards presented to people or developing plans and effective arrangements for care to mitigate risk of harm.

Care plans were not always developed to ensure staff had guidance on meeting the person’s needs and some were found to be inaccurate. We found one person’s care plan outlined a care practice which was potentially dangerous and put the vulnerable person at risk.

In response to concerns we had raised with the local authority they asked an occupational therapist (OT) to check moving and handling procedures in the home. The OT visited the home and reported back that they had identified issues that required urgent action because moving and handling plans were inaccurate and staff seemed to be unsure about which bits of the plan to follow when.

We found that people had not always received their medicines as their doctor had prescribed them and a medicines trolley was left unattended near to where people were seated with a bottle of medicine on top.

We found that care records could not be relied upon. Care staff were not always making timely or accurate records of care provided and we witnessed staff falsifying records of food and fluids given to one person.

The provider had instigated systems to monitor the quality of care provided but these did not identify the concerns we identified during our inspection. The provider and registered manager had failed to take effective action to address the breaches in regulations at our last inspection, which meant people had remained at risk of receiving unsafe and infective care.

The home was clean and odour free throughout. Most of the people spoken with presented as relaxed and at ease in the home’s environment. They all spoke well of the care provided and we could see they had good relationships with the staff. They told us that they were offered plenty of drinks and the food was good. Records showed that staff were monitoring people’s weights but their calculations were not always correct giving a false impression of the person’s wellbeing despite this issue being raised as a concern during our last inspection.

The overall rating for this provider is 'Inadequate'. This means that it has been placed into 'Special measures' by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider's registration to remove this location from the providers registration.

Brookfield House is a care home close to Nantwich town centre. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked t during this inspection. Originally a private house it has been renovated and extended to provide care for up to 51 adults who present with needs associated with old age, dementia and/or physical disability. It is a two storey building and people live on both floors. Access between floors is via a passenger lift or the stairs. The home is set within well maintained gardens.

The service has 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.

During our last inspection we identified a breach of regulation 14 of the Health and Social Care Act (Regulated Activity) Regulations 2014. The service received an overall rating of Requires Improvement. Following that inspection we asked the provider to complete an action plan to show what they would do and by when. During this inspection we found that some improvements had been made with regard to meeting people's nutritional needs and that the service was no longer in breach of this regulation.

However, we found that the service was in breach of regulations relating to safe care and treatment, person centred care and governance. You can see what action we told the provider to take at the back of the full version of this report.

Risks to people's health and well-being were assessed and measures were put in place to support people to remain safe. However we identified that there was a lack of documented assessment for the safe use of bedrails and that MUST assessments were not accurately completed. During the inspection the registered manager implemented additional written guidance to support staff with the use of this assessment tool and confirmed they would also be sourcing additional training in this regard. Following the inspection they provided a copy of new documentation to be introduced to support initial assessment for the suitability and safe use of bedrails.

The service did not employ an activity co-ordinator and any activities taking place were provided by care staff. There was no allocated budget for activities were funded solely by staff fund raising. The majority of staff told us that they did not always have time to provide meaningful activities and this was echoed by relatives and a person using the service. People were not regularly supported to access the community and there were no organised trips.

We found that, although the audits carried out had identified some of the issues identified during the inspection and there was evidence of plans to address, quality assurances processes were not sufficient robust and established to have identified all.

People told us that they felt safe at Brookfield House. Policies and procedures were in place to protect people from the risk of abuse or neglect.

Medicine management and administrations processes were reviewed and were found to be safe. Some improvement was needed with regard to the use of protocols for medicines that were taken when needed. Following the inspection the registered manager provided a copy of a new protocol that was to be introduced to support administration of medicines prescribed that way.

Arrangements were in place for checking the environment at Brookfield House to ensure it was a safe place for people to live. Safety certificates were up to date. Some areas of the environment required improvement. We saw that plans were in place to address some of the areas we noted during the inspection. Following the inspection, the registered manager confirmed that the provider had arranged for carpet fitters and decorators to attend to address all of the areas noted with completion set for the end of June.

People had a personal emergency evacuation plan (PEEP) detailing the support they would need in the event of any major incidents/emergencies.

The registered manager maintained records of Deprivation of Liberty Safeguards authorisations and a system was in place to ensure that these were renewed as required. We saw that staff sought people's consent before carrying out tasks, for example when administering medicines.

People were supported to access health care professionals when needed to support their health and wellbeing.

We observed mealtime service and saw that people enjoyed their meals. Staff supported people discreetly and a choice of menu was available.

Staff received the necessary training, supervision and appraisal they needed to carry out and be supported in their role. Training was provided via a mixture of sources and staff were particularly complimentary about courses available from a local college.

We saw that care plans contained some person centred information, although in some instances the written plans did not reflect all of the person centred care taking place. Although the registered manager has made improvements in this regard since their appointment work is ongoing to ensure a consistent standard is maintained. In addition we found that there were insufficient meaningful activities taking place to support people’s well-being.

There was a policy and procedure in place to manage complaints. Staff, relatives and people using the service were complimentary about the registered manager and confirmed that improvements were evident since their appointment. Staff told us that they felt supported and that the registered manager was approachable and fair.

During the inspection records requested were made readily available and were clear and well organised. The registered manager and deputy manager were keen to engage with the inspection process, were open and transparent and received feedback positively acting immediately where able and implementing plans where actions may take longer, for example re-decoration and review of quality assurance procedures.

Brookfield House provides accommodation and personal care for up to 51 older people. Some people have dementia related needs. The inspection was completed on 12 September 2016 and there were 24 people living at the service at the time.

A manager was in post but they were not 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. The current manager is new to the service and intends to register with the Care Quality Commission.

The last inspection on 3 and 12 February and 29 April 2016, found that the provider was not meeting the requirements of the Health and Social Care Act 2008 in relation to safe care and treatment, consent, premises and equipment, staffing and good governance. The overall rating of the provider was “inadequate” and they were placed into special measures by the Commission. We conducted this inspection to review whether sufficient improvements had been made since the last inspection. We found that improvements had been made in all of these areas, but we also identified a further breach of the relevant regulations. However, the inspection found that there was sufficient improvement to take the provider out of special measures.

During the inspection we saw that improvements had been made within the service in relation to staffing, the safety of the premises, medication, staff training, implementation of The Mental Capacity Act (MCA) 2005, planning and meeting people’s care needs, maintaining contemporaneous records, quality assurance and notifying the Commission about significant events. However, there remained concern in regard to meeting people’s nutritional needs. You can see what action we told the provider to take at the back of the full version of this report.

People who used the service told us that they felt safe and well cared for. There had been significant improvements to the security of the premises. A number of safety measures had been implemented to maintain the safety of people living at the service.

We found that medicines were managed and administered safely in the home and people received their medicines as prescribed.

There were sufficient number of staff deployed to meet the needs of people at the current time. The management team were seeking to identify a suitable staffing analysis tool which could help them to determine the staffing levels required. We noted that it was important to keep this under review if the number of people living at the home increased to the maximum occupancy.

Improvement had been made to how people’s mental capacity to consent to care and treatment had been assessed and documented. Staff had received training in the MCA and had an understanding of the principles of MCA and DoLS.

Significant improvements had been made to training available to staff. We saw that staff had undertaken training in dementia care and other subjects and saw that learning from this training was being put into practice.

People were positive about the food provided and choices were available. However we found that people’s nutritional needs had not always been met effectively. Where the records suggested that a person had lost a significant amount of weight, staff had not taken any action. Although the records were thought to be incorrect and the person had not lost this amount of weight, this had not been identified. We noted some further concerns around the monitoring of people's nutritional needs.

People were complimentary about the staff and told us that they were kind and caring. People were treated with dignity and respect. Work was being undertaken to improve the quality of the care plans. The manager wanted to develop the service to embed a personalised approach to care. Key workers were being introduced and care was being planned with people and their relatives, to include preferences, likes, dislikes and choices.

There was a new manager in post, who intended to apply to become registered. The management team were focused upon making the necessary improvements to the service. Our records demonstrated that the registered manager notified the Commission of significant events appropriately, as legally required to do so. Some systems were in place to monitor the quality of the care. However, these needed to be developed further. We found at this inspection that a number of improvements had been made to the service. The registered provider needs to demonstrate that these improvements can be sustained over a longer period of time.

Brookfield House is a care home close to Nantwich town centre. Originally a private house it has been renovated and extended to provide care for up to 51 adults who present with needs associated with old age, dementia and /or physical disability. It is a two storey building and people live on both floors. Access between floors is via a passenger lift or the stairs. The home is set within beautifully maintained gardens.

When we carried out our last inspection of the home on the November 2013 the registered persons were meeting all the requirements for a service of this type.

There was a change of registered provider on the 3 September 2015 which meant that the home was not scheduled for inspection until September 2016. However on the 26 January 2016 we were notified of a serious untoward incident in the home which had resulted in a vulnerable person who lived at the home being placed at extreme risk to their health and well-being. We brought our planned comprehensive inspection forward in accordance with our new regulatory processes to inspect the home in accordance with the fundamental standards of quality and safety.

On the first day of our inspection there were 43 people living in the home most of whom were older people with dementia and associated physical disabilities.

Although most people told us they felt safe, we found that the premises were insecure on the first two visits of our inspection. The registered persons had not responded effectively to assess, monitor and mitigate risks and had failed to improve the quality and safety of services provided.

We identified breaches of the relevant regulations in respect of the need for consent, safe care and treatment, premises and equipment, staffing and good governance.

The overall rating for this provider is 'Inadequate'. This means that it has been placed into 'Special measures' by the Commission.

The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear time frame within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider's registration to remove this location or cancel the provider's registration.