Brookdale View

Brookdale View accommodates up to 48 people across two floors. The ground floor provides nursing care, and the first floor provides residential care. At the time of the inspection there were 43 people living in the home.

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

We received very positive feedback about the new manager and less positive feedback about the number of management changes in the previous 12 months. Relatives told us, “It’s lovely [Staff] are lovely. It’s been difficult with the changes in manager, but the one that’s here now is right on top of it, she’s brilliant.” The area manager had been involved throughout this period and effective oversight of the service was in place. We received positive feedback about the staff and the culture of the service. People told us staff were kind and caring and treated them with dignity and respect.

Staff understood how to safeguard people and when to raise concerns. People received their medicines safely and recruitment practices were safe. Risks associated with people’s care were assessed and monitored. Staff followed infection prevention and control guidance to minimise risks related to the spread of infection.

The service was accessible and had been adapted to meet people’s needs. Relatives told us the home needed decorating. They told us, “The building’s a bit worse for wear; it needs decorating” and “I think that it needs redecorating; it’s a bit tired.” A programme of improvement had already begun prior to the inspection and the new manager was being supported to make improvements to the environment.

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.

The provider followed governance systems which provided effective oversight and monitoring of the service. These governance systems and processes ensured the service met people’s assessed needs.

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 16 April 2019).

At our last inspection we recommended that staffing levels considered people’s individual needs. At this inspection we found no concerns about how staffing numbers were calculated. At our last inspection we recommended that signage for people with dementia was improved. At this inspection we found adequate signage was in place and plans were in place to make the home more dementia friendly.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We were assured that this service met good infection prevention and control guidelines as a designated care setting.

We found the following examples of good practice:

• Families named ‘Essential Visitors’ were part of the homes PCR and LFT inhouse testing programme.

• The organisation provided staff with a free ‘wellbeing’ councillor via phone which had been invaluable to staff.

• Selected members of staff had received enhanced training around infection control and prevention (ICP) and were known as the ‘ICP army’, their role to support people and staff to keep safe.

People’s experience of using this service:

People received help with the administration of medicines. All medicines were given as prescribed and recorded on the medication administration record. However, we observed a nurse administering a fluid thickening agent with the wrong measuring spoon. A thickening agent is used to enable a thicker consistency of fluids for people who are at risk of choking. Also, body maps for identifying the location of transdermal patches were not always recorded. The provider should assure themselves of the competency of its nursing staff to manage and administer medicines.

People felt safe while being supported by the service and told us there were enough staff on duty to support them. Rotas we saw reflected this. Staff did not appear rushed and were visible. We received three comments about more staff being required. We recommended that the registered provider reviewed dependency levels based on people’s individual needs.

Risk assessments to support people were fully completed and regularly reviewed. Staff could describe how people were supported to keep them safe.

Staff were trained to enable them to identify and report any safeguarding concerns. Staff told us they felt the registered manager would listen to concerns they raised and report them appropriately. People told us, if they were worried, they would tell their family, a staff member or the manager.

Internal and external health and safety checks of the service were completed within appropriate time scales.

People were supported to eat a healthy and nutritious diet. Culturally appropriate diets were offered, and a varied menu was available. People told us they could change their mind if they did not want what was on offer and the chef would make them an alternative meal.

The introduction of a pilot programme with the care home nursing team and GP’s had enabled people to receive quicker diagnosis and treatment of their illness and referral to the appropriate healthcare services. The programme had enabled people to be treated at the home rather than go into hospital.

People were fully assessed prior to moving into the service to ensure their needs could be met.

The home worked in line with the Mental Capacity Act 2005 and we observed agreements to consent and decisions were made and recorded in people’s best interests.

The home was well equipped to support people with aging conditions, however, we made a recommendation for the registered provider to review signage around the home to help people living with dementia find their way round.

There were caring and kind interactions from the staff team to people they supported. We observed appropriate humour and support throughout our inspection.

Staff were seen to knocked on doors and were polite and respectful to people. Staff spoke to people in a sensitive manner and used other forms of communication such as Google translate and photographs and symbols with people whose first language was not English.

We noted doors were left open while people were in their bedrooms. Although this was not raised as a concern, the service should review peoples preferences for this.

Care plans identified the support people needed. Staff could describe how to support people and told us they were able to read care plans during their induction. Care plans were regularly reviewed and were planned involving people and their families.

Complaints were responded to in a timely manner. People and their relatives knew how to make a complaint and felt their concerns would be listened to.

People were supported at the end of life. Care plans captured any preferences and choices people had about how they wished to be cared for as they neared the end of their life.

Audits were in place to monitor and improve the service. The new registered manager had made improvements to the service since the last inspection. Staff and relatives told us improvements had been made for the better.

Staff felt well supported by the new registered manager.

Rating at last inspection: The last inspection of this service was on 6 and 7 June 2018 where we rated the service as overall requires improvement and inadequate in the well-led domain. We also found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The report was published on 9 October 2018.

Why we inspected: This was a scheduled inspection based upon the previous rating of the service.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our programme of inspection. 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

Our last inspection of this service was on the 22 and 23 May 2017 and we found concerns relating to regulation 9, 17 and 18 of the Health and Social Care act 2008 (Regulated Activities) Regulations 2014. We found that the provider had not effectively operated systems and processes to monitor and improve the quality and safety of the service. Care plans did not always meet the assessed needs of people. Staffing levels were not always adequate to support people and there was a lack of person centred activities. The overall rating for the service was requires improvement. At this inspection, we found significant improvements had been made in relation to activities, but found continued breaches in regulations 9, 17 and 18, with a new breach in regulation 12.

Brookdale View is a care home. The home is based over two floors. The ground floor provides nursing care and the first floor provides residential care. People in care homes receive accommodation and nursing or personal care as a 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. The service can provide accommodation and personal care for up to 48 people at this location. On the dates of inspection, there were 36 people living at the home.

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 in safe, effective, responsive and well led to at least good. This is the third consecutive time that this service has been rated at least requires improvement and we are considering what further action will be taken in response.

There was a registered manager in post since November 2011. 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.

Staffing levels continued to be an issue. There were not enough staff on the nursing floor to support people's assessed needs. Staff members were also visibly stretched on the nursing floor.

Staff members were aware of their responsibilities in safeguarding vulnerable people from abuse and could give signs and symptoms of abuse and who they would contact if they suspected abuse was occurring.

All medication administration records had been appropriately completed there were no gaps. However, stocks of medicines were not always accounted for on the nursing floor.

People said they felt safe living at Brookdale View. We saw risks to people were assessed and monitored.

Staff members were recruited safely and we saw satisfactory disclosure and barring service (DBS) checks in place prior to commencing employment.

Staff had access to personal protective equipment such as gloves and aprons throughout the service to prevent from any health and safety and infection control risks.

Accidents and incidents were monitored for themes and protocols put in place to reduce the risk of an incident occurring again. All premises safety such as electrical, gas and water safety was in place and up to date.

People were generally happy with the choice of meals; however, the service was not providing an alternative diet for those people who preferred a diet for their own culture.

People who could not speak English were isolated and relied on their relatives to support them in communicating with the service. The service was not working in line with the Accessible Information Standard.

Induction for new staff members varied in length and there was no evidence that staff had completed inductions. Staff members received appropriate training to enable them to carry out their role effectively.

The service complied with the Mental Capacity Act 2005 and received assessment in line with Deprivations of Liberty Safeguards.

There were kind and caring interactions between staff members and people living at the service and people, their relatives and professionals were very complimentary of staff members. We saw that people had their dignity observed and respected throughout the inspection.

Activities for the service had much improved since the last inspection. Activities were varied and available for people of all abilities and interests. There has been support from the local authority to enhance activities.

People received pre-assessments of their needs prior to moving into the service. Pre-assessments recorded people’s previous health history and support needs.

Care plans did not always meet the assessed needs of people. One person who was required to be moved with a hoist did not have this information recorded in the care plan.

Complaints were actioned in a timely manner and outcomes shared. There were a number of compliments thanking the service for the care and support they have provided.

People were supported with end of life care. Staff were aware of who was being supported at the end of life and the service has completed the six steps framework for supporting people who were nearing the end of life.

Staff members felt unsupported by the registered manager. Staff members told us that they felt the registered manager did not listen to them and did not recognise the hard work they did. Also, that the registered manager spent a lot of time in the office. Some health professionals felt there was a lack of leadership at the service.

There were audits and internal inspections in place to monitor and improve the service, but we did not see continuous improvements. Satisfaction surveys completed by people living at the service were positive.

Brookdale View is a purpose built care home which offers accommodation for up to 48 people. There were 42 people in residence on the day of our inspection. Brookdale View provides nursing care on the ground floor and residential accommodation on the first floor. There are two lounges and a dining room on each floor, laundry facilities and hairdressing salon. There is a car park within the grounds. The home is situated in the Newton Heath area of Manchester, close to local amenities and with good transport links.

There was a registered manager in post. 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 this inspection we found that some improvements had been made. However, they were not sufficient enough to meet the requirements of the regulations. We also found new breaches of the regulations.

At the last inspection we identified a breach of the regulations due to the inconsistency of staffing levels and the high level of usage of agency staff.

At this inspection we found staffing levels had not improved and we noted people did not receive their care in a timely manner.

The majority of staff we spoke with felt there was a lack of leadership at the service. Overall staff morale was low. The provider was aware of this, and were working to find a way forward.

Audits on the home's quality were not accurate which meant systems to improve the quality of provision at the home were not always effective.

Policies were in place to ensure people's rights under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) were protected. Although policies and procedures were in place it was clear that some staff were not aware who had a DoLS authorisation in place.

Staff training was recorded effectively and attendance was monitored. Staff received regular supervision. Recruitment procedures were thorough and ensured the staff who were recruited were suitable to work in the home.

People's needs had been assessed before they moved into the service and they had been involved in formulating and updating their care plan. The home focused on person-centred care giving people as much choice as possible, such as when to get up, and most records were reflective of individual needs. However, not all the information was current and some records needed further scrutiny on the residential unit. We were concerned as some staff told us they did not have time to read the records which could have meant incorrect care was potentially being provided.

People had access to activities; however we received mixed feedback with regards to the activities on offer. People were not always protected from social isolation. The range of activities available were not always appropriate or stimulating for people on the nursing unit.

Procedures were in place to manage people’s medicines safely.

Feedback on the meals provided was varied. On the two days of our inspection we observed there was sufficient quantity and choice available.

We saw people's weight, their nutritional intake and their ability to eat and drink safely was monitored and referrals to dieticians and speech and language therapists took place when required for treatment and advice. During the day, we observed people were served drinks and snacks between meals.

People were supported by staff who were kind, caring and friendly. We observed people being acknowledged throughout the day which was an improvement from our previous inspection. Staff were discreet in offering support and worked well with colleagues to ensure people's needs were met in a timely manner.

People's privacy and dignity were respected and staff provided people with explanations and information so they could make choices about aspects of their lives. There were positive comments from relatives about the staff team.

There was an effective complaints procedure. Complaints were responded to within the stipulated time. We found the manager had archived all complaints for 2016, and we could not view them.

People's healthcare needs were met. People told us that they had access to their GP, dentist chiropodist and optician should they need it. The service kept clear records about all healthcare visits and appointments.

All areas of the home looked clean. Procedures were in place to prevent and control the spread of infection.

In relation to the breaches of regulations, you can see what action we told the provider to take at the end of the full version of the report.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

This is a summary of what we found-

Is the service safe?

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Suitable policies and procedures were in place and staff had been trained to understand their responsibilities under the DoLS Codes of Practice. There were no DoLs authorisations in place on the day of our visit.

Care plans and our observation of staff provided evidence of good practice in applying the least restrictive options to promote each person's autonomy.

Staff records contained all the information required by the Health and Social Care Act. This meant the provider could demonstrate staff employed to work at the home were suitable and had the skills and experience needed to safely support the people accommodated.

People told us they felt safe and systems were in place to make sure managers and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

The home took people's care needs into account when making decisions about the numbers, qualifications, skills and experience required to cover the rotas with the correct level and calibre of staff.

Recruitment practice was safe and thorough. Policies and procedures were in place to make sure unsafe practice was identified and people were protected.

Is the service effective?

People's care needs were assessed by the manager and nursing staff and along with their family members. People were involved in developing their own plans of care. We saw care plans reflected their current needs and we saw they were up to date.

We saw people being supported well by staff who demonstrated empathy and listened to what the person wanted.

People told us they were happy living at the home.

Is the service caring?

We received feedback from people using the service and their families. We asked them for their opinions about the staff supporting them. All the feedback was positive and included comments like " I like the staff", "they support me well" . When speaking with staff and managers it was clear they genuinely cared for the people they supported. We were shown pictures of a St Georges day party and feedback was "I enjoyed the party it was a nice change".

The service was person centred and took into account the diverse range of people needing support. We found the home respected people's preferences, interests and wishes and cared about the people using the service, their families and the staff team.

Is the service responsive?

People we spoke with knew how to make a complaint if they were unhappy. The service worked well with other agencies and services to make sure people received care they needed.

The manager was able to access all the information we asked for on the day of our visit in order for us to make our judgements.

Is the service well-led?

Speaking with the manager we could see there was strong leadership within the home. They told us their emphasis was on ensuring people received a good service and were treated with dignity and respect. The manager was a Dignity Champion for the home.

The manager was "hands on". This meant they supported people regularly within the home and maintained good relationships with people using the service, their families and the staff team. Staff had a good understanding of the ethos of the agency and quality assurance processes were in place. This helped to ensure people received a good quality service at all times. People we spoke with confirmed this and family members told us they trusted the manager and staff and were happy with the level of support their relative received.

One visiting relative said about the person living in the home: "We can see she's a lot better since she came here - everything we wished for. They're nice here."

We also spoke with staff, including some who had also moved across from the former home run by the same provider. They assured us that the move had been arranged so as to cause minimum stress and inconvenience to the people who had moved.

We found that the system for assessing mental capacity and for conducting best interest decisions when appropriate was much improved since our last visit in February 2013. We also found that training on safeguarding had been carried out effectively and that incidents were for the most part correctly identified and notified.

We examined the system for managing medicines and found that it was fit for purpose. We found that staff were supported by the provision of training and supervision, and that Brookdale View had managed the transfer of staff from the former home effectively.

We found that there was a comprehensive system of quality monitoring conducted both by the manager and the provider, and that this would help ensure the safety and welfare of people living in the home.

However, we found that for those residents who did not have the capacity to consent to treatment, the provider did not always establish and act in accordance with people's best interests.

People told us that staff were professional and treated them well. One person said: "I couldn't fault them". Another person said: "The carers are very hard-working". One person said that they felt confident that a complaint would be treated seriously and commented on the approachability of the manager: "I'd have a word with Laura [the registered manager] about it". We found that complaints received during 2012 had been dealt with appropriately.

We found that staff were well trained in how to recognise and report abuse. However we found that there had been a substantiated allegation in 2012 and a number of incidents which had not been properly identified as possible abuse which should have been reported.

We found that staff received relevant ongoing training and were well supported in their work.