All inspections: Brookview - Care Quality Commission

This inspection took place on 29 September 2015 and was unannounced.

Brookview is registered to provide personal care for up to eight people with learning disabilities and physical disabilities. At the time of our visit there were eight people living at Brookview.

At our last inspection in June 2014 we identified a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 in relation to infection control. The provider sent us an action plan outlining how they would make improvements. At this inspection we found improvements had been made.

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 and associated Regulations about how the service is run. At the time of our inspection a registered manager was not in post although the provider had appointed a manager who started in September 2015. Prior to this, the provider had appointed an interim manager who managed the home.

Staff were not always available at the times that people needed them in order to meet their needs and preferences. The interim manager told us recruitment of staff had been a concern and people were supported by a high number of agency staff which meant people were not always provided with continuity of care by staff who knew them well. To try and ensure continuity the provider would request agency staff who had worked at the home before. The provider had recently recruited new staff and this was on going.

Relatives told us they felt that people were safe at Brookview and staff treated them well.

Staff were kind and caring to people but told us they were not always able to spend time individually with them.

Relatives thought staff were kind, caring and responsive to people’s needs and people’s privacy and dignity was respected.

The interim manager and staff understood how to protect people they supported from abuse, and knew what procedures to follow to report any concerns.

There were risk assessments in place to identify risks to people’s health and wellbeing. Where risks had been identified, there were management plans to minimise these risks, however we found that these were not always followed. We found improvements were required in how the provider analysed incidents, and accidents, which would help protect people from further risks.

People’s care plans were not always up to date or reviewed regularly, however staff had a good understanding of people’s care needs and preferences. Documentation regarding people’s nutritional intake, falls and accidents were not always completed correctly and actions were being taken to address this.

Medicines were stored and administered safely, and people received their medicines as prescribed.

People were supported to attend health care appointments with health care professionals when they needed to and received healthcare that supported them to maintain their wellbeing.

Recruitment procedures made sure staff were of a suitable character to care for people.

Management and staff understood the principles of the Mental Capacity Act 2005 (MCA) and DoLS, and supported people in line with these principles. Correct procedures had been followed regarding referrals to the local authority.

Activities, interests and hobbies were arranged according to people’s individual needs and abilities. However staff were not always available to provide support with these at people’s preferred times.

Staff felt the interim manager and team leader were supportive however the lack of a permanent manager, and reduced staffing levels, meant that staff supervision meetings were not consistently carried out. Staff had regular team meetings and felt their training and induction supported them to meet the needs of people they cared for.

Relatives told us they knew how to make a complaint if they needed to.

There was a provider audit system that identified and improved the quality of service people received. These checks and audits helped ensure actions had been taken that led to improvements.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

This inspection was completed by one inspector. Due to their complex health conditions and communication difficulties, we were unable to speak with people who used the service. We observed their experiences to support our inspection. We spoke with one visiting relative. We also spoke with the registered manager, the deputy manager and three care staff. The evidence we collected helped us to answer five questions;

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what relatives and staff told us. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

One relative told us, "I feel my relative is completely safe". Safeguarding procedures were in place and staff understood their role in safeguarding the people they supported. Staff were aware of the provider's whistleblowing policy.

Staff knew about risk management plans and we saw people were supported in line with those plans. This meant people were cared for in a way that protected them from harm.

The provider worked well with health care providers to ensure people's health needs were met and they were protected against harm.

The provider had robust recruitment procedures in place to ensure staff were of a good character and had the skills to support people appropriately.

Systems were in place to make sure the manager and staff learned from events such as accidents and incidents, complaints and checks made on the service. This reduced the risk to people and helped the service to continually improve.

People were not protected from the risk of infection.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made and how to submit one.

Is the service effective?

People's care needs were assessed with them. We saw evidence that people were involved in their care planning and reviews by using communication methods that met their needs. We saw care plans were regularly updated.

Where people had complex needs that required the input of specialist health care services, assessments had been made by the appropriate professionals. Their recommendations were carried out by staff. This meant the provider worked well with other services to ensure people's health care needs were met.

Staff told us they were well supported and trained to ensure they effectively met people's needs.

Is the service caring?

People were supported by kind and caring staff. One relative told us, "The staff are wonderful".

People's preferences, interests and diverse needs had been recorded and care and support was provided in accordance with people's wishes.

Is the service responsive?

People had the opportunity to plan and engage in a range of different activities each day.

People were asked their views about the service using appropriate communication methods and the provider acted on comments that people made.

Where care staff had noticed people's changing needs, their care plans were updated to reflect this. We found staff discussed people's care needs with them on a regular basis.

Is the service well led?

The provider had quality assurance and risk management systems in place. We found the registered manager checked that risks were managed effectively. We found the provider had recently changed the audit format and this had not identified all risks in relation to hygiene and infection control.

The provider sought the views of people who used the service. Records seen by us indicated that shortfalls in the service were addressed where they had been identified.

Staff told us they were clear about their roles and responsibilities and understood the quality assurance and risk management systems. This helped to ensure people received a good quality of care. Staff told us the service was well organised and they felt supported by their manager.

When we visited Brookview there were eight people living in the home. Seven of the people who lived there either had no or very limited verbal communication. People were unable to tell us about their care. We therefore looked at care records and how care workers assisted people. We spoke with three members of staff and the manager.

Support plans were easy to read and described what people could do for themselves and how they wanted care workers to support them. We saw care was being provided in the way it had been planned.

We spoke with three members of care staff. They understood the importance of supporting people to make decisions and choices in their lives. They were also aware of their responsibility to obtain people's consent before they provided support.

Three people who lived at Brookview required the use of a wheelchair when mobilising around the home. We saw that all corridors, communal rooms, bathrooms and bedrooms were spacious enough for people to safely access and move around them in their wheelchairs.

Staff received regular training that helped to maintain their skills and knowledge to work with people in a safe way.

There were processes in place to assess and monitor the quality of the service provided.

We visited Brookview on 20 November 2012. Nobody knew we would be visiting. There were seven people living at Brookview at the time of our visit. All the people living there had complex needs. Most people had limited communication so we spent time observing the care being provided to those people. We spoke with the manager, three staff members and three relatives visiting the home.

We saw plans of how care should be delivered were person centred and reflected people's individual needs. Relatives we spoke with were positive about the care provided. One relative said, "We couldn't ask for better. We are so lucky X is in Brookview." They went on to say how they 'definitely feel involved' in their family member's care. Another relative said, "We are very satisfied."

We noted the service had a full and varied programme of activities on offer for people. We saw that staff supported people to access the community through social activities.

Staff we spoke with showed a good awareness of the importance of keeping people safe and reporting any concerns regarding potential abuse.

Archived: Brookview

All Inspections

29 September 2015

During a routine inspection

16 June 2014

During a routine inspection

6 November 2013

During a routine inspection

20 November 2012

During a routine inspection